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Anal warts are raised nodules which appear inside or around the anus due to the anal cells being infected by human papilloma virus (HPV). Once anal warts appear, they rarely spontaneously. They tend to continue growing and may affect the anal muscles or even turn cancerous several years later if untreated. This is a contagious disease even when the warts have been treated.
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The main symptom is the raised nodules around the anus. The surface feels rough and harder than skin. By the time one notices the anal warts, they tend to be multiple and may be associated with itching around the anus (pruritis) as well as mucus discharge from the anus.
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If you suspect that you have anal warts, you should check your genital area for presence of warts there as well. In a man, the warts can be present around the glans penis or along the shaft of the penis. In a woman, the warts may be around or inside the vagina.
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Anal warts are due to infection of HPV in the cells of the anus or perianal skin. The transmission may be due to sexual intercourse (direct contact mode of transmission) or non-sexual transmission via micro-tears in the skin. Examples of non-sexual transmission are sharing of undergarments, swimwear or use of public baths. Please remember that HPV is highly contagious in patients with anal warts. Ask your doctor to check your partner for anal warts if you have them yourself.
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The clinical features of anal warts are unique and usually do not need further diagnostic tests. If your doctor is unsure, he may take a biopsy to confirm the diagnosis. If the warts are excised surgically, they will be tested for histological confirmation. The histological tests are performed to ensure that the warts have not transformed into skin cancer (squamous cell carcinoma).
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The biggest fear of untreated anal warts is the risk of malignant transformation into cancer. While the chance of cancer is low, the only treatment for anal cancer from anal warts is wide excision of the anus and permanent stoma. Therefore, every patient with anal warts should get it treated. However, removal of anal warts does not equate cure from HPV.
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The main aim of treating anal warts is to treat symptoms related to the warts or to prevent the warts from transforming into cancer. Treatment options currently are:
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- Topical agent application
- Physical ablation e.g. liquid nitrogen cryotherapy, laser coagulation.
- Surgical excision
- Behavioural therapy e.g. psychotherapy
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Surgery is indicated when other treatment options are not successful. In some cases, surgery is the first option because of suspicion of cancer. Otherwise, surgery is indicated when other treatment options are not successful in removing the anal warts.
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Surgery involved excision of the warts while preserving as much of the anus lining as possible. The surgery involves removing the warts with a superficial layer of skin only. This is a minor operation and performed as day surgery only. The operation does not require any special preparation and usually takes less than an hour. Most patients can return to work within a week and there is minimal discomfort.
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Anal warts may recur after treatment as HPV is not fully eradicated. Treatment can be repeated and this includes surgery. The key principles in treatment are preservation of anal function and prevention of cancer transformation. It is important after your successful initial treatment to follow-up regularly with your doctor for at least 2 years to look for recurrent anal warts or genital warts.
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