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

The Centers for Disease Control and Prevention (CDC) estimate that high risk HPV strains cause around 10% of anal warts cases. These strains are 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. If they do occur, they may include 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 discuss treatment options.

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If a person suspects they have anal warts, they should see a doctor for a diagnosis.

In most cases, anal warts are painless.

A person may be completely unaware that they have them. If a person does have symptoms, 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
  • the sensation of having a lump or something similar in the anal area

In some cases, a person may mistake anal warts for hemorrhoids.

HPV causes anal warts. However, there are many different strains of HPV.

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

The CDC also note that scientists associate the HPV strains 16, 18, 31, 33, and 35 with potentially cancer causing lesions. A person can have anal warts from several types of HPV.

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

However, it is possible for a person to develop anal warts without having anal intercourse. For example, hand-to-anal contact or exposure to a partner's infected fluids around the anal area can also lead to anal warts.

Anal warts are contagious, particularly during an outbreak. That said, people can pass HPV to someone else even if they do not have any warts.

A person can also still transmit the virus when they have had treatments for anal warts.

People with a weakened immune system, including those with HIV, are more vulnerable to infections. Therefore, they may have a higher risk of contracting HPV if they become exposed to it.

People with HIV may wish to talk to their doctor about ways to reduce their HPV risk. This may include attending regular screenings.

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

A doctor can usually tell from a visual inspection if the bumps are anal warts due to HPV.

Sometimes, they may perform a biopsy, which involves taking a sample of the wart tissue and sending it for further testing. They might do this if the warts are not responding to treatment, or if they are getting worse despite treatment.

Treatment options for anal warts depend on their number, size, and symptoms.

Sometimes, the body will clear the HPV itself, or the warts will go away without treatment. As a result, doctors may recommend waiting to see what happens after a small outbreak if a person is not keen to pursue treatment at that time.

However, HPV can stay dormant in a person's body for several years. Therefore, even after a person undergoes treatment, anal warts can sometimes come back.

When a doctor decides that treatment is necessary, they may suggest one of the following options:

Topical treatments

If a person's symptoms are mild, such as rectal bleeding or nonhealing sores, or if the warts are not overly large, a doctor may prescribe a topical medication that will 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)

Some drugstores sell over-the-counter (OTC) remedies for warts, but people should not use these in the anal area. The skin on this part of the body is very delicate, and a person should only apply treatments that a doctor prescribes or recommends.

Freezing or burning

A doctor may sometimes apply liquid nitrogen to anal warts to remove them. The liquid nitrogen freezes the wart tissue, causing it to fall off.

Alternatively, a doctor may apply acids to cauterize the warts. Examples include trichloracetic acid or bichloracetic acid, which can destroy the wart tissue.

Both of these treatments usually take place in the doctor's office.

Surgery

If a person has anal warts that are internal or very large, a doctor may suggest surgery.

The surgical removal of anal warts will take place under general anesthesia. If it is necessary to remove many warts, a doctor may recommend more than one surgery to allow for healing time.

Following surgical anal wart removal, a person may need to take several days off work or school. They may wish to take OTC pain relievers, or a doctor may prescribe stronger pain medications.

The time that it takes for a person to return to their usual daily activities is likely to depend on the extent of the surgical treatment.

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

To avoid contracting or transmitting anal warts:

  • Refrain from having sexual contact with people who have active anal or genital warts.
  • Use condoms or other barrier methods when engaging in sexual intercourse. Although this is not a guaranteed way to prevent HPV transmission, it can reduce the risk.
  • Ask a doctor if the HPV vaccine Gardasil is necessary. This vaccine can prevent the HPV types that cause most strains of genital warts, as well as those that cause cancer.

There is no cure for HPV. This means that once a person has it, they have it for life. Therefore, it is important to adopt safe sex practices such as using barrier methods.

People usually develop anal warts as a result of having receptive anal sex with someone who has HPV. Some people will not be aware that they have them, whereas others may experience severe symptoms such as bleeding.

Anyone who suspects that they have anal warts should see a doctor for diagnosis and treatment.

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