Washington University Colorectal Surgeons answer patient questions regarding anal warts.

What are anal warts?

Anal warts can first appear as tiny bumps or growths inside or around the anus. They are often flesh-colored or brown, and can be shaped like a small cauliflower. When anal warts are small, they often do not cause any symptoms. As they become larger, patients may notice cauliflower-like bumps around their anus that itch or bleed. If left untreated, they can grow quite large to cover the entire perianal area. They can also grow anteriorly around the genitals.   

What causes anal warts?

Anal warts are caused by the human papilloma virus (HPV), which is the most common sexually transmitted disease. Warts are spread by person-to-person contact. Anal intercourse is a risk factor, but is not necessary to develop anal warts. Warts do not need to be visible in order to spread the virus. A person may have been exposed to the virus years ago, but only recently develop warts. 

How are anal warts treated?

If warts are very small and only located on the skin around the anus, they can be treated with topical medications. These medications can cause burning or skin irritation. Topical treatments are usually needed for several weeks or more. Surgery for anal warts can provide immediate results. Warts are often surgically removed, burned or treated with a combination of both. This is most commonly done in the operating room, with some sedation, as an outpatient procedure. Both internal and external anal warts can be managed with surgery, as well as larger, more extensive disease. Patients generally have some pain, bleeding and discharge following surgery. This generally lasts for several days, but can last longer depending on the severity of disease. This is one reason why it is best to treat anal warts early. 

Can anal warts come back?

The virus that causes anal warts (HPV) can live in skin that appears normal for long periods of time before another wart develops. There are over 40 strains of HPV that affect the anal and genital area, and some strains are more aggressive than others. There is always a chance of developing recurrent warts. Patients should see their physician if they notice any new growths or develop new symptoms. 

What is anal dysplasia?

Some warts have abnormal changes that can be seen by a pathologist when they look at a removed wart under the microscope. These abnormal changes are called anal dysplasia. They can be graded by the degree of abnormal change. Anal dysplasia is a “precancerous” or “premalignant” condition. This does not mean that you have cancer. Anal dysplasia that is left untreated can progress to cancer. This is another reason why it is best to treat anal warts early. The majority of patients with anal dysplasia will not develop anal cancer, but patients with compromised immune systems are at an increased risk and should be seen and examined regularly by their physician.

Where can I find a doctor for anal dysplasia?

Washington University Colorectal can provide options and treatments for anal dysplasia. Meet our specialists below. 

To request an appointment, please fill out this online form or call 314-454-7177.