What Are Anal Warts?

Anal warts are small growths on the skin inside and around the anus. They are usually painless, but they can itch or bleed and may have a cauliflower-like appearance.

A healthcare provider can diagnose anal warts by visual examination. They may use a tool called an anoscope or a pelvic exam (for women and people assigned female at birth).

Doctors can remove anal warts by using liquid nitrogen, cauterization or surgical removal. But close follow-up is important.

Causes

Anal warts (also called condyloma acuminata) are growths that develop on the skin around and inside the anus and the lower rectum. They are caused by human papillomavirus (HPV), the most common sexually transmitted disease.

HPV is spread by direct contact between people, including hand-to-hand and skin-to-skin genital contact. It is the most common cause of sexually transmitted warts, but anal HPV can also occur without having any anal sex. In fact, many people who have anal warts were exposed to HPV years before they developed them.

Most anal warts are caused by strains of HPV that are not associated with cancer. However, some strains can change genetically and lead to more serious health problems, including anal cancer.

The time from when a person is first infected with HPV to when anal warts form can be one to six months. During this period, the virus is present in the anal canal but not growing. If a woman is pregnant, anal warts may grow more quickly and the virus can spread from the anus to other parts of the body, such as the penis or vagina.

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Treatment of anal warts depends on the location, number and size of warts. Small warts are often treated in the office with podophyllin or bichloracetic acid solutions that are applied directly to the warts and cause them to slough off. In cases of a large number of anal warts, surgical treatment at a hospital or surgery center is sometimes necessary.

Symptoms

Symptoms of anal warts may not be obvious, especially if they are small or on the skin around the anus. However, if they grow larger or start to cluster together, they are likely to cause itching or burning in the anal area.

If the anal warts are small, they can be treated with podophyllin or bichloracetic acid, solutions applied directly to the warts to cause them to slough off. This is an office procedure that usually takes just a few minutes. Ointments are sometimes prescribed to be used at home, in addition to the treatment given in the doctor’s office. If anal warts are large or internal, a doctor can use liquid nitrogen to freeze them, causing them to fall off. They can also use acid solutions, such as trichloroacetic acid or bichloracetic acid, to cauterize the wart tissue. If anal warts are numerous, a doctor may choose to remove them surgically. This is done as a same-day procedure in a hospital or surgery center.

Anal warts, also known as condylomata acuminata, are caused by the human papilloma virus (HPV). They appear mainly in the perianal or genital areas, inside and around the anus. If HPV is left untreated, anal warts tend to grow larger and spread to other parts of the body. They can even transform into cancer of the anus or genital tract.

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Diagnosis

A healthcare provider can diagnose anal warts through a physical exam. They might inspect the area with a special tool called an anoscope to check inside your anus for warts, or they might perform a pelvic exam for women and people assigned female at birth (AFAB). Your healthcare provider may also ask you about any symptoms you have. For example, bleeding from the anal canal might suggest that you have hemorrhoids, but it could also be a sign of anal warts.

If your anal warts are small and only on the outside of your anus, your healthcare provider may recommend that you use over-the-counter wart removers. These can be bought at most drugstores and are safe to use if you follow the directions on the label.

Your doctor might also want to take a biopsy, in which they remove a sample of the wart for testing in the laboratory. This is usually only done if your anal warts don’t respond to other treatments or they are making you uncomfortable.

If you have anal warts, it’s important to get them treated as soon as possible. If you don’t, they can grow large and become painful. They can also spread to other parts of your body if you come into contact with someone who has them. It’s especially important to get them treated if you’re pregnant, as genital warts can spread through sexual activity and skin-to-skin contact.

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Treatment

Anal warts are caused by the human papillomavirus (HPV). HPV is an extremely common sexually transmitted virus. The virus can live in your body for one to six months and then become active, causing warts. There are many different types of HPV that can cause warts on the hands, feet, genital area, or anus.

Most often, anal warts are small and can be treated with medication. There are topical medications that can be applied in the office and at home, such as podophyllin, trichloroacetic acid, or bichloroacetic acid. These medicines need to be carefully and precisely applied by a physician in order to avoid injury to surrounding healthy tissue.

If warts are extensive, don’t respond to treatment, or are located inside the anus canal, they may need to be removed surgically. This can be done in the office under a local anesthetic or, for extensive surgery, in a hospital or surgery center.

Occasionally, anal warts develop abnormal changes under the microscope that look like pre-cancerous cells. These are called low- and high-grade anal intraepithelial neoplasia (LGAIN/HGAIN) or anal dysplasia. They can grow and spread rapidly if they are not treated. Your physician will discuss with you whether LGAIN/HGAIN is a reason to treat your anal warts now, or if watchful waiting would be appropriate in your case.

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