Q: I am a 27-year-old man and I consider myself to be in good health. I exercise regularly and eat a diet rich in fruit and vegetables. Recently, I noticed some little growths around my anus.
I opted to ignore them but 10 months down the line, they have become significantly larger. They are painless and do not bleed. However, I am worried about them.
They have made my anal hygiene poor as I cannot properly clean the area and I often find my underwear stained. I, initially, thought that the growths were piles (looked up the symptoms on google) but when I went to the doctor, he told me that I have anal warts.
I opted not to have them treated at the time, but now I have a similar growth on my penis. How did I end up with anal warts? Are there tests that can confirm the diagnosis? Can they become cancerous?
Should I abstain from sexual intercourse? Can they invade the genital system and cause infertility? Can they clear on their own? What treatment would you recommend?
A: Warts can occur in any part of the body. You have anogenital warts. They are caused by a virus known as HPV (Human Papilloma Virus).
They often start as a little pimple and have the potential to become very large (look like cauliflower) and cover the entire anal and genital area.
In most cases, they are sexually transmitted. However, there are people who get anogenital warts without sexual contact. If you have direct contact with someone who has anogenital warts and touch yourself in those areas, you could get the same condition (skin-to-skin contact).
HPV transmission can occur even if there are no visible warts on the carrier.
Most anogenital warts are painless. However, large anal warts can cause significant discomfort, mucus discharge and itching in the anal area. Itching may cause a break in skin leading to bleeding and occasionally, infection in the area.
Diagnosis does not require tests. Often your doctor can make a diagnosis just by looking at them. If there are concerns that the growths may be cancerous, then your doctor may perform a biopsy. Your doctor will also look inside your anus to check for internal warts.
If warts are not treated, they can become larger and multiply (as is your case). For this reason, it is important to eradicate them. The choice of treatment is decided upon depending on their size, location and patient preference.
Most of the time, warts require multiple treatment sessions. Treatment options include:
Creams: These are mainly used to clear small warts. They include formulations that burn warts on application. (Creams containing Bichlorocetic or Trichlorocetic acid and Podophyllin).
They can be a little harsh on the anogenital skin and should not be used inside the anus. Immune therapy: A drug known as imiquimod may be applied to the warts to stimulate an immune response by the body to clear the warts.
Cryotherapy: This treatment will freeze the warts and cause them to fall off. The drug used is liquid nitrogen. This is available locally.
Laser therapy: This uses energy transmitted from an intense light to eliminate the growths. This is also available locally.
Surgery: This is usually reserved for large warts or those that fail to respond to medical treatment. Most surgeons use electric current to cut and burn the warts off (electrocautery). Extensive warts may need surgery in stages.
No treatment: Small warts that are not increasing in size may be monitored without treatment. These small ones have been known to sometimes resolve on their own within a year.
HPV is a resilient virus and can last in the body for months after you get your treatment. For this reason, it is not unusual to have the warts re-occur and require repeat therapy.
Complications of treatment
Most anogenital warts clear after three to six months of treatment. Occasionally, the skin may become lighter or darker after treatment. There may also be significant scarring in the genital or anal areas.
This may lead to significant genital or anal pain/hypersensitivity. This is, however, rare and should not prevent one from seeking treatment.
Protect your partner
It is important to protect your sexual partner. Preferably, abstain from intercourse until you have had your warts fully treated. If you cannot, use condoms (but this might not be effective in protecting your partner since you also have anal warts).
Oral sex should ideally be done with dental dams (these are latex sheets that can be put on the genitals during oral intercourse).
Usually, anogenital warts do not lead to infertility or impotence.
Risk factors for getting anal warts
You are at an increased risk for contracting and spreading anal warts if you have unprotected sex, have multiple sex partners, had sex at an early age, have sex with a person with HPV (even if they don’t have visible warts), have anal intercourse or have a weakened immune system. The immune system can be compromised by illness or medication.
Can warts be prevented?
There is a vaccine against HPV. It is best given to people at the age of 11 or 12 years but it can be administered up to the age of 45years. It has been known to reduce the occurrence of HPV complications such as cervical/anal cancer and even warts.