Anal warts

Anal warts, or condyloma acuminate, are a very common sexually transmitted disease. The warts are caused by the human papilloma virus (HPV) which is very contagious. Well over 70% of all sexually active individuals have been infected with HPV at some point, although not all people infected with HPV will develop warts. There are over 200 types of this virus, with some being more likely to cause warts and some more likely to cause cancer than others.

What are the risk factors for anal condylomata?
HPV can be easily transmitted from person to person by direct skin contact during sexual activity.  Therefore, anyone who is sexually active is at risk for infection with HPV.  Anal penetration during sexual activity carries the risk of developing anal warts. The more sexual partners one has had, the higher the risk. While using a condom is always important, condoms may not always cover an area infected with HPV.  This virus can hide in your cells for months or even years before becoming visible growths or warts.

What are the symptoms of anal condylomata?
Anal warts first appear as small blemishes or bumps that can grow to very large cauliflower-like growths in and around the anus as well as on the genital area.  The warts usually do not cause pain or bleeding.

How are anal condylomata diagnosed?
An in-office examination by a colon and rectal surgeon will generally allow proper diagnosis of anal condylomata.  Anoscopy will generally be performed as part of the examination to evaluate for warts inside the anal canal, in addition to what can be identified externally.

How are anal condylomata treated?
All anal and genital warts should be treated.  If warts are left untreated they may grow larger or multiply.  It is believed that you are more contagious to others when you have the warts present.  People with HPV or anal warts also have a higher risk of developing anal cancer.

If warts are small they can often be treated in the office with bichloroacetic acid, cauterization (burning), or removal.  If the warts are multiple or extensive, they may need to be removed in the operating room under sedation in an outpatient surgery center.  Topical creams such as Aldara or 5-FU may be used in addition to surgery or to treat patients with recurrent warts.

What is the prognosis after treatment?
The recurrence rate of developing new warts is very high, so close surveillance is mandatory.  This occurs because viruses that cause warts can lie dormant in tissues that appear normal.  Frequent evaluations are recommended so that if the warts recur they can be treated in the office with much less pain and a quicker recovery.

The human papilloma virus (HPV) is believed to be the cause of anal cancer.  It is hypothesized that pre-cancerous anal cells can lead to anal cancer.  Anyone who has ever had anal warts, HPV, or anoreceptive intercourse, is at an increased risk of developing anal cancer throughout their lifetime.  Once the warts have been eradicated, yearly anorectal evaluations are recommended surveillance to detect any pre-cancerous changes in the anal canal and prevent anal cancer.

Regardless of which form of therapy is chosen by the patient and physician, it is important to understand that recurrences are common.  Close follow-up is indeed necessary.  It is also recommended that all the patient’s sexual partners be screened and evaluated.  The status of the immune system plays an important role in the ability to rid the warts and potential for recurrence.  Patients should inform their physician if there are factors that may alter the immune system, such as renal disease, cancer, HIV, hepatitis and diabetes.