<s>[INST] Hi, I have had extreme anal itching for 7 years, I had 2 polyps removed in 2009 via colonoscopy. I also should tell you that in 2000 I had a very large cone biopsy done due to abnormal cells from HPV. I have recently discovered a perianal high fistula which is extremely painful and itchy. My gyno did a punch biopsy of it last Friday and am currently waiting the results. I am seeing the gyno due to a large calcified cyst inside my right ovary and am waiting for a radical hysterectomy. Should I be worried the fistula is a symptom of cancer from the HPV? and what kind of over the counter cream can I use in the meanwhile? [/INST] Hello, Welcome to Chat Doctor, The usual causes for perianal itching is a fungal infection or a parasite called entertains vernaculars (Pin worm). In pin worm the itching is mainly at night and if you inspect your motion or the perianal region you might see the worm. The fungal lesion can also be diagnosed by a KOH preparation, which can be done at most labs. Check your blood sugar if it has not checked recently, as diabetes makes one prone to fungal infections. If you are unable to meet a doctor, for the symptoms you can try with Albendazole tablet and canes ten cream locally.Thank you. </s>