Anal Warts - (Genital Warts)
What are anal (genital) warts?
Anal warts (also called "condyloma acuminata") are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area and may grow on the penis, scrotum, or vaginal folds. They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow larger than the size of a pea. Usually, they do not cause pain or discomfort to afflicted individuals in the earliest stages. As a result, patients may be unaware that the warts are present. Some patients will experience symptoms such as itching and bleeding with genital warts. When they are present around the anal area, the patient may experience a mucus discharge and/or a feeling of a lump.
What causes these warts?
They are thought to be caused by the human papilloma virus (HPV) which is transmitted from person to person by direct contact. HPV is considered a sexually transmitted disease. You do not have to have anal intercourse to develop anal condyloma.
Do these warts always need to be removed?
Yes. If they are not removed, the warts usually grow larger and multiply. If left untreated, the warts may lead to cancer in the affected area.
What are the options for removing these warts?
Removal of anal and genital warts should only be done by a surgeon trained in proper surgical techniques for excision. Often such surgeons can offer removal in the office, avoiding an inpatient surgery. Options regarding office removal of anal warts are chemical cautery, electrocautery, cryotherapy (freezing), or mild surgical excision. Other practitioners may have different names for these procedures, but all fall into one of the categories below.
1. Electrocautery - This modality involves the application of an electric current directly to the wart, causing its complete removal all at once. The electric current is applied with a "pencil" device for a couple milliseconds, effectively removing the wart.
2. Chemical cautery - This involves application of certain agents directly onto the wart such as a substance called podophyllin. Podophyllin application usually causes the wart to "die off" a few days after application.
3. Cryotherapy - Cryotherapy is the "freezing" of warts with a super-cool agent. Generally cryotherapy causes a lot of "collateral damage" to surrounding normal tissue. This causes increased pain over the other modalities and is often not recommended.
4. Mild Surgical Excision - This involves the injection of an agent to numb the wart prior to removal. After the area is numb, the wart is grasped with a surgical forcep and removed with sterile scissors. Generally this is only used on large lesions (groupings of many warts) and is an alternative to having a surgical procedure done in the hospital. Again, this should only be done by a trained surgeon to minimize discomfort and recurrence.
What can be done to avoid getting these warts again?
Since the virus that causes the warts often persists in a dormant state in body tissues, warts can sometimes recur after successful removal. Discuss with your physician how often you should be evaluated for recurrent warts. Early detection allows for easier removal and decreases the risk of subsequent recurrence again . As a precaution, sexual partners ought to be checked, even if they have no symptoms.
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