QUESTION
I recently got rid of my external anal warts, but am now concerned that they may have traveled up to become internal. Do you think I should have them removed? If I let them go away on their own, how long would that take? Thanks for reading.

ANSWER
Anal warts are caused by the Human Papilloma Virus (HPV), which is very easily spread. The virus can cause warts on the outside anal and genital skin but may also cause warts inside. Internal warts are not easy to treat and in general if they are not bothering you it’s generally best to just leave them be. Often they will subside on their own as your immune system clears them. People can and do have wart virus infections of their skin without seeing visible warts. That virus infection can be spread to other people.

Since wart viruses are so common--more than 70% of all sexually active adults have gotten infected--and most warts go away on their own, the CDC does not make specific recommendations to tell partners about warts. Importantly, more recent science shows that condoms do prevent the spread of wart viruses and can prevent wart virus-associated cancers.

If you are HIV positive, speak with your health care provider about HPV and warts to see if she or he recommends anal PAP smears to see if HPV is causing any other problem in your rectum. For further information, please call the San Francisco City Clinic at 415-487-5500 or go to www.SFCityClinic.org, where you will find several articles on anal warts, how they are transmitted, treatment, and how to talk to your partners about the virus.

To your health,
Dr. K