What are Anal Warts?

Anal warts (condylomas) are small skin-colored or pink-colored growths or spots in or around the anus. These growths can become large and cover the entire anal area. Anal warts are one of the most common sexually transmitted infections in the United States. Although anal warts affect both genders, more women than men are diagnosed with anal warts.

1. Symptoms of Anal Warts

Anal warts are a commonly transmitted sexual infection among young adults. It is a painless condition and most are unaware of the diagnosis as there are no symptoms. Some persons may complain of anal itching. Tiny spots or growths can be seen and also can be felt with fingers. When they become large, you may feel a lump or mass in the anal area. You may also notice bleeding or increased mucus discharge.

2. Causes of Anal warts

Anal warts are caused by a virus called the human papilloma virus (HPV). HPV is one of the most common sexually transmitted disease (STD) in the Unites States. There are more than 100 different types of HPV, which can infect and cause growth of warts in the different parts of the body. Most anal warts are caused by two types of HPV virus (types 6 and 11). These two types do not cause cancer. It is not necessary to have an anal receptive intercourse to develop anal warts. HPV can transmit through direct contact exposure to the anal area (hand contact, secretions from a sexual partner) resulting in anal warts.Apart from anal area, HPV may cause warts in other nearby areas such as vulva, cervix, vagina, and penis. Usually it takes months to develop anal warts after a HPV infection.

3. Risk Factors of Anal Warts

Multiple sexual partners
Anal receptive intercourse
Not using barrier contraceptives, such as condoms

4. Prevention of Anal Warts

Human papillomavirus vaccine is available that prevents the HPV infection and formation of anal warts. Other preventive measures include:

Using condoms
Limiting sexual contact to a single partner
Sexual abstinence

5. Complications of Anal Warts

Anal warts are not life-threatening. If untreated, anal warts increase in size and can cause bleeding and discomfort. The risk of anal cancer also increases slightly with some HPV subtypes.

6. Diagnosis of Anal Warts

Your doctor will first take a detailed history and perform the relevant physical examination. A detailed history regarding the sexual practices, anal receptive intercourse, and previous history of sexual transmitted diseases will be taken. Your doctor will look into your anal area and most warts are easily diagnosed by looking at them. Your doctor may also perform a digital rectal examination (DRE). It is a simple bedside procedure in which your doctor will insert a gloved finger into your anus to look for any abnormality. Anoscopy is also usually performed to look for additional warts within the anal canal. Anoscope is a small instrument of few inches in length and is inserted within the anal canal. In women, vaginal examination may also be done to look for warts in vagina as well.

7. Treatment of Anal Warts

Untreated anal warts may grow and increase in size. It is, therefore, better to treat them and remove them. The treatment will depend on the size, number, and location of warts. For small warts, medical treatment is tried first. Treatment options are:

Topical medicines – putting cream or a liquid on to the warts (trichlorocetic acid, podophyllin, imiquimod).
Freezing (cryotherapy using liquid nitrogen).
Heat (electrocautery) using local anesthetic.
Laser treatmen, using local anesthetic.
Surgical Management of Anal warts

Surgery is considered when anal warts are large or are located in the internal anus where it is difficult to apply local creams. Surgery is performed to remove the warts and can be done as an outpatient basis. It means you do not have to stay overnight in the hospital.

Your doctor will explain the procedure. It is usually performed under local anesthesia but general anesthesia or spinal anesthesia may be given if warts are extensive. During the procedure, your doctor will use a special tool to remove the warts.

8. Follow Up

Your doctor will remove all the anal warts but the anal warts can recur, even without sexual intercourse. HPV can hide in tissues for many months and can again cause new anal warts to grow. In this instance, a repeat treatment or surgery will be needed.

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