[Question #1655] Anal Warts

80 months ago

I’ve had anal warts for about five months now, and in my previous question I asked about surgery options and how long I would remain contagious. My warts have not gone away, and although they are not causing blockage yet they aren’t getting smaller. My external warts have reappeared after anally masturbating with a finger, which brings me to another point: I love to exercise, but since I got these warts I’ve been abstaining from doing the intense leg work outs on the elliptical and treadmill that I desperately would like to do. This is because I brought this point up to my dermatologist and he agreed that it was possible the excess rubbing and sweat was making my anal warts worse. I wanted to confirm whether or not that’s an accurate assessment, and if it is, if there’s any way I can do lower body exercises without making my warts any worse.

I’d also like to ask how long it usually takes before the warts begin to shrink in most people, as after five months I still have some spreading. I don’t have HIV or any immune system disease, nor do I have other STDs. At what point should I start feeling that surgery might be necessary even though complete blockage hasn’t happened?  
H. Hunter Handsfield, MD
80 months ago
Welcome back to the forum. I reviewed your previous discussion with Dr. Hook and agree with his comments. As he did, I'll make a few general comments before addressing your specific questions.

I'm not clear on what sort of "anal masturbation" you are referring to:  your own? a partner's fingering of your anal area? something else? But I'm confident it has nothing to do with reappearnce of external anal warts. Almost certainly that would have happened without the fingering event. The point is that you shouldn't feel guilty or responsible:  most likely nothing you did had any effect on regrowth of external warts. I also don't see that exercise of any kind is likely to have any effect. There are no external factors, or influences on the immune system, that are known to have any effect on growth of warts. Perhaps in agreement with your dermatologist, rubbing or manipulation of warts might make them appear more prominent or more uncomfortable because of irritation, but I doubt it actually contributes to wart growth; and even the irritation/appearance issue would require very vigorous, repeated manipulation of the warts -- probably a lot more than you are experiencing. Anyway, lower body exercises aren't likely to make any difference.

To my knowledge, little research has addressed the natural history of anal warts. However, the clinical experience of most experts is that it can take many months or even years for anal and rectal warts to resolve -- perhaps years in some cases. My advice is to find a protolotist or colon and rectal surgeon you trust and go ahead with surgical treatment. "Blockage" is not the main reason for surgery anyway, and it's not an outcome to await before considering surgery. Recovery is painful for a couple of weeks, but it's probably the best approach in most cases. In your previous thread, you apparently wanted to not use your health insurance because "I know they’ll be able to put two and two together if I have this surgery using insurance". So what? Some anonymous computer in an insurance company indeed will "know" you had anal warts. But nobody is going to reveal that to anyone. Millions of people every year have medical treatment under their insurance policies for HIV, gonorrhea, herpes, or other conditions they wouldn't want their friends, co-workers, or families to know about. But those people never learn about these events because of insurance, only because the patient him/herself tells them.

I hope these comments have been helpful. Let me know if anything isn't clear.

Best regards--  HHH, MD

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80 months ago
Thank you for your speedy reply. The reason I was worried was because I'm under my parent's insurance plan, and a discussion with a potential colorectal surgeon told me that indeed the information of what kind of surgery I've had would not be kept from insurance payment reports my parents receive. However, if it could potentially take years for the warts to resolve themselves, I probably will need surgery, in which case I probably should use my parents insurance simply because I know these procedures often need to be done multiple times. In that case I'll probably tell one parent I'm having a private, very minor and embarrassing surgery that I don't want to go into the details for, and I'm sure they'd understand. Either way, thank you for your reply.
H. Hunter Handsfield, MD
80 months ago
OK, understood. But anal warts occur commonly without anal sexual contact, e.g. in strictly heterosexual men. At your age, presumably your parents know you are sexually active. That you have anal warts says nothing about your sexual lifestyle. Of course I understand that this doesn't necessarily make for an easy conversation, and your parents might make unwarranted assumptions. But if they are as intelligent and insightful as you (my "between the lines" judgment based on your writing and overall context of your comments), they'll get it. Best wishes in working it out.

I suppose it's true that anal wart surgery sometimes needs to be done more than once as warts recur. But most people have only one procedure.

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80 months ago
Thanks for all your help! My dermatologist and general physician said people with HIV tend to have more aggressive warts, but other than that I think pretty much everything I need has been cleared up for me.  
H. Hunter Handsfield, MD
80 months ago
OK, thanks for the thanks. That concludes this thread. Best wishes in all this.

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