Anal warts are small growths that appear around and inside the anal area. The human papillomavirus (HPV) causes anal warts, which doctors call condylomas.

The Centers for Disease Control and Prevention (CDC) estimate that high-risk HPV strains cause around 10% of anal wart cases.

These strains are also more likely to cause anal cancer. However, it is rare for anal warts to indicate the presence of cancer.

Anal warts do not always cause symptoms. A person may notice small bumps and growths around the area, as well as some bleeding.

In this article, we explain how to identify anal warts and when to see a doctor. We also describe the treatment options.

a doctor discussing anal warts. Share on Pinterest
Anyone who may have anal warts should see a doctor.

In most cases, anal warts are painless, and a person may be unaware that they have them. If symptoms do occur, they may include:

  • bleeding
  • bumps near or inside the anal opening that are usually light brown or skin-colored
  • growths resembling small cauliflowers around the anus
  • mucus-like discharge from the bumps
  • sores
  • the sensation of having a lump or something similar in the anal area

It may be easy to mistake anal warts for hemorrhoids.

HPV causes anal warts, and there are many strains of the virus.

According to the CDC, an estimated 90% of anal warts occur due to HPV types 6 or 11. These strains can also cause warts on other areas, including the nose, eyes, and mouth.

The CDC also note that scientists associate the HPV strains 16, 18, 31, 33, and 35 with lesions that may become cancerous.

In most cases, people develop anal warts as a result of having receptive anal intercourse with someone who has HPV.

The virus can also transmit and cause anal warts through hand-to-anal contact or the anal area being exposed to someone’s bodily fluids that contain the virus.

Anal warts are contagious, particularly during an outbreak. It is also worth noting that HPV is contagious even when it does not cause warts.

Even if a person is undergoing treatment for anal warts, the virus can pass from them to someone else.

People with weakened immune systems, including those with HIV, are more vulnerable to infections. They may therefore have a higher risk of contracting HPV if they are exposed to the virus.

A person with HIV may wish to speak with a doctor about ways to reduce their HPV risk. This may include attending regular screenings.

A healthcare provider can diagnose anal warts by examining the anus. They may use a medical instrument called an anoscope to view the inside of the anal canal and check if warts are present there.

A doctor can usually tell from a visual inspection if any growths are anal warts.

A doctor may need a biopsy, a sample of tissue from a wart, for further testing. They may request this if the warts are not responding to treatment or are getting worse despite treatment.

A doctor may recommend different options for anal warts depending on their number, size, and any symptoms.

Sometimes the body clears the underlying virus, or the warts simply go away on their own. If a person is not eager to start treatment right away and the outbreak is small, the doctor may recommend waiting to see what happens.

It is important to note that HPV can stay dormant in the body for several years, and even after a person undergoes treatment, anal warts can come back.

When a doctor recommends treatment, they may perform or prescribe:

Topical treatments

If symptoms such as rectal bleeding or sores are mild or if the warts are relatively small, a doctor may prescribe a topical medication to kill the warts.

Examples of these treatments include:

  • imiquimod 3.75% (Zyclara) or 5% (Aldara) cream
  • podofilox 0.5% solution or gel (Condylox)
  • sinecatechins 15% ointment (Veregen)

A person can buy some wart treatments over the counter, but these should not be used in the anal area, where the skin is very delicate. Only use treatments approved by a doctor, and follow the instructions carefully.

Freezing or burning

A doctor can apply liquid nitrogen to remove anal warts. This freezes the wart tissue, causing it to fall off.

Alternatively, a doctor may apply an acid solution, involving trichloracetic or bichloracetic acid, to cauterize and destroy wart tissue.

Surgery

If anal warts are internal or very large, a doctor may recommend surgery. This takes place under general anesthesia.

If removing many warts is necessary, a doctor may recommend more than one surgery to allow for healing time.

Following a surgical removal, a person may need to take several days off of work or school. A person may need over-the-counter pain relief medication, or the doctor may prescribe something stronger.

The time that it takes to return to regular activities is likely to depend on the extent of the surgery.

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Using a condom during sexual intercourse may reduce the risk of anal warts.

To keep the virus that causes anal warts from passing on:

  • Avoid sexual contact with people who have active anal or genital warts.
  • Use condoms or other barrier methods during sexual intercourse. This is not a guaranteed way to prevent HPV transmission, but it can reduce the risk.
  • Ask a doctor about the HPV vaccine. It can protect against the strains of HPV that cause most cases of genital warts and those that cause cancer.

There is no cure for HPV, and the virus can remain in the body for life. Therefore, it is important to use the prevention strategies above.

People usually develop anal warts as a result of having receptive anal sex with someone who has HPV.

Anal warts may cause no symptoms, and a person may be unaware of them, but they can cause bleeding and other symptoms that can be severe.

Anyone who may have anal warts should see a doctor for a diagnosis and treatment.

While there is no cure for HPV, anal warts are usually highly treatable. They may reoccur, however.