and Treating Anal Warts: Your Questions Answered

Anal warts

Hello doctor, in the past, due to my lack of understanding, I had unprotected sex for the first time, and since then, I have not engaged in any sexual activity.
I have developed warts inside my anus, and despite undergoing three sessions of electrosurgery, small warts continue to appear after the third treatment.
The doctor mentioned that they are very small and advised me to get tested for HIV, but I have been abstinent for a year and a half and tested negative.
I am still fearful.
After my third electrosurgery, the doctor recommended that I apply phenol to the area.

1.
What are the options available to resolve this issue?
2.
After my third electrosurgery, I am recovering without any bleeding.
How many months should I apply phenol?
3.
Would you recommend that I switch to a different hospital?

RACK, 20~29 year old female. Ask Date: 2020/07/03

Dr. Ke Fangxu reply Surgery

Removing warts in the anal area can be challenging because local anesthesia may not adequately relax the anal sphincter, making it difficult to completely excise the lesions.
If multiple treatments fail to eliminate the warts, I generally recommend hospitalization for electrosurgery under general or spinal anesthesia, as this increases the likelihood of complete removal.
If larger lesions have been successfully excised, applying topical medication to address any remaining micro-lesions is also a reasonable approach.
The treatment regimen for phenol is typically 16 weeks, or four months.
Whether to switch doctors depends on your level of trust in your current physician.

Reply Date: 2020/07/03

More Info

Anal warts, also known as genital warts, are caused by certain strains of the human papillomavirus (HPV). They can be a source of discomfort and anxiety, especially when they persist despite treatment. Your situation, where you have undergone multiple treatments including electrosurgery and are still experiencing the growth of warts, is understandably distressing. Let's address your questions and provide some additional context regarding the treatment and management of anal warts.

1. What can be done to resolve the issue?
The persistence of anal warts after multiple treatments can be frustrating. While electrosurgery is a common method for removing warts, it does not eliminate the underlying HPV infection, which can lead to the recurrence of warts. Other treatment options include topical treatments such as imiquimod (Aldara) or podofilox (Condylox), which can help stimulate the immune system to fight the virus and reduce wart growth. In some cases, cryotherapy (freezing the warts) or laser therapy may be recommended. It's essential to have an open discussion with your healthcare provider about the best course of action tailored to your specific situation.

2. How long should I apply the topical treatment (e.g., phenol)?
The duration of treatment with topical agents like phenol or imiquimod can vary based on the specific product and your doctor's recommendations. Typically, imiquimod is applied three times a week for up to 16 weeks, but your doctor will provide guidance based on your condition. If you are using phenol, follow your doctor's instructions closely regarding the frequency and duration of application. It's crucial to monitor the area for any signs of irritation or adverse reactions and report these to your healthcare provider.

3. Should I consider switching to another hospital or healthcare provider?
If you feel that your current treatment is not effective or if you are not receiving the support and information you need, seeking a second opinion can be beneficial. Different healthcare providers may have varying approaches to treatment, and a fresh perspective might offer new options or insights. When considering a new provider, look for someone who specializes in dermatology or infectious diseases, particularly those with experience in treating HPV-related conditions.

In addition to these specific questions, it's important to address the emotional and psychological aspects of dealing with anal warts. The fear of recurrence, concerns about sexual health, and anxiety about potential HIV exposure can significantly impact your mental well-being. Engaging in open conversations with your healthcare provider about these fears can help alleviate some anxiety. They can provide reassurance, education about HPV, and discuss preventive measures for the future.

Lastly, practicing safe sex in the future is crucial to reduce the risk of HPV transmission. Using condoms can lower the risk, but they do not provide complete protection since HPV can infect areas not covered by a condom. Vaccination against HPV is also an effective preventive measure, and it is recommended for individuals up to age 26, and in some cases, up to age 45.

In summary, while anal warts can be persistent and challenging to treat, there are multiple avenues to explore for resolution. Open communication with your healthcare provider, adherence to treatment protocols, and addressing any underlying fears or anxieties are essential steps in managing your condition effectively.

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