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ANAL-High grade HPV lesions; I'm devastated
Mar 10, 2001

I recently had (within 6 months of each other) two pap smears that were completely normal. However, I had anal warts about 9 years ago and haven't had any recurrences. The dermatologist I saw did not look for internal warts and that bothered the researcher at the HPV clinic in San Francisco. So, I went up (I live about 400 miles away) and had high resolution anoscopy and two lesions were biopsied. One was benign and the over was high grade dysplasia. I am devastated. I am HIV-negative and have not had any anal sex in over two years. I haven't had any unprotected anal sex in almost nine years. I am wondering if you can comment on the success of treating high grade intraepithelial lesions (less than 1 cm) with TCA. Are recurrences common. Also, I keep reading that condoms are not effective at preventing HPV infection. The virus sheds easily and is unpredictable. I found out all this information too late. However, I am going to get a negative HPV DNA test (Digene) within 1-2 years. It is my goal in life. I am afraid of anal surgery if my treatment fails. Any advice would be appreciated. I am only 37 years old. By the way, should I tell anyone I have sex with after all of this is taken care of that I'm infectious for the rest of my life? And, is it true that almost all sexually active anal receptive gay men have been infected with at least one strain. Too much information? I'm sorry.

Thank You

Response from Dr. Dezube

I appreciate your concern about high grade dysplasia. It can indeed be effectively treated. The good news is that the lesion was found before it developed into cancer. All high grade lesions need to be removed; the method for removal is not as important as the fact that they are removed. Such treatments can include excision, applications on to the area, laser treatments and so on. You are correct that recurrences can occur. Typically after removal of lesions you should have anoscopy to check for recurrences, perhaps once or twice per year initially, and then less frequently as time progresses. Condoms do indeed offer some measure of protection. It is true that the majority of sexually active anal receptive gay men (bottoms) have been infected with at least one strain of HPV. As for what you tell your partners; my advice would always be to practice safer sex, which would mean in this case the use of condoms. The last thing to say is that you might consider inquiring about HPV vaccine trials; they are happening in several areas of the country including San Fransico (you had indicated you have access to there). Hang in there, many many men have your diagnosis, the important thing is to just deal with it. BD.


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