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.

In most cases, the warts don’t cause discomfort or pain. However, they can become irritating if they grow large enough, and might itch or bleed. If no symptoms occur, people with anal warts may not even know they have them.

Anal warts may occur only in one spot, or may spread to different parts of the genitals and anus over time.

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-like appearance as they grow, or when several are clustered together. Warts may be peach-colored, yellow, pink, or light brown, and may blend in with your skin color.

Anal warts often occur without pain or discomfort. Other symptoms of anal warts are rare but can include itching, bleeding, or discharge from the anus. A person with anal warts may also feel like they have a lump in their anal area.

Warts may occur on other parts of your body at the same time that you have anal warts. 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.

Warts may also grow on the mouth or throat of someone with HPV. Oral sex with a person who has genital warts, or deep kissing a person with throat warts can also lead to infection.

Genital warts, including anal 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. However, the virus can linger in the body 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 generally lead to cancer.

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

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

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

  • have unprotected sex (are not using barrier protection, such as a condom or dental dam)
  • have multiple sex partners
  • have anal intercourse
  • have had sex or intimate contact with a person with HPV
  • have sex at an early age
  • have an immune system that is compromised by illness or medication

However, you can get anal warts even if you only have one sexual partner, and condoms don’t fully protect against them.

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 exam with a tool called an anoscope to look for warts inside the anal canal. Your doctor may also do a full exam of your pelvic region to look for other forms of genital warts. For women, this may include a Pap smear.

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

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. Be sure to avoid using them on anal warts.

Some medications to treat anal warts are applied by a doctor in their 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)

Other treatment options

Other treatment options may be used depending on the severity and location of anal warts. These treatments include:

  • Cryotherapy. This procedure uses liquid nitrogen to freeze the warts. After freezing, the warts fall off.
  • Electrocautery. In this procedure, doctors use an electric current to burn off the warts.
  • Laser treatments. Laser therapy uses energy transmitted from an intense light. This technique is typically used only for difficult cases.

If warts are extensive, treatment may be given in stages. And in some cases, surgery may be needed.

Surgical options

Surgical options may be more effective for larger warts that don’t respond to other treatments, or for 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.

During the procedure, the surgeon will use a special tool to cut off the warts. You’ll likely be given a local anesthetic. General or spinal anesthesia may be needed if the number and location of anal warts is extensive.

After electrocautery, cryotherapy, or surgical treatment of anal warts, most people are uncomfortable for a few days. To help ease the discomfort, your doctor may prescribe pain medication. Your ability to work or perform normal activities varies depends on the extent of your treatment.

Anal warts are not life threatening, and in most cases, don’t turn into cancer. However, HPV can linger in your body, causing anal warts to recur.

To watch for a recurrence, schedule follow-up appointments with your doctor. This is especially important in the first three months after treatment.

HPV testing is not routinely recommended, but an HPV vaccine is available. It can be given to individuals until the age of 26 years. The CDC recommends that individuals get vaccinated for HPV at age 11 or 12 so that they’ll be immune to the virus before being exposed to it through sexual activity.

Other ways to help prevent the transmission of HPV and anal warts include:

  • abstaining from sexual contact
  • using barrier methods such as condoms or dental dams
  • limiting your number of sexual partners

However, barrier methods don’t protect completely from HPV, and it’s possible to get HPV with only one sexual partner.

Anal warts can be uncomfortable and in rare cases painful, but they are treatable. If you think you have anal warts, your first step should be to see your doctor. They can examine you, confirm a diagnosis, and recommend the treatment plan that may be best for you.