[Question #1565] Anal Warts

81 months ago

I’ve had two treatments of cryosurgery for anal warts (some external stuff remains still), and I’ve just been to a colorectal surgeon who’s urging me to have surgery. I’m not out of the closet, and I’m on my parent’s insurance. I can hand-wave cryosurgery on the insurance billing as removing a regular planar wart, but I know they’ll be able to put two and two together if I have this surgery using insurance. As such, I’d have to do it out of pocket, which I CAN do if need be. Still, this has been quite traumatic for me.

My doctor told me I’ll always be a vector for the virus and I’ll have to disclose my status as having had HPV for the rest of my life, even if the warts are gone, and my dermatologist said something similar, but I’ve seen information online that says that isn’t the case. I don’t want believe in false hope, but I’d long to hear that one day it’ll be suppressed enough in my system that I can’t give it to other people. I’m still mulling over the details of surgery, but before I go through with it it’d help me to know if what my doctor said was accurate: will I always have a risk of giving genital warts to other people I have sex with from now on? 

Edward W. Hook M.D.
81 months ago

Your doctors' perspectives differ from ours and represent an area of great controversy in our field.  I'll be happy to present our perspectives.  Part of what I will say reflects statements that Dr. Handsfield or I have said before on this forum and represent shared beliefs and comments

As a sexually active man it is no surprise you have HPV- virtually all sexually active persons (conservatively over 80%) have or will almost certainly have HPV in the future.  these infections may be manifest as genital warts or may be asymptomatic.  This however should not concern you as virtually every other sexually active person who has not had the vaccine will be infected too.  In the vast majority of cases the infections would resolve without treatment in 6-24 months and would only lead to the serious consequences of HPV (cancer and dysplasia) in a small (1-2% at most and probably less) of infected parsons.  When persons are aware of infection, treatment hastens resolution but persistent HPV DNA may be detected years later- there is no good evidence that this persist , hard to detect DNA is infectious to others and our counsel is that if no recurrence and no further evidence of infection 6 months after treatment, then persons should consider themselves non-infectious (it is this issue of persistently detectable DNA that gives rise to the different perspectives that you hear from us vs. your colo-rectal surgeon and dermatologist.    This is part of the reason that we do not feel it is necessary for everyone who has had genital warts or HPV diagnosed to tell sexual partners- the infection is too common for anyone to think that they are not infected, of little consequence, and poorly understood. The concern about HPV infections is their long term association with pre-cancerous lesions and cancer. 

I hope this explanation is helpful to you.  As far as the issue of your health insurance, this is a dilemma that I would honestly discuss with your surgeon if you have not already.  Unless that warts are obstructive, surgical removal is certainly not emergent.  EWH