Hello,

I'm a current graduate student at Harvard, and I was diagnosed today with HPV. I noticed perianal warts three weeks ago and made an appointment immediately. I met with anal surgeon today. He painted the region with acid, told me that aside from the three warts I had externally, there were some within as well, and then broke it down in what he called "the worst case scenario"...

He said that surgery would be my best option, with some warts being removed physically, and others being CO2 lasered. That there would be a biopsy done on some of the tissue to see if I had a strain of HPV that leads to anal cancer. And that I was going to be in a LOT of pain for about a week after the procedure.

I notice that you work in Beth Israel, which is where I was told to make an appointment. I guess my question is how worried I should be. It sounded to me like I was well on the road to anal cancer, although reading up on the web for the past two hours since I returned from diagnosis, it seems that the cancerous strains of HPV are less likely to exhibit warts...? I guess I am looking for some hope here. I am a gay male, 26, HIV negative.

I'm also really worried about this week of intense pain... And I don't even have a bath in my home, which I hear I have to take to make sure the area is clean...

Thanks for your help, J

Dear J: This is indeed a lot of news you received over a very short period of time. You raise many interesting points, which I will go over one by one

1) You are HIV negative. The course of warts and other HPV-related diseases tends to be more mild in HIV-negative folks than in HIV-positive folks.

2) It will be most important to see the results of your biopsies. Only then we will know if you have warts and low grade dysplasia (called AIN I) or the more worrisome high grade dysplasia (called AIN II and III). As your query indicates, many patients end up having just warts without any of the precancerous lesions.

3) How worried should you be? That's a question I am asked each and every day which I see patients. My message is that you have a disease with pretty good treatments. You need to be followed to see that the surgeon removes as much disease as possible and that if and when it recurs, it is treated early rather than later. The vast majority of folks like you will NOT develop full blown cancer, particulary if you are having your HPV disease dealt with.

4) Lastly, as for the external warts, if and when they recur Aldara cream is an effective way to deal with them

Good luck. I think, based on what you have written to me, you'll do well.