What are anal 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. 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. As a result, patients may be unaware that the warts are present. Some patients will experience symptoms such as itching, bleeding, mucus discharge and/or a feeling of a lump or mass in the anal area.

Anal warts, thought to be caused by the human papilloma virus, can grow larger and spread if not removed.

It is important to know that Anal warts can be found both heterosexuals and in men who have sex with men.  Either way, it is nothing to be ashamed of – and it is something that you SHOULD SEEK TREATMENT FOR.

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 an increased risk of cancer in the affected area.  This is similar to the risks of cervical cancer in women.

What treatments are available?

If warts are very small and are located only on the skin around the anus, they may be treated with a topical medication. They may also be treated by a physician by freezing the warts with liquid nitrogen. Warts may also be removed surgically. Surgery provides immediate results but must be performed using either a local anesthetic – such as novocaine – or a general or spinal anesthetic, depending on the number and exact location of warts being treated. Warts inside the anal canal usually are not suitable for treatment by medications, and in most cases need to be treated surgically.

Must I be hospitalized for surgical treatment?

No. Surgical treatment of anal warts is usually performed as outpatient surgery.

How much time will I lose from work after surgical treatment?

Most people are moderately uncomfortable for a few days after treatment, and pain medication may be prescribed. Depending on the extent of the disease, most people return to work the next day.

How long is treatment usually continued?

Follow-up visits are necessary at frequent intervals for several months after the last wart is observed to be certain that no new warts occur.

What can be done to avoid getting these warts again?

In some cases, warts may recur repeatedly after successful removal, since the virus that causes the warts often persists in a dormant state in body tissues. Discuss with you physician how often you should be evaluated for recurrent warts. Abstain from sexual contact with individuals who have anal (or genital) warts. Since many individuals may be unaware that they suffer from this condition, sexual abstinence, condom protection or limiting sexual contact to single partner will reduce your potential exposure to the contagious virus that causes these warts. As a precaution, sexual partners ought to be checked, even if they have no symptoms.

as a urologist i see a lot of patient with growths or bumps on the penis

some patients ask do I have cancer? do I need a biopsy? 

Most patients with a classic wart or HPV do not need a biopsy, patient who are uncircumcised or recurrent growths may consider a biopsy.

Freezing a wart with liquid nitrogen, cauterization, or topical treatments like aldara (imiquimod topical cream)

if you have a wart get to a doctor and have it treated.  A biopsy is not a  bad idea but no always necessary

thanks for all of stories and questions I hope this site can help you fight your personal war on warts. 

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by: Michelle Lipke

Liquid nitrogen is a popular destructive treatment for warts.  It is readily available in both dermatology and primary care offices.   Verucca-Freeze and many similar brands available over the counter are a liquid applied from a spray can, but only freeze to -70C.  Warts may not resolve with the over the counter freezing due to the fact that they do not freeze as fast as the liquid nitrogen available in the clinic setting; as well as the proper application technique may not always be used. The wart virus, known as human papilloma virus (HPV), is not destroyed by the freezing procedure.   Liquid nitrogen freezes at -196C and works by destroying the skin cells which in turn release the wart virus.  They body responds to this process by causing an immune response to resolve the wart.

The cryo-spray gun and cotton wool bud are the two main methods for treating common warts with liquid nitrogen.  Different providers often have a personal preference of which method they choose to perform this treatment.   There was no difference in cure rate between cryo-spray gun and cotton wool bud for warts treated every two weeks for three months.

Warts need to be frozen until 1-2 mm of surrounding skin turns white.  Repeat freezing after thawing may cause more effective tissue damage for some wart locations to help them resolve.  Paring the wart down with a scalpel or razor blade may reduce callous which can act as an insulator reducing the effect of the freeze.  Warts are usually treated on average of every two weeks, but sometimes the interval of treatment can depend on how a patient responds to the freezing in regard to side effects.

The common side effects from liquid nitrogen include redness, swelling, blistering and pain.  Plantar wart treatment may temporarily reduce the ability to walk due to pain and blistering.  Excessive blistering may create a ring recurrence around the treated wart which is thought to be caused by bordering dormant wart virus.  The freezing may cause lightening or darkening of the skin after the wart has resolved, especially in dark skinned individuals.  Deeper structures such as tendons, nerves and veins can be damaged with treatment that is too aggressive.