Anal Warts

diagram of anal warts

 


DEFINITION

Anal warts (Condyloma acuminate) are small or large growths located around or inside the anus. Occasionally, anal warts will develop on the skin surrounding the genital area.

They can begin as the size of a pinhead and grow to be pea-sized. Their size can have an impact on treatment.

Most anal warts are flesh-toned or brown in color. Their texture resembles a head of cauliflower. Warts can form in groups or a single blemish. They can also grow inside the anal canal.

Anal warts do not usually produce pain or discomfort. However, there are instances where anal warts lead to symptoms of pain, bleeding or a mucus discharge.

CAUSES

Anal warts are a direct result of the human papilloma virus (HPV). This is the most common sexually transmitted disease in the U.S. Highly contagious, most sexually active people in the U.S. develop HPV and anal warts.

It’s important to note anal intercourse is not the only type of exposure that leads to anal warts. In fact, HPV can be exposed to the anus and surrounding areas from hand contact or secretions from a sexual partner.

Additionally, it is possible to have been exposed to HPV years ago, but just now develop anal warts. It can take anywhere from six months to a year for anal warts to grow after exposure to HPV.

RISK FACTORS

Having unprotected sex may increase the risk of anal warts. The risk increases if you or your partner have not recently been checked for STDs.

Additionally, having a chronically weakened immune system from certain medications, inflammatory bowel disease, or HIV may increase the likelihood of developing anal warts.

SYMPTOMS

The warts are typically painless, so many patients do not know they have them. At first, you may notice soft, brown spots near the anus. Other symptoms of anal warts typically include:

  • Itching around the anus

  • Anal bleeding

  • Mucus discharge or mass located around the anus

  • Moisture in the anal canal

If you experience any of these symptoms, talk with your doctor, or visit the colorectal specialists here at West Valley CRS.

PREPARING FOR AN APPOINTMENT

Seeing a doctor for any medical issue can be nerve-wracking. The same is especially true for anything regarding your private area. Prepare for your appointment by making a list of questions for your doctor:

  • Do I have anal warts?

  • What causes anal warts?

  • Can I pass them to my partner?

  • What are the treatment options and are they painful?

Making a list of your medical history, sexual activities, and symptoms will aid in the diagnostic process.

You should be prepared to answer personal questions regarding your sexual activity. Honesty will help your doctor determine the best course of action.

Your doctor might also suggest getting tested for other STDs. Understand that having an STD does not reflect on your personal behavior regarding sexual activities. Most STDs can also be passed along in a non-sexual manner.

DIAGNOSING ANAL WARTS

Most doctors begin the diagnosis of anal warts with patient history. They look for any previous experience with STDs.

They check the area around the anus for lumps. They will also look over the entire genital area. In some cases, your doctor may want to examine the anal canal. This is done with a small tool called an anoscopy.

If signs of warts are found, your doctor will move on to treatment options.

TREATING ANAL WARTS

It is possible for anal warts to become larger and multiply if left untreated. The virus in your system can create more warts or increase the size of your current warts.

Although rare, untreated anal warts may also lead to anal cancer.

Doctors prescribe treatments based on the size, location, and volume of the anal warts. Treatment for anal warts typically includes:

  • Topical medication: creams that work best on small, external anal warts. Some medications simply make the anal wart shed off of the skin. Others slowly freeze or burn them off.

  • Cryotherapy: this treatment uses liquid nitrogen to freeze the wart

  • Fulguration: a laser is used to burn the wart off

  • Surgical excision: typically used for internal warts, as they do not respond to topical creams

In some cases, a combination of the previously mentioned treatment options will be considered to remove anal warts. The presence of different sized warts makes a combination of treatments necessary. Your doctor may use cryotherapy to remove the larger warts then use creams to remove smaller ones.

TYPES OF MEDICATION FOR ANAL WARTS

There are several medicated creams available to treat anal warts. Your doctor will use any of the following to get rid of the warts:

  • Imiquimod (Aldara, Zyclara): boosts your immune system. Can weaken condoms and irritate your partner’s, so avoid sexual activity while in use. May cause redness of skin and rashes.

  • Podophyllin and podofilox (Condylox): plant-based resin. Destroys the tissue of the wart. Must be applied by your doctor. Can cause mild skin irritation, soreness, and pain.

  • Trichloroacetic acid (TCA): a chemical treatment that burns off warts. Can be used internally. May cause skin irritation, soreness, and pain.

  • Sinecatechins (Veregen): used only for external warts. May cause mild reddening of the skin, itching, burning, or pain.

Do not use over the counter medications that treat general warts. These medications are meant for use on tougher skin. Using them on the thinner, moist skin of the anus causes more harm to the area.

IS ONE TREATMENT ENOUGH?

Viruses linger in the body for some time after exposure. Because of this, anal warts can return. You may need several treatments over your lifetime once anal warts emerge. Unfortunately, there is no “cure” for anal warts or HPV.

You may require multiple treatments to get rid of your current warts. The size and volume of the warts have an impact on the number of treatments you need.

Smaller warts may come off with the first or second treatment. Larger warts may need multiple treatments. The more anal warts you have, the more treatments you will need.

Even if your warts are completely removed, it is vital to have follow-up appointments. Untreated warts can increase your risk of anal cancer.

Removing them as soon as possible will help reduce this risk. Catching the warts while they are still small will also reduce the number of treatments you will need.

AFTERCARE

In many cases, the post-treatment prognosis is only slight discomfort. You may be sore for a time. Your doctor may have you take sitz baths to aid in the healing process.

Mild treatments require less recovery time. Surgical treatments may require a few days of recovery.

WHY ARE ANAL WARTS SO DANGEROUS?

HPV can cause anal cancer. Over 20 million people in this country have HPV and most do not know it. Many of these infections progress to anal cancer if left undiagnosed or untreated.

They are visible to the patient on the outside of the anus but are frequently present inside the anus as well, making diagnosis and treatment mandatory.

Some men are more likely to develop HPV-related diseases than others:

Men who have sex with men are about 17 times more likely to develop anal cancer than men who only have sex with women.

Men with weakened immune systems are more likely than other men to develop anal cancer. HIV is one possible cause of a weakened immune system. Men with HIV are also more likely to get severe cases of genital warts that are harder to treat.

PREVENTING ANAL WARTS

Prevention is as simple as abstaining from sexual activity. However, there are other options:

  • Limit your sexual activity to one partner. Having multiple partners increases the risk of exposure to HPV, causing anal warts.

  • Get tested for STDs. Have yourself and your partner checked for STDs on a regular basis. If you find that you or your partner have an STD or HPV, abstain from sexual activities.

  • Use condoms and practice clean hygiene when engaging in sexual activity. As previously stated, anal warts can result from contact with hands.

MANAGEMENT OF SEXUAL PARTNERS

Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can easily be passed on.

Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.

Partner(s) might benefit from a physical examination to detect genital warts and tests for other STDs. No recommendations can be made regarding informing future sex partners about a diagnosis of genital warts. The duration of viral persistence after warts have resolved is unknown.

Although genital warts are common and usually benign, some persons might experience considerable psychosocial impact after receiving this diagnosis

ABOUT HPV VACCINES

There are many HPV vaccines in the medical world today. HPV exists in different forms. Some vaccines only prevent a few of these forms. Others prevent most, if not all, types of HPV.

Typically, you receive the vaccine in three shots over a six month period. Getting vaccinated will not cure current HPV in your system. However, it will help you build an immunity to other types.

Most vaccines do not have serious side effects. The most common side effect is soreness in the arm from the injection site. They are proven safe and effective treatments for HPV, according to the CDC.

The common HPV vaccines are Gardasil 9, Gardasil, and Cervix. Doctors recommend getting the vaccines before you are sexually active. This increases your resistance to strains of HPV.

An HPV vaccine will reduce the risk of developing anal warts and other related STD symptoms.

THE LINK TO ANAL CANCER

Anal warts are a common symptom of HPV. The virus causes 90% of developments of anal cancer. Allowing anal warts to grow can increase the risk of anal cancer.

Anal cancer is an uncommon form of cancer. It only affects one in 600 people in the U.S. However, it can lead to death in rare cases.