and Managing Anal Warts: Treatment Options and Concerns

Cauliflower issue

Hello Doctor, last year I went to a large hospital for an examination and found cauliflower-like growths around my anus (there are also a few similar spots in my private area).
The gynecologist suggested using Podophyllotoxin for treatment, which reduced the size but did not completely eliminate them.
I also sought traditional Chinese medicine to remove the warts, but it seems they were not completely eradicated.
I switched to another brand of ointment (Anyou Cream) and continued applying it.
During the treatment, I received the HPV vaccine, but recently, due to itching in my private area and fear of recurrence, I visited the gynecologist again.
The doctor said it was not warts, but to be sure, I underwent an HPV Pap smear test to check for warts.
Recently, I switched back to using Podophyllotoxin around the anus, and the area around the anus and the lesions became very itchy, to the point where I had to scratch to relieve the itch (initially, when I used Podophyllotoxin for a long time, I did not experience this discomfort).
I scratched and it seemed to break the skin, causing redness and swelling.
Because it was too itchy and uncomfortable, I stopped the medication for a few days since my menstrual period started.
Additionally, using cooling pads helped alleviate the itchiness.
However, at night or in the early morning, the area around the anus would still be very itchy.
Later, the HPV test results came back normal and negative, but there are still wart-like growths around the anus.
The doctor mentioned they resemble polyps but advised me to continue applying the ointment for another month, using it every other day.
However, the itching persists, and the area around the anus is still swollen and has broken skin.
Should I continue applying the medication, or should I treat the broken skin first? If I want to freeze the anal warts, can I have that done at the gynecology department? Thank you.

W, 20~29 year old female. Ask Date: 2019/06/30

Dr. Cai Zhuorong reply Urology

For uncertain diagnoses, surgical excision and pathological examination can be considered.
Lesions around the anal area are recommended to be evaluated by a colorectal surgeon.

Reply Date: 2019/06/30

More Info

Managing anal warts, also known as genital warts, can be a challenging process, especially when dealing with persistent symptoms and treatment side effects. Anal warts are caused by certain strains of the human papillomavirus (HPV), and while they can be treated, complete eradication may not always be possible. It’s essential to work closely with your healthcare provider to determine the best course of action for your specific situation.

From your description, it seems you have undergone multiple treatments, including the use of topical medications like Podophyllotoxin (commonly known as Condylox or by its brand name, Fenofibrate) and have received the HPV vaccine. While these treatments can help reduce the size of warts, they may not eliminate them entirely, and recurrence is common. The fact that you have experienced itching and discomfort suggests that your skin may be reacting to the medication or that there may be irritation from the warts themselves.

Here are some considerations and recommendations based on your situation:
1. Continue Communication with Your Healthcare Provider: Since you have already consulted with a gynecologist and have undergone HPV testing, it’s crucial to keep them informed about your symptoms, especially the itching and any skin irritation. They can assess whether the irritation is a side effect of the medication or a reaction to the warts.

2. Managing Itching and Irritation: If the topical medication is causing significant discomfort, it may be wise to take a break from it, especially if you notice that the irritation worsens. You mentioned that stopping the medication provided some relief. Discuss with your doctor whether it’s advisable to pause treatment temporarily to allow your skin to heal before resuming.

3. Alternative Treatments: If topical treatments are not effective or are causing too much irritation, other treatment options are available. Cryotherapy (freezing the warts) is a common procedure that can be performed in a gynecological or dermatological setting. This method can effectively remove warts and may be worth discussing with your doctor.

4. Follow-Up on HPV Testing: Since your HPV test results came back negative, this is a positive sign. However, it’s essential to continue monitoring for any changes. Regular follow-ups with your healthcare provider can help manage any new or recurring symptoms.

5. Consideration of Other Conditions: The presence of lesions that resemble warts but are not confirmed as such could indicate other conditions, such as skin tags or polyps. If your doctor suspects these, they may recommend a biopsy or further examination to clarify the diagnosis.

6. Lifestyle and Home Remedies: While waiting for your next appointment, consider gentle home remedies to soothe the area, such as warm baths or over-the-counter hydrocortisone cream to reduce inflammation and itching. However, consult your doctor before trying any new treatments.

7. Emotional Support: Dealing with genital warts can be emotionally taxing. Consider seeking support from counseling or support groups where you can share experiences and coping strategies with others facing similar challenges.

In summary, while managing anal warts can be frustrating, it’s essential to maintain open communication with your healthcare provider, explore alternative treatment options, and prioritize skin health. If you continue to experience significant discomfort or if the warts do not improve, further intervention may be necessary. Always consult your healthcare provider before making any changes to your treatment plan.

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