Treatment
Treatment of non-cancerous HPV
Treatment of anal HPV-associated disease depends on the diagnosis, location, and size or amount of disease. Most clinicians treat grossly evident genital warts, or those that can be seen with the naked eye. However, despite the fact that treatment of cervical, vaginal, and vulvar HSIL is routine in clinical practice and that there are common clinical practices for treatment and follow up of non-warty cervical, vaginal, and vulvar LSIL as well, there are no current standards of care for non-warty anal LSIL or HSIL. There are arguments both in favor and against treatment of anal warts, LSIL and HSIL disease. Because LSIL (including warts) is benign, and usually regresses on its own, it may be unnecessary to treat. However, many patients and clinicians prefer to remove warts rather than waiting for them to go away on their own. Treatment of HSIL may be unnecessary because most HSIL does not progress to cancer, and much of it also regresses without treatment, nor it been proven to be the definitive cancer precursor lesion. However, it is also argued that since some HSIL does progress to cancer, the prevention of cancer overrides these concerns. In our practice we accept the limitations of current knowledge, and hypothesize that treatment of the precancerous lesions (HSIL) will result in a decreased incidence of anal cancer.
There is considerable overlap in the treatment of warts, LSIL and HSIL. However, there are principles for treatment that are specific to each, and the way each looks may be somewhat different. Therefore treatment guidelines will be presented first, followed by a description of the treatments that may be relevant to either warts, LSIL or HSIL.
Treatment of anal warts, LSIL or HSIL can take a long time and may require many visits over several months. It will also require long-term follow up to be certain that the disease has not recurred and to evaluate for any new developments. It is common, especially in people who are immune-compromised, to have ongoing HPV and to develop HSIL within a few years of developing LSIL or warts. As such continued evaluation is recommended. It is important for patients to work with their providers in developing both a treatment and follow up plan.
One aspect of treatment which is in the hands of the person being treated is smoking. Tobacco has been implicated in the development of all HPV disease, although the evidence is sometimes confused by other risk factors. In practice, we strongly believe that people who smoke are harder to treat successfully, and that smoking cessation can contribute to faster treatment and less recurrence. In addition to the cancer producing elements of tobacco, it also suppresses the immune system which contributes to the development and persistence of HPV and its associated diseases. Treating your warts or HSIL may be the excuse you were looking for to quit smoking now! Every local community and hospital has many programs to help you quit. There are also many web-based programs.
You can find information at the following sites: