Anal Warts

July 3rd, 2013 by Eduardo Krajewski, MD, FACS, FASCRS

Anal warts and genital warts are collectively referred to as anogenital warts. These warts are caused by the human papillomavirus or HPV. They are the most common viral sexually transmitted disease in the United States. However, the danger of these warts goes beyond just the warts themselves. HPV is actually the most important infectious cause of cancer worldwide, and nearly 16,000 cancers are attributed to HPV infection every year in the United States alone.

What causes anogenital warts?

The warts are caused by HPV which is transmitted through sexual contact. After exposure to the virus, it can take anywhere from three weeks to eight months before the warts appear. This is called the incubation period.

What cancers are associated with anogenital warts?

Really, it is not the warts that lead to the cancers, but the virus itself. Some strains of human papillomavirus have been shown to cause cancers of the:

  • Anus
  • Vulva
  • Vagina
  • Cervix
  • Penis
  • Head and neck

What are the risk factors for getting anogenital warts?

Anogenital warts are acquired through sexual contact. Most of the time, this means intercourse, either vaginal or anal. However, the disease can also be spread by the hands and mouth upon contact with the anogenital area.

People with multiple sex partners are also at increased risk as are persons infected with the HIV virus.

Condoms can help prevent virus spread, but they are not 100% effective. Also, condoms are less effective at preventing HPV transmission as compared to preventing other sexually transmitted diseases. This is because the warts can be present on areas of the skin that are not protected by the condom barrier.

What are the signs of anogenital warts?

The warts usually are a small bump or collection of bumps on the genitals or anus. They can vary in shape and often have a cauliflower like appearance. In some cases, HPV infection is not visible at all and can only be detected in women by special screening tests.

The warts often do not bother you at all. But they can also cause itching, bleeding, burning, tenderness or pain. In women they can sometimes lead to vaginal discharge. Less commonly, the warts can grow large enough to interfere with defecation, sexual intercourse and even childbirth.

In most cases, a doctor can make the diagnosis based on examining the wart(s) visually. If there is any doubt, a biopsy can confirm the diagnosis.

How are anogenital warts treated?

Treatment of HPV warts can be achieved through a variety of methods. There is no evidence that one method is better than the other. The treatment decision depends on the location and size of the wart as well as your physician’s preference.

Unfortunately there is a high recurrence rate for anogenital warts with estimates between 30 to 70 percent. Some of the treatments for anogenital warts include:

  • Podoplyllin: A topically applied chemical agent that stops cell division and leads to cell death.
  • Trichloroacetic acid: Leads to physical destruction of wart tissue. Applied topically.
  • Imiquimod: Topical medication that works by modifying the immune response.
  • Surgery: Used when warts do not respond to medications or are very large.
  • Cryotherapy: Use of extreme cold (liquid nitrogen) to destroy warts.
  • Laser therapy: Requires anesthesia and is expensive.
  • Topical antimicrobials: These medications are designed to stop infection.
  • Infrared Coagulation: Uses a beam of infrared light to get rid of warts.


Anogenital warts are the result of the most common viral sexually transmitted disease in the United States, that is, HPV infection. There is a wide range of symptoms that can go along with the appearance of the warts. Association with cancer is an especially dangerous aspect of some strains of human papillomavirus.

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