Seeking Guidance for Persistent Anal Warts: Which Specialist to Consult?

Regarding the treatment specialties for cauliflower?

Hello doctor, I discovered a cauliflower-like growth near my anus at the end of November and immediately consulted a colorectal surgeon who performed an anoscopy.
The internal examination showed no growth, so I was scheduled for a local anesthesia electrocautery procedure in early December.
However, two weeks later, the growth recurred and was larger.
The doctor performed another anoscopy and found additional growth inside.
At the end of December, I underwent another electrocautery procedure under spinal anesthesia.
Today, during my follow-up appointment two weeks later, the growth has increased in size and number, leaving the doctor at a loss.
He suggested I seek care at another hospital, stating that my recurrence is too rapid.
The doctor mentioned he cannot prescribe ointments similar to Aldara (Imiquimod) due to lack of authority and recommended that I might need to see an infectious disease specialist.
I am feeling quite lost and unsure whether I should see an infectious disease specialist, a dermatologist, or return to the colorectal surgeon.
Could you please provide me with some advice?

Hank, 20~29 year old female. Ask Date: 2016/01/22

Dr. Ke Fangxu reply Surgery

Lederme is not a controlled substance, so it can be purchased at pharmacies.
However, if the cauliflower-like lesions are extensive, the effectiveness of topical ointments may be limited.
The preferred treatment for anal warts is electrosurgery.
It is advisable to consult a different physician for a reassessment and also to get tested for HIV to determine if the recurrent symptoms are related to compromised immunity.

Reply Date: 2016/01/22

More Info

It sounds like you are dealing with a challenging and frustrating situation regarding the persistent anal warts you have been experiencing. Anal warts, also known as condylomata acuminata, are caused by certain strains of the human papillomavirus (HPV). They can be quite stubborn and may require a multifaceted approach for effective treatment.

Given your history of treatment and the recurrence of warts after procedures, it is essential to consult with the right specialists who can provide you with the best care. Here are some recommendations based on your situation:
1. Infectious Disease Specialist: Since your doctor has suggested seeing an infectious disease specialist, this could be a good first step. These specialists have expertise in managing infections caused by viruses, including HPV. They can provide insights into the nature of the virus and may suggest antiviral treatments or other management strategies that could help reduce the recurrence of warts.

2. Dermatologist: A dermatologist, particularly one who specializes in sexually transmitted infections or dermatological conditions, can also be beneficial. They can offer various treatment options, including topical medications that might not be available to your current physician. Dermatologists are well-versed in skin conditions and can provide alternative therapies that may be more effective for your specific case.

3. Colorectal Surgeon or Proctologist: Since you have already seen a colorectal surgeon and undergone procedures like electrosurgery, it might be worth seeking a second opinion from another colorectal specialist. Different surgeons may have varying approaches to treatment, and a fresh perspective could lead to new options. They might also consider more advanced surgical techniques or combination therapies that could be more effective in your case.

4. Consideration of HPV Vaccination: If you have not already been vaccinated against HPV, discussing the HPV vaccine with your healthcare provider could be beneficial. The vaccine can help prevent the strains of HPV that cause warts and certain cancers, potentially reducing the risk of future outbreaks.

5. Support and Counseling: Dealing with recurrent anal warts can be emotionally taxing. Consider seeking support from a counselor or therapist who can help you cope with the stress and anxiety that may arise from your condition. They can provide coping strategies and emotional support as you navigate your treatment options.

In summary, it is advisable to consult with an infectious disease specialist first, as they can provide a comprehensive evaluation of your situation. Following that, seeing a dermatologist or obtaining a second opinion from another colorectal surgeon could also be beneficial. Remember to communicate openly with your healthcare providers about your concerns and the impact this condition has on your quality of life. They are there to help you find the best path forward.

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