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Can I get internal Anal Warts with none on the outside
Nov 22, 2001

I'm a 38 negative gay man. My partner and I have been together for 6 years and only on occasion perform protected anal sex. I did not see any exterior warts but after an examination in the shower believe to have slight lumps just in the interior. Is is possible for interior warts and none showing on the outside? Should I see my GP?

Response from Dr. Dezube

Anal warts are caused by human papillomavirus (HPV). Unfortunately HPV can cause a patient to have just internal warts, just external warts, or a combination of both. Furthermore many gay men are infected with HPV infection, yet do not have any warts. It is for this reason that we recommend that folks who are at risk for HPV infection, and this includes most gay men whether or not they are HIV positive, should have an anal PAP smear. This is a procedure, akin to cervical PAP smears in women, by which a health care provider inserts a swab into the anal canal to obtain cells which are viewed under a microscope for early cancerous changes. Depending on the findings of the anal PAP smear, further investigation may be necessary. Gay men, who are HIV positive, and particularly those with CD4+ counts <200, are at higher risk for both HPV infection and anal cancer.

I would indeed recommend that you get evaluated by a health care professional, hopefully one who has the three A's (ability, availability, and affability) when it comes to men anal health issues. If you feel a lump, then I would recommend that you have anoscopy performed; this is a procedure where someone looks up you butt to see what's going on. I would recommend also an anal PAP smear as above. Not all these procedures are available at all locations. Your GP is a good start.

I should add that not all lumps are warts or cancer; sometimes hemorrhoids or benign tags can feel just like lumps.

The bottom line is that you need to get your bottom to be evaluated. Good luck.

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