An Overview of Anal Warts

In many cases, anal warts can be removed with topical therapy or surgery

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Condyloma acuminata is the medical term for a type of wart that can develop in and around the anus. Anal warts are caused by a common type of virus, the human papilloma virus (HPV). Many people will not know that they have anal warts, as there may not be any symptoms. However, it is important to have anal warts diagnosed and either treated or followed in order to prevent or be aware of their becoming more numerous and/or growing larger. Most anal warts are not associated with cancer but a small percentage are, which is a good reason to have them examined and evaluated by a doctor.

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Symptoms

In many cases, anal warts will not cause any symptoms. If they are small and not causing any symptoms, anal warts may not be noticed until going for a routine doctor’s visit for another reason. If an anal wart causes bleeding, it might be mistaken for a hemorrhoid. However, anal warts and hemorrhoids are treated differently and are from different causes. Bleeding from the anal area (even a little bit that only shows up on the toilet paper) should always be checked out by a doctor in order to get the right diagnosis and treatment. When there are symptoms of anal warts, these can include:

  • A feeling of a lump or bump in the anal area
  • Bleeding
  • Itching
  • Mucus discharge

Symptoms of anal warts may not develop for years after being infected, making it hard to know when you might have been exposed to the virus.

Causes

Anal warts are caused by the human papilloma virus. HPV is a common virus that is spread from person to person, usually through sexual activity (even skin-to-skin genital contact). Most adults are infected with one or more strains of HPV at some point during their lives. According to the World Health Organization, there are more than 100 strains of HPV and 14 are known to be associated with cancer (these strains are called high-risk type).

There is a vaccine available that protects against two strains of HPV (called 16 and 18). However, the vaccines can not treat current infections with the virus and it does not protect against every possible strain. It’s currently recommended that adolescents receive the HPV vaccine prior to engaging in sexual activity because this offers the best chance of avoiding infection. Adults who are sexually active have likely already been exposed to HPV, even if they have had only one partner.

HPV types 6 and 11 are most often (about 90% of the time) associated with the development of anal warts. It’s important to keep in mind that these strains are not known to cause cancer. Other HPV strains, including 16, 18, 31, 33, and 35 may also cause anal warts. While types 16 and 18 are HPV strains associated with cancer, having warts does not mean that there is anal cancer present.

Diagnosis

A primary care provider, gynecologist, gastroenterologist, or colon and rectal surgeon are all physicians that may diagnose anal warts. A diagnosis of anal warts is usually done through a visual inspection. That means that a physician will look at the anal area to identify the lesions (bumps or growths). In most cases, looking at the growths will be enough to determine that they are anal warts. In that case, treatment to remove them might start right away, especially if the warts are not very numerous or large and don’t require removal through surgery.

However, if there is a question about the warts, such as if they look different than a typical anal wart in some way, it may be necessary to take a biopsy. A biopsy is a small piece of tissue that is taken from the wart in order to look at it under a microscope or test it in other ways. For people who are immunocompromised because of an underlying medical condition or because of medications that suppress the immune system, a biopsy might also be considered necessary.

It might also be part of the exam to look inside the anus and/or the vagina to determine if there are any internal warts. For those that are in the anus, they might be found through the use of a tool called an anoscope. An anoscope is inserted into the anus to look inside and find any abnormalities, such as anal warts. For women, part of the diagnosis process might include a pelvic exam.

Treatment

Anal warts tend to spread, becoming more numerous, and grow larger. For this reason, in most cases the recommendation is to treat them through removal.

Additionally, it’s important to understand that untreated anal warts which are caused by the type of HPV that are associated with cancer may lead to an increase in the risk of anal cancer. (However, keep in mind that anal cancer is rare and most anal warts are not caused by the HPV strains that are known to be cancer causing. ) All of these factors should be taken into account when deciding how to proceed in the treatment of anal warts. Making a choice on which treatment (or watchful waiting) should be decided by the patient and the physician together.

There are a few different ways in which anal warts can be treated, with the ultimate goal being in their removal. Anal warts might be treated with one of several different types of substances that are applied to the skin, either at home or by a physician in their office, or with surgery. Over-the-counter wart removers are not suitable for use on anal warts.

Topical treatments. For smaller warts that are located on the surface of the skin around the anal area, and not actually in the anus, there are topical treatments that may help avoid the need for removal with surgery. In some instances, topical treatments are given by prescription and can be applied to the warts at home. In other cases, where warts may be larger or more numerous or where treatment at home isn’t possible, a topical therapy might be given by a physician either in their office or in another medical setting.

Topical treatments that are used to remove anal warts include:

  • Aldara, Zyclara (imiquimod). This is a cream that is thought to work by increasing the immune system’s ability to attack the wart. It may irritate the skin, so it should only be applied to the affected area. It may make condoms or a diaphragm less effective and therefore shouldn’t be used prior to sexual contact. It may cause minor burning or discomfort in the area applied.
  • Condylox (podofilox). Condylox is a gel that’s applied to the anal warts at home. A physician will give specific directions, but it might be used twice a day for three days, and then repeated in a week if needed. It may cause discomfort, inflammation, and burning in the area where it is applied.
  • Bichloroacetic acid (BCA) or trichloroacetic acid (TCA). These treatments work by destroying the protein in the cells of a wart when they are applied. They are used in the office by a physician. They can cause a burning sensation or discomfort but most people can go back to their normal activities after treatment.
  • Podocon (podophyllin). Podocon is a treatment that is given in a physician's office. It is applied directly on the warts. Side effects may include burning and discomfort. The doctor will advise when the solution can be washed/wiped off the skin, which might be anywhere from one to four hours.
  • Cryotherapy. Another type of topical treatment that is used to remove anal warts is liquid nitrogen. When liquid nitrogen is applied to the warts, it freezes the skin. The process of freezing/thawing may be repeated during a treatment session for larger or thicker warts. Side effects may include discomfort, swelling, and skin irritation. The dead skin from the warts may slough off after the treatment.

Surgery. Warts that are larger or are located internally (inside the anal canal) might require surgery to remove them. Surgery is done with the use of a topical numbing agent, a general anesthetic, or a spinal anesthetic, either in office or in the operating room due to the severity of the case. The type of anesthetic used will depend on how many warts there are and their size, as well as other factors as determined by the physician. Warts might take one or more treatment sessions to remove them, especially if they are numerous or large. The surgeon will make a recommendation to use surgery alone or a combination of surgery and topical agents based on how many warts there are and where they are located. A surgeon will also be sure to carefully look inside the anal canal for any warts that are located in that area, so those can be removed as well.

Watchful waiting. Another alternative to removal of the warts is to keep an eye on them and see if they change over time. In some instances, which are estimated to be between 40 and 60% of cases, anal warts may go away on their own in about a year. People who have anal warts may choose to have them removed for cosmetic purposes or because it can be upsetting to know that they are there, which are valid reasons that should be discussed with a health care provider. However, the cost involved with medications and/or surgery and the associated discomfort are other reasons that might be considered in favor of watchful waiting. Not treating or delaying treatment are potential choices and they should be discussed along with other treatment options.

Treatment After Care

Treatment can lead to discomfort, whether that is from topical agents or from surgery. A physician may recommend some over-the-counter pain medications that can help with discomfort. For more invasive removals, other pain medications might be prescribed because the discomfort may last for a few days. Removal methods with topical treatments may not require any time off from work or school. Surgical treatment, however, depending on how extensive it is, might mean a recovery period of a few days to a few weeks.

For irritated skin, reducing the potential for further discomfort may include avoiding activities that involve pressure on the anal area, such as biking or sitting for long periods of time. 

In some cases, using a sitz bath, where the anal area is immersed in a bath of warm water may be recommended. A plastic sitz bath that is placed over the toilet can be purchased in many drug stores or medical supply stores or a bathtub with a few inches of water in it might also be used.

Follow-Up

It’s important to note that while anal warts can be treated, in most cases successfully, removal is not the same as a cure. In some cases, anal warts may recur after treatment. This could be because the underlying cause, which is the HPV virus, has not cleared. Recurrent warts may be treated again. For this reason, it’s important to keep follow-up appointments with a physician to assess how the area is healing and to check for any new warts.

A discussion of how HPV may be transmitted to future sexual partners may be part of follow-up care. Besides being vaccinated against HPV, using barrier methods, such as latex condoms or dental dams, during sex is also recommended to help prevent the spread of the virus. Condoms aren’t completely effective, however, because they don’t cover all of the areas that can be affected by HPV.

A Word From Verywell

Finding out that one has anal warts can be distressing. While the cause of warts is the HPV, it’s important to remember that these viruses are extremely common. They are most frequently passed from person to person via sexual contact but most adults have one or more strains at some point during their lives. What’s important is to get the anal warts evaluated by a physician and treated/removed if that is the desired course. There should be no judgment or stigma from health care professionals regarding either the infection with HPV or the anal warts. 

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Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Centers for Disease Control and Prevention. Genital HPV infection fact sheet. Updated August 20, 2019.

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