Recurrent Perianal Warts -- Best Treatment?

Question

Hi -- I wrote to you before, when I was being treated for a squamous cell carcinoma in my external, perianal region. In December, I had surgery to remove it and also to remove "extensive" anal and perianal condyloma/warts, then in January completed 25 sessions of radiation. Since then, I have had a sudden spate of 5 new warts just as I was healing up from the radiation. My surgeon treats me every week by applying Podophyllin to my perianal area, and I use Aldara cream 3 nights per week. It's better, but not gone (it's just been about 3-4 weeks). I saw an ad in a gay magazine for another doctor who claims to "cure" anal warts by injecting them with something, and I'm going to see him for a consultation. The weekly applications of Podophyllin make my "hole" sore for about 24 hours afteward, requiring hot baths and pain meds to sleep. Of the several treatment options (Podophyllin/Aldara, injections (interferon?), another I heard of called Bleomycin), which do you think would treat my hole once and for all so that I'm not chronically sore?? After surgery, radiation, and weekly follow-ups, I want my poor hole left alone! What do you think is "state of the art"? Thanks!

Answer

Sounds like no fun having these recurrent warts. Basically you have a chronic HPV (human papillomavirus virus) infection. I don't think there is really a "state of the art" treatment. I imagine you may get recurrent outbreaks which will need to be treated recurrently as you indicate.

I am assuming that all your warts are external. I prefer Aldara for my patients. It is self-administered. I recommend patients use it three times per week, but to back off to two times per week per week if their hole is sore. If you get all your warts cleared up by this treatment, then I would recommend that you use Aldara once or twice a week on a chronic basis, at least for several months. This will help keep your warts suppressed. I recommend to my patients that they apply a pea-sized quantity of Aldara at night and to wash it off in the morning. Ultimately the best treatment for your condition may be an HPV vaccine. HPV vaccines are currently in trials, but unfortunately, are not widely available.

Lastly, if you have recurrent external warts, then it would pay to have a health care provider look internally. External warts often travel with internal warts. The treatment for internal warts would be different than the treatment outlined above for external warts.

Also you do not mention whether or not you are HIV positive. If you were to be HIV positive, then it's important you do whatever is possible to maintain your CD4 count high and your viral load low.