Anal Warts: Causes, Symptoms, Treatment and Prevention

WHAT ARE ANAL WARTS?

Anal warts (also called "condyloma acuminata") are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area. They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow quite large and cover the entire anal area. They usually appear as a flesh or brownish color. Usually, they do not cause pain or discomfort and patients may be unaware that the warts are present. Some patients will experience symptoms such as itching, bleeding, mucus discharge and/or a feeling of a lump or mass in the anal area.


WHAT CAUSES ANAL WARTS?

Warts are caused by the human papilloma virus (HPV), which is transmitted from person to person by direct contact. HPV is considered to be the most common sexually transmitted disease (STD). You may be upset when you are given this diagnosis and it is important to note that anal intercourse is not necessary to develop anal condylomata. Any contact exposure to the anal area (hand contact, secretions from a sexual partner) can result in HPV infection. Exposure to the virus could have occurred many years ago or from prior sexual partners, but you may have just recently developed the actual warts
HOW ARE ANAL WARTS DIAGNOSED?

Although potentially sensitive and difficult to talk about, your doctor may inquire as to the presence or absence of risk factors to include a history of anal intercourse, a positive HIV test or a chronically weakened immune system (medications for organ transplant patients, inflammatory bowel disease, rheumatoid arthritis, etc).

Physical examination should focus primarily on the anorectal examination and evaluation of the perineum (pelvic region) that includes the penile or vaginal area to look for warts.  Digital rectal examination should be performed to rule out any mass.  Anoscopy is typically performed to look within the anal canal for additional warts.  This involves inserting a small instrument about the size of a finger into your anus to help visualize the area.  Speculum examination may also be performed to aid in vaginal examination in women.

CAN I PREVENT MYSELF FROM GETTING WARTS?

The safest way to protect yourself from getting exposed to HPV or any other STD is to use safe sex techniques. Abstain from sexual contact with individuals who have anal (or genital) warts. Since many individuals may be unaware that they suffer from this condition, sexual abstinence, condom protection or limiting sexual contact to a single partner will reduce the contagious virus that causes warts. However, using condoms whenever having any kind of intercourse may reduce, but not completely eliminate, the risk of HPV infection, as HPV is spread by skin-to-skin contact and can live in areas not covered by a condom.

The U.S. Food and Drug Administration (FDA) has approved the vaccine Gardasil (vaccine against certain types of HPV that more commonly cause cervical and other HPV-related cancers) in certain patients age 9 to 26 prior to HPV exposure (sexual activity) to prevent the development of HPV- related cancers and associated precancerous lesions (called dysplasia).  Your physician may recommend you to be evaluated if you would potentially be a candidate for this vaccine.  However, the vaccine’s role to prevent anal warts and anal cancer is unknown.

DO THESE WARTS ALWAYS NEED TO BE REMOVED?

Yes. If they are not removed, the warts usually grow larger and multiply. Left untreated, warts may lead to an increased risk of anal cancer in the affected area. Fortunately, the risk of anal cancer is still very rare.

WHAT TREATMENTS ARE AVAILABLE FOR ANAL WARTS?

Topical Options for Treating Warts

Medications: If warts are very small and are located only on the skin around the anus, they may be treated with a topical medication in the office and sometimes at home. Common topical medications applied directly to the warts are podophyllin, trichloroacetic acid and bichloroacetic acid. These office treatments do not require anesthesia and only take a few minutes to apply to the warts. Minor burning or discomfort may be experienced after treatment and, thus, most patients can return to work after the procedure. Your physician will recommend when to wash off the medication after treatment. Topical agents that can be applied at home on small warts include Imiquimod or 5-fluorouracial (5-FU), although how well they work to eliminate anal warts completely is unknown. Side effects include skin irritation, burning and painful ulcerations of the skin. If you develop severe side effects, immediately stop using the cream and contact your physician.

Cryotherapy: Anal warts may also be treated in the physician’s office by freezing the warts with liquid nitrogen. Similar recovery as the topical agents mentioned above is expected.

SURGICAL OPTIONS FOR TREATING WARTS:

Surgery provides immediate results, but must be performed using either a local anesthetic - such as Novocaine - or a general or spinal anesthetic, depending on the number and exact location of warts being treated. Fulguration (burning), surgical excision (removal), or a combination of both, are used to treat larger external and internal anal warts.

MUST I BE HOSPITALIZED FOR SURGICAL TREATMENT?

Surgical treatment of anal warts is usually performed as outpatient surgery.

HOW MUCH TIME WILL I LOSE FROM WORK AFTER SURGICAL TREATMENT?

Most people are moderately uncomfortable for a few days after treatment, and pain medication may be prescribed. Depending on the extent of the disease, some people return to work the next day, while others may remain out of work for several days to weeks. Pain, discomfort and slight bleeding are expected in the recovery period and may last at some level for several weeks. Excessive bleeding is abnormal and your physician should be informed immediately if you experience large amounts of bleeding.  Clear, yellowish or blood tinged drainage or moisture will be expected for days to weeks after the procedure. Placement of a pad and frequent dressing changes will help lessen the moisture and itching associated with the drainage.

WILL A SINGLE TREATMENT CURE THE PROBLEM?

When warts are extensive, your surgeon may wish to perform the surgery in stages.  Additionally, recurrent warts are common in over 50% of patients. The virus that causes the warts can live concealed in the skin that appears normal for several months before another wart develops. As new warts develop, they usually can be treated in the physician's office. Sometimes new warts develop so rapidly that office treatment may not be possible or could be quite uncomfortable. In these situations, a second, and occasionally, third outpatient surgical visit may be recommended.

HOW LONG IS TREATMENT USUALLY CONTINUED?

Follow-up visits are necessary at frequent intervals for several months after the last wart is observed to be certain that no new warts occur. It is important to see your physician on a routine basis as recommended by her/him or if you notice any new lesions or new symptoms (pain, rectal bleeding).

WHAT CAN BE DONE TO AVOID GETTING THESE WARTS AGAIN?

In some cases, warts may recur repeatedly after successful removal, since the virus that causes the warts often persists in a dormant state in the skin. Discuss with your physician how often you should be examined for recurrent warts.

To prevent further spread of HPV, safe sex practices are recommended and include sexual abstinence, condom protection or limiting sexual contact to single partner. As a precaution, sexual partners ought to be checked for warts and other sexual transmitted diseases (STD), even if they have no symptoms. Your physician may also recommend that you be tested for other STDs.

Post a Comment

0 Comments