-Connie Pennington, MD
Anal warts, also called "condyloma" is a condition that affects the area around and just inside the anus. They may also effect the skin of the entire genital area. They first appear as tiny spots, or growths, and may grow quite large. They are fleshy or pink in color. They usually do not cause pain, but they may bleed and cause itching. Condyloma are caused by the human papilloma virus (HPV), which is transmitted by direct contact, although it may not manifest for years. This contact can come from unwashed hands, toilet seats, or sexual contact. HPV is considered to be the most common sexually transmitted disease. Due to the fact that unattended condyloma can lead to cancer, it is very important to be promptly treated.
The diagnosis of anal warts is usually made on visual inspection of the perineum, or groin, vaginal area or penis and scrotum, as well as the anal opening. Digital examination may be necessary inside the rectum or vagina. Risk factors for the development of condyloma includes a history of contact with the HPV virus, even though it may have been totally unrecognized. A medical history of any type of immunosuppression, (organ transplant, steroids) and medication history, etc. is important. Dr. Pennington does not generally inquire about a sexual history because it does not change surgical management. We are here to diagnosis and support you, and care for you. We are here to help you maintain health. Once a diagnosis of condyloma has been made, they will need to be removed. If not removed they will usually grow and multiply. They also can invade the anal canal and increase the risk of anal canal cancer.
Small warts may be treated with medications used to eradicate them, such as podophyllin, trichloroacetic acid and bichloroacetic acid. These agents can be applied in the office, with only minor burning or discomfort. Imiquimod (Aldara) or 5-fluorouracil (5-FU) are topical agents that are applied at home, usually every other day in the evening, and washed off the next morning. These agents often cause burning and discomfort. Smaller warts can also be treated with cryotherapy or freezing in the office setting.
Surgery for anal condyloma involves removal and destruction of the warts while the patient is asleep under general anesthesia. This is the best method for removing large warts, and warts that have invaded the anal canal. Removal occurs by cutting the warts at its base, and then using electrocautery or electricity to burn the base of the condyloma. This can produce the same effects as a second degree burn. Surgery is performed on an out-patient basis and patients are given pain medications and numbing jelly to assist in the post operative period. Most people will need some time off work, depending on the extent of surgery this could vary between a few days, to a couple weeks. Pain, discomfort, and some bleeding are expected in the immediate post operative period, and with bowel movements for several days, up to two weeks. As the skin heals it weeps clear to orange-yellowish fluid and pads help prevent chapping.
Follow up from surgery is important. Anal condyloma are caused by a virus and recurrence is common occuring in up to 50% of patients. If recurrences are small they are easily treated in the office. Once all condyloma have been removed, it is important to be checked routinely. If regrowth is noted, call the office immediately for examination and treatment. Typically follow up intervals begin at every 3 months, then move to every 6 months unless regrowth occurs.
Warts that are surgically removed will be sent to pathology to determine if they contain any dysplasia, or abnormal growth. If dysplasia is present, then the pathologist will determine the specific strain or type of HPV present. Some strains are more likely to develop into cancer than others, and in these patients careful follow-up with anal PAP smears will be recommended on routine intervals.
Anal condyloma are caused by the HPV virus, which to date, cannot be eradicated. To prevent further spread of HPV, safe sex practices are recommended and include sexual abstinence, condom protection or limiting sexual contact to single partner. Do not have sex with someone with anal warts. HPV is spread by skin to skin contact and may be spread by areas not covered by a condom. As a precaution, sexual partners should to be checked for warts and other sexually transmitted diseases, even if they have no symptoms. You may also need to be tested for HIV.
The U.S. Food and Drug Administration (FDA) has approved the vaccine Gardasil (vaccine against certain types of HPV that more commonly cause cervical and other HPV-related cancers) in certain patients age 9 to 26 prior to HPV exposure (sexual activity) to prevent the development of HPV- related cancers and associated precancerous lesions (called dysplasia). Your physician may recommend you to be evaluated if you would potentially be a candidate for this vaccine. However, the vaccine’s role to prevent anal warts and anal cancer is unknown. Also some harmeful effects, including death, have been reported in a number of young women.