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Interferon injections to treat internal warts/prevent anal cancer
Sep 11, 2001

Despite a relatively modest CD4 count of 324, I have been able to treat external anal warts very succesfully, eliminating them in only 3 weeks by appying Aldara. However, I have not had any luck what so ever in removing them internally using any of the traditional destructive methods (they recur within 1-2 weeks) or Aldara (can't apply it properly). Now they're growing really big (the doctor just called one "the mother of all warts"!) and they often cause bleeding when I go to the toilet, so I'm getting a little desperate! I've searched the internet for alternative methods and some webpages suggest injecting interferon directly into the warts. I'm quite enthusiastic about trying that, especially given my good experiences with Aldara (which I understand is also interferon based). What are your thoughts on that? Thanks in advance for your answer! PS: I've been examined visually lots of times but we have never performed a PAP smear. Should we do that?

Response from Dr. Dezube

The situation of persistent pesky internal anal warts with relatively good control of external warts is unfortunately not that uncommon. I'm glad that Aldara is helping the external warts. In terms of the internal warts, there are a few concerns-- the "traditional destructive methods", which you refer to, can actual vary from center to center. Some centers use a CO2 laser to the bases of the lesion to prevent recurrence. You might want to inquire with your surgeon if such a laser or alternative is available. Sometimes reinfection can occur through seemingless harmless objects. Concern has been raised about anal douching devices. If you use such a device, are you sterilizing it before repeat use in order to prevent reinfection by the papilloma virus?

Interferon does indeed have activity against papilloma virus lesions. Typically the lesions need to be injected on multiple occasions, something which is simply not practical for anal lesions. Some practioners prescribe low dose systemic (subcutaneous) interferon for their patients. You might want to consider this if all else fails. Ultimately the best treatment for internal warts may be a vaccine. At least two vaccines are in clinical trials in very limited geographic areas. Depending upon your geographic location, you may want to inquire about such trials.

Lastly you bring up the PAP smear. The PAP smear is a great way to screen for papilloma virus disease and its associated early cancers. Since you've had surgery, there is presumable tissue submitted to pathology. This surgically removed tissue should be as good, if not better, than a PAP smear. In your case, once you have all your butt warts removed, then the PAP smear is a great way to screen for recurrent disease. So long as you do have the butt warts, I'm not sure you need a PAP smear; rather you need surgery. GOOD LUCK.


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