Managing Anal Warts: Effective Treatments and Medication Options

Anal warts

Hello, doctor.
A few months ago, I developed genital warts that have grown inside the anal area.
I have undergone two rounds of electrosurgery; the first one was a month ago, but the warts reappeared, leading to a second procedure about three weeks ago.
However, I have noticed that new warts seem to be appearing in areas outside the anus where there were none before.
I'm really unsure about what to do, so I would like to ask you some questions regarding topical treatments.

First: The doctor I saw initially said there was no need for a topical ointment inside the anus, but the second doctor I consulted mentioned that there is one available.
However, he said that currently, there is no such ointment available in the Keelung area.
I would like to know which topical treatments on the market can be applied both externally and internally around the anus.
Are there any ointments available in Keelung? (I have heard that applying the ointment on a suppository can help achieve internal application.) I would like to inquire about the validity of this method.
Second: While electrosurgery is said to be the fastest method, I feel that the warts are growing back quite rapidly, although they seem to be in new areas.
Could this be because the doctor did not remove all the warts completely, or is it simply due to a weakened immune system? If the warts reappear shortly after the procedure, does that mean I will need to undergo electrosurgery every two months? Just the thought of that is hard to accept.
If there is a way to combine the use of ointments with the electrosurgery, I would appreciate it.

I have been feeling quite overwhelmed by the situation with the warts, and the information I found online seems to differ from what the doctors have told me.
Therefore, I would like to consult you, Dr.
Ke, about these issues.
Thank you very much! 🙏

Niming, 20~29 year old female. Ask Date: 2022/03/22

Dr. Ke Fangxu reply Surgery

1.
Cauliflower ointment can be irritating, so caution should be exercised when using it on mucous membranes.
Both Wart Freeze and Wart Remover contain the same active ingredients; however, the former's instructions explicitly state not to use it on mucous membranes, while the latter does not provide such a warning.
Additionally, Laderma also does not specify that it cannot be used on mucous membranes.
You might want to try looking for Laderma at larger pharmacies.
2.
If cauliflower warts are located inside the anus, it is difficult to completely remove them with just local anesthesia.
For recurrent cases, hospitalization is generally recommended for surgery under either spinal or general anesthesia, as this reduces the likelihood of recurrence.

Reply Date: 2022/03/22

More Info

Managing anal warts, also known as genital warts or condylomata acuminata, can indeed be challenging, especially when they recur after treatment. The human papillomavirus (HPV) is the primary cause of these warts, and while treatments like electrosurgery can effectively remove visible warts, they do not eliminate the virus itself, which can lead to recurrence.

Treatment Options for Anal Warts
1. Electrosurgery: As you've experienced, electrosurgery is a common and effective method for removing anal warts. However, the recurrence you mentioned may indicate that not all warts were removed during the procedure, or that new warts have developed due to the persistent HPV infection.

2. Topical Treatments: There are several topical medications available that can be used for treating anal warts. These include:
- Imiquimod (Aldara): This is an immune response modifier that can be applied to the affected area. It works by stimulating the immune system to fight the HPV virus. It can be used for both external and internal warts, but care should be taken when applying it internally.

- Podophyllin: This is a plant-derived resin that can be applied to warts. It is typically used for external warts and should be applied by a healthcare provider.

- Trichloroacetic acid (TCA): This chemical can be applied to warts to destroy them. It is usually applied by a healthcare professional.

3. Combination Therapy: Some patients benefit from a combination of treatments, such as electrosurgery followed by topical medications to prevent recurrence.

Application of Topical Treatments
Regarding your question about applying topical treatments internally, it is crucial to follow your healthcare provider's instructions. While some topical treatments can be applied internally, they must be used with caution. Using a suppository or a similar method to apply the medication internally can be effective, but it should be done under the guidance of a healthcare professional to avoid irritation or injury.

Recurrence and Resistance
The recurrence of anal warts can be frustrating. Factors that may contribute to this include:
- Incomplete Removal: If the initial treatment did not remove all the warts, they may regrow.

- Immune Response: A weakened immune system can lead to a higher likelihood of recurrence. Factors such as stress, illness, or other infections can impact your immune response.

- New Infections: HPV is highly contagious, and new infections can occur, leading to the appearance of new warts.

Recommendations
1. Follow-Up Care: Regular follow-up with your healthcare provider is essential. They can monitor the situation and recommend additional treatments if necessary.

2. Consider HPV Vaccination: If you haven't already, discuss the HPV vaccine with your healthcare provider. It can help protect against the strains of HPV that cause warts and certain cancers.

3. Healthy Lifestyle: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and stress management, can help support your immune system.

Conclusion
Managing anal warts often requires a multifaceted approach, including both physical removal and topical treatments. If you continue to experience rapid recurrence, it may be beneficial to discuss alternative treatment options or a more aggressive treatment plan with your healthcare provider. They can provide personalized advice based on your specific situation and help you navigate the complexities of managing HPV-related conditions. Remember, you are not alone in this, and there are effective strategies to help manage and reduce the recurrence of anal warts.

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