Warts in the anus are a type of genital wart. They are small lesions on the skin of the anal area, both around and inside the opening (1). Also called condyloma acuminata, they appear as skin-colored or gray bumps (2). 

The most common cause of warts in the anus is the human papillomavirus or HPV. The most common route of transmission is therefore sexual contact with a person who is infected, even if there are no obvious signs of the disease (2,3,4). 

Symptoms associated warts in the anus 

Anal condylomata are visible to the naked eye. They are small elevations on the skin with a similar skin tone or somewhat darker (1). In addition, they may be accompanied by any of the following symptoms (5): 

• Itching. 

• Burning. 

• Pain. 

Lesions may also bleed from friction and rubbing. Although this is rare in everyday activities, it can occur during sexual intercourse (2,5). 

As they are most often asymptomatic, they may be diagnosed at a doctor's visit for another reason. For example, they can be found during a gynecological examination for vaginal dryness, vaginitis, or just a routine check-up (2). That is why it is important that, if you suspect HPV infection, you seek medical attention. It is not advisable to self-medicate or try home remedies for warts (3). 

How can warts in the anus be treated? 

There is no single treatment option for condylomata acuminata. The physician will evaluate the size of the lesions and their extent to decide on one or the other approach (2). He or she may also suggest a combination of therapeutic methods. This is useful because none of the available treatments is effective in the long term. In most cases, there is a recurrence of the warts (6). 

Topical treatments 

When condylomas are very small and limited to the skin around the anus, local treatment may be sufficient. However, this does not mean that just any cream is the solution. A physician will also prescribe active ingredients (3). 

Among the most used drugs for this purpose are trichloroacetic and dichloroacetic acid, imiquimod, and sinecatechins. However, they are not fast-acting and require several weeks of constant and regular use (5). 

Surgery 

If the warts in the anus are large, with little response to topical treatments, or located inside the orifice, then surgery will be necessary. This does not require major interventions. It is possible to operate on an outpatient basis, without hospitalization (7). The procedure consists of removing the condylomas. To do this, the doctor cuts the lesions with a scalpel or scissors (5).  

Other treatments

Some situations are somewhere in between. For example, a person may have large warts for topical treatment, but small warts for surgery. Then, one of the following procedures will be chosen:  

• Laser with focused infrared light (5). 

• Cryotherapy with liquid nitrogen (3). 

• Electrocautery with electric current (5).  

Any of these three therapies are not usually completed in a single session. Successive applications are necessary, especially if there are many lesions (3,5). 

How to prevent warts in the anus 

To reduce the risk of anal condylomas, HPV infection must be prevented. And because sexual transmission is the most common, the basic recommendations are to use condoms and limit the number of sexual partners (5). 

In addition, HPV vaccination is available, which is an immunization that protects against different types of the virus, including 6 and 11. It should be given to young people aged 12 and 13 years, and to people who are at high risk of infection (8,9). 

Sex education is another pillar for the prevention of condylomata acuminata. Knowing what HPV is, how it is spread, and how not to transmit it helps to limit its spread. And if you know that you are infected, it is essential to tell your sexual partner (4). 

In conclusion, the problem with warts in the anus is that they develop silently. They do not show obvious signs, do not alter female orgasm, and do not evolve rapidly. Moreover, without timely treatment, they spread. Therefore, underestimating them is not an option. 

Bibliographic References

1. Primary Care Dermatology Society. Warts [Internet]. pcds.org.uk. 2022 [cited 2024 Feb 17]. Available from: https://www.pcds.org.uk/clinical-guidance/warts

2. Pennycook KB, McCready TA. Condyloma Acuminata. StatPearls Publishing; 2023 2023 [cited 2024 Feb 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547667/

3. National Health System. Genital warts [Internet]. nhs.uk. 2023 [cited 2024 Feb 17]. Available from: https://www.nhs.uk/conditions/genital-warts/

4. Centers for Disease Control and Prevention. Genital HPV Infection – Basic Fact Sheet [Internet]. U. S. Department of Health and Human Services. 2022 [cited 2024 Feb 17]. Available from: https://www.cdc.gov/std/HPV/STDFact-HPV.htm

5. Diţescu D, Istrate-Ofiţeru AM, Roşu GC, Iovan L, Liliac IM, et al. Clinical and pathological aspects of condyloma acuminatum – review of literature and case presentation. Rom J Morphol Embryol [Internet]. 2022 [cited 2024 Feb 17];62(2):369–83. Available from: https://pubmed.ncbi.nlm.nih.gov/35024725/

6. Zhan M, Tong Z, Chen S, Miao Y, Yang Y. Establishing a prediction model for recurrence of condyloma acuminatum. Eur J Med Res [Internet]. 2022 [cited 2024 Feb 17];27(1). Available from: http://dx.doi.org/10.1186/s40001-022-00816-7

7. Al-Ghamdi AM, Alfalah S, Anwer K, Alzaher I, Alsuhaimi AA, Aldhafeeri SM. Giant condyloma acuminatum surgical management: a case report and literature review. Ann Med Surg (Lond) [Internet]. 2023 [cited 2024 Feb 17];85(9):4638–42. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266468/

8. National Health System. HPV vaccine [Internet]. nhs.uk. 2023 [cited 2024 Feb 17]. Available from: https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/

9. Electronic Medicines Compendium. Gardasil 9 suspension for injection. Merck Sharp & Dohme (UK) Limited .2023 [cited 2024 Feb 17]. Available from: https://www.medicines.org.uk/emc/product/7330/smpc#about-medicine