and Managing Recurring Anal Warts: A Patient's Journey

Anal warts

Hello Doctor, I have been troubled by genital warts for 3.4 years and they are still present.
After discovering the infection, I have maintained safe sexual practices or tried to avoid sexual activity as much as possible, but they keep recurring.
A year ago, I underwent electrosurgery, and in the meantime, I have been applying wart removal gel myself.
Each time I start the first treatment, the reaction is very noticeable, and I have managed to endure 3 to 4 treatment sessions, feeling quite clean afterward.
However, after 2 to 3 months, I notice a slight recurrence, so I can only continue applying the gel, which leads to a cycle of recurrence.
There have been a few occasions when a doctor examined me with an endoscope, and he mentioned that some of the tissue I felt was scar tissue from the previous electrosurgery, which can appear slightly raised or uneven, and that is normal.
Recently, it has been over 2 months since my last application, and I have felt some raised areas, but there has not been much significant change in that area; the only change is that it has softened and grown a little.
The changes are very slow, taking about 1 to 2 weeks to notice.
I have also tried to look with a mirror; the appearance of what I see now resembles genital warts somewhat but also somewhat does not.
Previously, the warts were harder and had a rougher surface, but now they look more like small flesh balls with slightly rough surfaces, rather than the previous appearance of tiny, acne-like bumps that resembled very small seaweed and could be moved side to side.
There are also a few small flesh balls clustered together, and the changes have been very slow over 1 to 2 weeks.
I would like to ask the doctor if the scars inside the anus can change slowly over time or if they will not change at all.
Additionally, although the wart removal gel has not completely cured my condition, it has a strong reaction on my lesions, while the electrosurgery did not have much of a reaction.
Can I use the wart removal gel for one treatment session, and if there is a significant change, can I confirm it is genital warts? If it is not genital warts but just previous scar tissue, what changes might I expect? Will there be slight peeling, or will there be no effect at all, indicating it is not genital warts? Thank you, doctor.
I am already exhausted and feel like I fall into despair every time I seem to be getting better.
It is really tiring and distressing, and I hope you can provide me with advice.
I am currently very afraid to see a doctor again.
In previous visits, the doctors said it was a very small lesion and that applying medication would be sufficient.
Please help clarify my concerns.
Thank you.
Do I need to get vaccinated? My previous doctor said I already had it and that getting vaccinated would be useless, so I did not get the vaccine.
However, I see many people here seem to have been vaccinated.
I have tested negative for HIV, and there is a small area that looks somewhat like this.
This is an image I found online: https://www.readhouse.net/upfile/2017/0321/7247f3c0c536ebfe27ccd4ea3447056a.jpg

S, 20~29 year old female. Ask Date: 2018/04/24

Dr. Ke Fangxu reply Surgery

Is the image you found online a photo of yourself? If so, I’m afraid I cannot assess your condition based on someone else's image.
If the physician has already diagnosed it as scar tissue from electrosurgery, then it is normal for topical ointments to show no response.
I recommend that you stop using the ointment and monitor the situation.
If the lesion continues to enlarge, please consult your physician for electrosurgery treatment.
Vaccines are intended for individuals who have never been infected, with the goal of preventing infection; those who have already been infected will not benefit from vaccination.

Reply Date: 2018/04/24

More Info

Understanding and managing recurring anal warts, also known as genital warts, can be a challenging journey for many patients. It is understandable that you feel frustrated and exhausted after dealing with this condition for several years. Let's break down your concerns and provide some insights into the management of anal warts.

First, it's important to understand that anal warts are caused by the human papillomavirus (HPV), which is a sexually transmitted infection. While you have been practicing safe sex, it is still possible to contract HPV, as it can be transmitted through skin-to-skin contact. The virus can remain dormant in the body, which is why you may experience recurring outbreaks even after treatment.

You mentioned that you have undergone electrocautery (burning) treatment and have been using topical treatments like imiquimod (often referred to as "wart cream"). These treatments can be effective in removing visible warts, but they do not eliminate the virus from your body. This is why recurrence is common. The immune system plays a crucial role in controlling the virus, and sometimes it may take time for your body to mount an effective response.

Regarding the changes you are observing in the anal area, it is not uncommon for scar tissue to form after treatments like electrocautery. This scar tissue can feel different from the surrounding skin and may appear as raised or irregular areas. It is essential to differentiate between scar tissue and new warts. If the area feels soft and is slowly changing, it could be a sign of scar tissue rather than active warts. However, if you notice any significant changes, such as increased size or texture, it is advisable to consult a healthcare professional for further evaluation.

You asked about the possibility of using imiquimod again to determine if the area is indeed warts. While this approach could potentially help, it is essential to proceed with caution. If the area is scar tissue, applying imiquimod may not yield the desired results and could cause irritation. It is crucial to have a clear diagnosis before starting any new treatment. If you are uncertain, consider seeking a second opinion from a dermatologist or a specialist in sexually transmitted infections.

As for the HPV vaccine, it is generally recommended for individuals who have not yet been exposed to the virus. The vaccine can help prevent certain strains of HPV that cause genital warts and cervical cancer. If your previous doctor advised against vaccination due to your history, it may be worth discussing this again, as guidelines can change, and new evidence may support vaccination even in those with existing infections.

In summary, managing anal warts can be a complex process involving various treatment options and ongoing monitoring. It is essential to maintain open communication with your healthcare provider and seek their guidance on the best course of action for your specific situation. Remember that you are not alone in this journey, and support is available to help you cope with the emotional and physical challenges of this condition.

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