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Anal Warts-Please Help!
Aug 6, 2001

Hi Dr. Cohen-PLEASE post an answer to my question as I really need some guidance. I have been HIV+ for about 3 years. I am on a combination of Combivir and Viracept and my T-Cells are high and my viral load undetectable. I have recently discovered what I am pretty convinced are anal warts just inside my anus about a quarter inch and seemingly only to one side. THey seem to be growing in size over time. I have several questions for you about this. 1. What kind of a doctor would I want to go to get help for diagnosis/treatment/removal for anal warts? 2. Because I have SOME anal warts in certain places does this mean that it is just a matter of time before more and more "sprout" up inside the anus? 3. If I get them surgically removed will they just come right back? 4. If another person happens to come in contact with these anal warts with say a finger does this mean that they will then get warts topically just from coming into contact with mine? Thanks in advance SO MUCH for taking the time to answer my questions! I really really appreciate it! - K

Response from Dr. Cohen

Well, a few comments on this troubling and pretty common condition. You also might check on the OI site on here since this overlaps both forums.

We understand that there is a virus called HPV that causes warts. Some strains of this virus cause just warts - the ones that cause the disfiguring growths in the anal area as well as elsewhere. Unfortunately, a few of these strains also carry an additional risk of leading to precancerous changes in the skin, and if untreated, can in time cause cancers in the area. And anal cancer is not easy to treat so worth preventing. Thus the renewed emphasis on finding and eradicating warts when we find them.

First step is to get a diagnosis since bumps in that area may or may not be warts. Someone skilled and experienced may be able to tell and the best way to be sure sometimes is a biopsy or smear of the cells. As for what type of MD to seek, your HIV treating MD should know who in your area is best suited to do this - the usual suspects include internists who do a lot of HIV care, dermatologists especially for external warts, and surgeons/GI specialists as well, especially if they are internal. At our clinical group, a gynecologist has become more involved based on the fact that these warts can be a problem for women and there are similar skills involved in diagnosis and treatment.

As for what is done - after the diagnosis is made, the steps include destroying the warts in a few different ways -including freezing them (cryo), and chemical methods, including topical treatments that we might use in the office (podophyllin), or ones people might use themselves (Aldara or Condylox are two name brands of two different products). And sometimes as I mentioned, a surgeon is needed to remove them. Finally, there is a clinical trial going on in a few cities exploring whether a vaccine might stimulate immune function to help our system control this virus - that study is going on in only a few locations, and I am not aware of any central site to check for where it is - but your own HIV treating provider might know if it is open where you are.

As for your other questions - if you do have some warts, it is considered likely you'll have some more. This virus is transmitted skin to skin and it is hard to eliminate this virus entirely since the skin in this area is often in contact with other areas - including on fingers and other bodily parts -- so multiple treatments are often needed. But it can be cured - or so it appears. It just requires dedication, diligence, and destruction each time one is found.

While contact can transmit this virus, it is not inevitable - sometimes it doesn't happen. But it can, to any body part. And PS this virus does not penetrate Latex...

Hope that helps.



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