Anal Warts: Definition and Patient Education
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Anal Warts

What are anal warts?

Anal warts are small warts that can occur inside and around the anus. The condition is also called condyloma acuminata. Anal warts are a form of genital warts.

The warts do not cause discomfort or pain in most cases. They can become irritating if they grow large enough, however, and might itch or bleed. People with anal warts may not even know that the warts exist. Anal warts may be only in one place, or may spread to different parts of the genitals and anus over time.

What are the symptoms of anal warts?

Symptoms

In many cases, anal warts may remain unnoticed. They often occur without pain or discomfort.

Anal warts are found inside and around the area of the anus. They start as small bumps that may be no larger than the head of a pin. Initially, they may be too small to be noticed. They can develop a cauliflower-appearance as they grow, or when several are clustered together. They may be flesh-colored, yellow, pink, or light brown.

The virus that causes anal warts also causes genital warts. Warts may occur on other parts of the body at the same time. Genital warts in women may appear on the vulva, vagina, or cervix. Genital warts in men can develop on the penis, scrotum, thighs, or groin. They may also grow on the mouth or throat of an infected person.

Other symptoms of anal warts are rare but can include itching, bleeding, or discharge from the anus. An infected person may also have the sensation of having a lump in the anal area.

What causes anal warts?

Causes

Genital warts are caused by human papillomavirus (HPV). HPV is a sexually transmitted infection (STI). In young people, HPV may go away on its own and might not cause any signs or symptoms. The virus can, however, remain and cause genital warts. Some types of HPV cause genital warts and others may lead to cancer, but the type of HPV that causes anal and genital warts does not lead to cancer.

Transmission of HPV can occur even if warts are not visible. It is spread by direct contact with the anus, mouth, penis, or vagina of an infected person. Intercourse is not necessary to spread the infection. It can be transmitted by skin-to-skin contact.

Genital warts can be spread easily. It is most commonly spread through anal and vaginal sex according to the Centers for Disease Control and Prevention (CDC). The CDC also states that nearly all men and women who are sexually active get HPV at some point in their lives.

Read more: Human papillomavirus infection »

Who is at risk for anal warts?

Risk Factors

You are at an increased risk for contracting and spreading anal warts if you:

  • participate in unprotected sex with more than one partner
  • participate in anal intercourse
  • have had sex or intimate contact with an infected person
  • have sex at an early age
  • have an immune system that is compromised by illness or medication

However, you can get HPV even if you are only with one partner, and condoms do not fully protect against HPV. It is very common, especially in young people, to be exposed to HPV.

How are anal warts diagnosed?

Diagnosis

A doctor can diagnose anal warts by visual examination. Some doctors apply acetic acid (vinegar) to the bumps during the examination. This causes the bumps to turn white and become more visible. However, this is not necessary to diagnose anal warts.

An examination for anal warts involves an internal examination with an anoscope to look for warts inside the anal canal. Your doctor may also conduct a full examination of the pelvic region to look for other forms of genital warts. This may include a Pap smear for women.

Diagnosis also can be made with a biopsy of the warts. This may be used to confirm a diagnosis when warts don’t respond to initial therapy.

How are anal warts treated?

Treatment

The choice of treatment depends on the number and location of warts, patient preference, and provider experience.

Topical medications

Treatment with a topical medication may be adequate for warts that are very small and limited to the outer area of the anus. In this case, a prescription medication for anal warts must be used. Over-the-counter wart removers are not intended for use in the anal or genital area.

Some medications to treat anal warts are applied by a doctor in the office. Others you can apply yourself at home. Regimens typically last for several weeks or more.

Topical creams include:

  • imiquimod (Aldara, Zyclara)
  • podofilox (Condylox)
  • podophyllin (Podocon)
  • trichloroacetic acid (TCA)
  • bichloroacetic acid (BCA)

Surgical options

Surgical options may be more effective for larger warts that don’t respond to topical treatments or anal warts located inside the anal canal. Surgical treatment is typically performed on an outpatient basis. This means you can go home the same day as the surgery.

The surgeon will use a special tool to cut off the warts. You will normally be given a local anesthetic. General or spinal anesthesia may be necessary if the number and location of anal warts is extensive.

Other treatment options

Additional treatment options depend on the severity and location of anal warts. These other treatments include:

  • Cryotherapy: Liquid nitrogen is used to freeze the warts. After freezing, the wart falls off.
  • Electrocautery: An electric current is used to burn off the warts.
  • Laser treatments: Energy is transmitted from an intense light. This technique is often limited to use for difficult cases.

Most patients are uncomfortable for a few days after surgical treatment of anal warts. Pain medication may be prescribed. Your ability to work or perform normal activities varies depends on the extent of your treatment.

What’s the long-term outlook for anal warts?

Outlook

If warts are extensive, treatment may be administered in stages. Recurrent warts are common. The virus can remain dormant in concealed tissues, only to appear months later with the growth of a new wart. Follow-up visits and treatments may be necessary for several months to ensure that no new warts exist. Warts may be harder to get rid of if you have a suppressed immune system, like with HIV.

How can anal warts be prevented?

Prevention

Anal warts can come back even after seemingly successful treatment. Your doctor may recommend reevaluation for recurrent warts at regular intervals after treatment.

There is no good test for HPV screening, and currently HPV testing is not routinely recommended.

The CDC recommends that boys and girls get vaccinated for HPV at age 11 or 12 in order to be immune before exposure.

You can reduce your risk of infection with HPV by abstaining from sexual contact, using condoms, or limiting the number of sexual partners. However, condoms do not protect completely from HPV, and it is possible to get HPV with even one sexual partner. HPV is very common and most people get this virus at some point in their lives.

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