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Me:Internal warts....should my partner be tested/treated?
Oct 13, 2002

My partner and I are gay men in our 30's. We have been completely monogamous for almost 4 years and are both HIV (-). I recently had internal anal warts removed, and I am about to start internal Aldara (the warts weren't that "far in"). My partner and I did engage in unprotective sex (no anal sex at all since my surgery!), with me being the receptive partner at all times. My partner "thinks" he "may" have had a "bump" on his penis decades ago that went away on it's own. My questions are 1) What is the success rate of Aldara for internal anal warts (I know it's not FDA approved for internal use but i'm willling to try anything!) 2) How often do you recommend anoscopy post-wart removal? 3) Since I know I've obviously already had internal warts, is there any need for me to get an Anal Pap smear, or should I just get anoscopies periodically? And, most importantly, 4) Should my partner's penis be "empirically" treated with Aldara? (I'm advising him to go get an anal Pap smear). Thank you in advance for your advice--the time you dedicate to this is an incredible service!

Response from Dr. Dezube

All your questions are excellent ones. You need to understand that your warts are caused by the human papilloma virus (HPV, also known as the wart virus). It's a good idea to have your internal warts treat with surgery, lasers, aldara and whatever else. However, you need to understand that you will still be infected by HPV. Treating your partner's penis with Aldara makes no sense to me. If your warts come back, then it is most likely due to your persistent HPV infection, and not necessarily to a new infection from his penis.

There's really not enough data to comment about the effectiveness of Aldara for internal warts. I am aware that this is being tried particularly for internal warts which are not that high up.

Should you be getting PAP smears or anoscopies? My preference would be to have you get anoscopies since your provider will get so much more information from your anoscopies. However, I am assuming that you have access to anoscopies. Is this indeed the case? By having anoscopy, you'll know the status of your warts and whether you have an early signs of cancer. A PAP smear gives less info; it basically let's your provider know if you have early cancer cells. So a PAP smear is more of a screening tool to let both you and your provider know that you need anoscopy.

So, what would I recommend for you? Probably an anoscopy about 6 months after your internal warts are cleared by surgery, laser treatments, and so on. Then maybe a second one after another 6 months, and then yearly. This is a pretty aggressive follow-up schedule. Other providers might recommend less follow-up. There are no official guidelines for your situation so different providers will recommend different approaches.

And yes, your partner should get an anal PAP smear. If it is anything but normal, then he too should have anoscopy.

Non-Hodgkins Lymphoma: Chemo & Rituxan; Epstein-Barr Virus in my tumor.
How does HIV-infection lead to cancer?

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