Treatment of Anal HPV infection
Asymptomatic anal HPV infection is very common and no treatment is required.
Anal warts should be adequately treated because they can grow into huge dimensions or may rarely undergo cancerous transformation. Small perianal warts can be treated with cryotherapy or imiquimod creams. Creams are more convenient in widespread involvement of perianal skin. Surgical resection or electrocauterization have the optimum results. They should be preceded by proctoscopy to rule out intraanal warts.
Anal cytology or even high resolution anoscopy should precede treatment in order to detect any coexisting intraanal infection. Serious dysplasias are not detected with direct vision and high magnification after acetowhitening is required for detection of any flat dysplastic lesions.
Most intra- or perianal warts are easily treated with electrocauterization in the proctologist’s office. Cauterization is the first-choice treatment for intraanal warts. International surveys have shown that laser treatment of warts of the skin of the anus has no advantage. If used for treatment of intraanal warts, laser treatment can cause serious bleeding.
HGAIN precancerous dysplasias are managed with electrocautery or infrared beams during high resolution anoscopy. Any treatment without HRA is not convenient because HGAIN lesions cannot be distinguished without magnification. Colonoscopy is not a convenient method for HGAIN treatment.
Smoke evacuator is necessary during HPV treatments with electrocautery or especially laser. smoke contains HPV DNA and may infect respiratory tract of medical providers. There is a confirmed case of laryngeal cancer in a provider of HPV treatment.
Follow-up examination after six weeks is necessary to look for any recurrence of anal warts. HGAIN should be followed closely because of possible progression to anal cancer. Tobacco smoking is a significant factor for HPV recurrence and discontinuation is mandatory. In any case, steroid ointments should be avoided in perianal area because the immunosuppression they cause may exacerbate HPV infection. A significant number of extensive anal condylomas have been encountered in our clinic after steroid treatment of lesions that were mistaken for hemorrhoids.