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Internal anal warts and their treatment.
Jun 19, 2001

About a year and a half ago I was diagnosed with HIV and anal warts. I immediately went on a regimen of Sustiva and Combivir. Since about a month after staring the meds my viral load has been undetectable and my CD4 count above 600. I was treated with Aldara for the external warts. My question is that I have never been examined internally for warts, and should I be concerned about that? I have had no recurrence of the warts since the inital application of Aldara. Also, who do go to for the internal exam? Is my primary care physician enough?

Response from Dr. Dezube

You ask an excellent question. Since you had external warts, you are indeed at risk for internal warts. It is important that these be checked since internal warts, if left untreated, can on occasion develop into cancer. At the very least, you should have an anal PAP smear. This is a procedure by which a provider inserts a swab into your bottom end and sends the swab to the pathology/cytology lab to look for early cancerous changes. These swabs are done routinely on the cervix of women; I can't say whether or not you'll be able to get an Anal PAP smear done in your location. Virutally all hospitals will have surgeons or other providers who have some experience with anal diseases (e.g. hemorrhoids, warts, fistulas). That would be a good place to start in terms of getting an internal examination. Basically you want to seek out someone who has an interest in the subject-- I can't comment about your specific primary provider since that would really depend on his/her level of interest. Most AIDS/HIV facilities have dealt with the issues you raised. They should be able to point you in the right direction. So in short, I would indeed recommend an internal exam, a PAP smear, or both. Good luck. BD.


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