[Question #6984] Anal Genital Warts / HPV?

10 months ago
I am a 28 year old male from the UK.Long story short after a delay due to COVID i finally had surgery to remove a large anal wart, but large it resembled a clam shell, and prior to this I was struggling to go to the toilet out my back passage, it was causing a lot of dripping blood and pain so bad I could barely stand, lay or sit. It was located in a very odd location. Just below the anal hole, in the crease of the buttons, so it grew outward and didn't stop, you could see it hanging out of buttons - I called it a "growth", although very much a wart.It was removed on March 24, some small ones under it burned and the area stitched. Very upset that in the last 3 weeks, I've had a reoccurrence, more widespread or there is more than when I went into surgery - the good news, no "MAJOR" pain anymore and i don't bleed when I go to the toilet. They also looked up by passage and didn't see any. Just upset they are back so soon, and one of them seems large already, it's on the opposite side of where the big one grew, my concern is this one will explode and grow massive like the previous one, I just don't understand why I got such an extreme anal wart. Sadly aldara cream burns my skin and ulcers it, so I'm unable to use - my DR is considering acid treatment to next burn off the new warts.

My questions 
1. I assume this reoccurrence is the same infection/strain? Can only assume, as I've not had any sex.
2. Am I right in reading 90% of people male/female will clear the warts within 2 yrs, what is your experience of this being the case?
3. I've had two shots of the HPV vaccine, 0, 1 month and 6 (due in the next couple weeks), I understand it won't help with the current infection, but it's worth having right?

 Overall I'm concerned these warts will be with me for life, meaning I'll never get over this, I'm a bit upset by it all, came out of nowhere, I've never had more than 2 sexual partners and I'm blaming nobody because they have no signs, I just wish i could clear this.
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago
Welcome to our forum and thanks for your question. I’ll do my best to help. There are several somewhat uncharacteristic elements to your story. First, it is rather unusual for warts anywhere to bleed or to hurt. This is far more typical of hemorrhoids.  Similarly from what I can tell the size and appearance of your lesions is somewhat uncharacteristic for warts.  Also, most genital warts are acquired as the result of direct sexual contact. You mention that you have only had two sexual partners.  Were they male?  Have you participated in receptive rectal intercourse?  Finally, I presume the fact that the lesions you describe were HPV caused warts was verified by pathologic examination. Is that the case? I may have more further comments upon your reply but below please find my responses to your initial questions.  In response to your questions:

1.  If these lesions are warts and not scar tissue or some other process, this is more likely to be a recurrence than a newly acquired infection. Has your doctor seen them?  When HPV infections recur following treatment, recurrences most typically occur in 2 to 3 months following initial response to therapy.

2.  You are correct. Most HPV infections resolve without therapy over a period of approximately two years. The regression rate for visible warts is somewhat lower than for so-called “flat” warts which may not be visible but are detected through testing such as Pap smears and women.

3.  Yes, I would certainly encourage you to get the final HPV vaccine injection. As you pointed out the vaccine has no appreciable affect on infections which have been acquired before vaccination however they will prevent future infections.

I hope these initial comments are helpful to you. As I suspect you know, we provide up to two follow up responses to questions. I will be happy to clarify any of the statements I have made or respond to your answers to my questions if you wish. EWH
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10 months ago
Yes, I’ve always thought why I got such a “bad case” but the sexual clinic and my consultant confirmed it as anal wart. It did get extra large and did bleed, I suspect due to it being right in the way of the anal hole. It was an extreme case, but then again what I’m dealing with now would be considered a significant reoccurrence (and so soon!). I did once have anal sex, so probably caught through this. Doctor is considering acid burning them off soon.   

Also with regards to the HPV Vaccines. In the U.K. the NHS gives Gardasil R, I understand there is Gardasil 9 now available privately. As I’ve had R would there be much benefit of getting the 9 also to cover new strains? Can you “overdose” on the vaccine, would it be dangerous to have more than the 3 shots? 

Just hoping my immune system clears this as I’ve generally well. 


Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago
Thanks for the additional information.  If possible, given the size and extent of your lesions, I think it would be helpful to see a proctologist for continuing therapy.  If this is not possible, certainly further therapy is certainly reasonable.  The best approach therapy should be determined by your care provider.

Regarding the Vaccine, the quadrivalent covers about 2/3 of the HPV types which cause ano-genital infections, the nine valent vaccine covers a little over 80%.  Whether there is Much added benefit from your getting the 9-valent vaccine With it’s modestly expanded spectrum is a largely personal decision which you might discuss as well with your doctor.   Certainly you cannot overdose on the vaccine.  EWH
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10 months ago
My fear with this reoccurrence is that the large one just a bit bigger than a finger nail will grow wild like the other one which measured 7cm across and as mentioned was like a clam shell. I guess worry has overcome me. I’m also worried as I get a wetness from the wart (is this normal) part of me is thinking as I’m 6 months into this, had surgery to remove one big one and now a reoccurrence- maybe just leave it and see it they go on their own. Isit wreckless? Just to leave them and see what happens? 
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago
As I have already mentioned, the size and course of the lesion previously identified as a wart is rather atypical. For a wart to be 7 cm across is virtually unheard of.  Similarly it sounds as though the lesions you have had have grown visibly over the course of just a week or two. This too is quite atypical. Given these abnormalities, my advice is to seek the advice of a specialist. Preferably a proctologist. Evaluation may include a true biopsy with pathological and micro scopic evaluations.

On the other hand, if the current issue for you is primarily apprehension and anxiety, I would do your best to not be concerned and move forward. If you are having doing this individually, in speaking with a counselor may be helpful as well. Hope this perspective is helpful. EWH
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10 months ago
One final question. The clinic I’m having my vaccination at is closed due to covid I had two shots of Gardasil R, but a private clinic can offer me Gardasil 9 to complete my final shot. Would it matter mixing the two for the final shot? I assume the 9 just covers a few more strains. 
Edward W. Hook M.D.
Edward W. Hook M.D.
10 months ago

Final response (typically we allow just a total of three responses but I kept your thread open out of concern related to the multiple abnormal aspects of your post.


You will be fine receiving Gardasil 9 as your final response.  It can't hurt and may offer a little bit of extra protection.

Take care.  EWH

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