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Yet another HPV question...Can I leave a single wart alone?
May 18, 2003

I first tested HIV+ in January of 1997. I have been on meds since May of that year and have been healthy and asymptomatic since day one. At a recent doctor's appointment, during a rectal exam, my doctor told me I have one small anal wart. He said since it is only one and small that he did not feel it needed to be diagnosed further at this time and that he would be checking it annually to look for changes and/or more or them. I have very low sexual activity since becoming HIV+, and none of that activity involved anal penetration of myself or my partner at all. My doc says I could have picked up the HPV 15 years ago and it's just now showing up, and I shouldn't worry about it if it stays as is. But, being poz, I can't help but wonder, is this a common first sign that I am headed toward some kind of anal cancer? Isn't this sort of a precursor of that, especially for the HIV+?

Response from Dr. Dezube

Excellent question. I too find myself in the exact same position with patients-- specifically that I find one single wart in a patient who hasn't had anal sex in a decade. The question is what to do with this finding.

Much depends upon what is available in your geographic locale. The single wart in itself is not worrisome and it is unlikely to become cancerous. What is more concerning is that the wart signifies that you are most likely to be HPV infected. It is therefore conceivable that you could have much more serious changes internally. So what would I recommend-- if you have the possibilty of high resolution anoscopy (not available in all geographic locations), then that is what I would recommend. If that is not available, can you get PAP tested? PAP smear would tell if there was anything more worrisome higher up in your butt. Although I tend to pursue this a bit more, which is why you are writing, I also must say that I don't think your doc is wrong. He is correct in that most likely it won't change. Some of this is philosophical. S/he is giving you a very conservative recommendation. If possible, I would recommend that you go for further testing.

Write back if you have other questions?

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