[Question #7156] HPV warts

9 months ago
Hi Drs, i am a female based in the UK and i have never received the HPV vaccine. Around 10 years ago i was treated successfully for 2 warts on the outside of the anus. These never recurred. 

A year ago i had one small smooth bump frozen on the perineum that didnt look typically like a wart nor as the sexual health nurse commented "reacted like a wart". Again this never recurred.

I now have 3 seperate small bumps in the anus (roughly 2-3cm inside) that i can feel and see if i try hard enough. All are small (poss 2-3mm) smooth, skin coloured protrusions. A colorectal specialist performed a sigmoidoscopy and DRE, he could feel them but could not see them when looking and commented that the anus/rectum appeared healthy. 
How likely are these to be warts after all these years? I have never received anal sex only digital penetration. What else could they be? 
The colorectral specialist didnt see any need to follow up but did say if i was still concerned to visit a GUM clinic once they begin appts again for warts post covid. 
What would be the treatment options if they are? As they are internal is cryotherapy still an option? 
Thanks in advance. 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
9 months ago
Welcome. Thanks for your confidence in our services.

A bump that a physican  can feel on exam, but not see, almost certainly is not a wart. That's especially true for an experienced provider like a colorectal surgeon.  There are all kinds of reasons for irregularities and "bumps" in the skin, rectal lining, and elsewhere. And >90% of genital and anorectal skin problems are not STDs. I see no reason to be concerned about recurrent warts. I agree yolu could get a second optinion at a GUM clinic, but I reallly doubt it is necessary.

As for treatment options, I would suggest waiting to cross that bridge if you get there, i.e. if warts are confirmed. But that probably won't happen. If it does, any of the standard treatments would be OK. Since they're apparently internal, cryotherapy might be the best. But frankly I recommend agasint reevalation. Almost certainly you con't have recurrent warts. And if you do, why no let them just melt away on their own -- which they likely would do over a fairly brief period.

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

HHH, MD
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