Anal Warts: Symptoms, Causes & Treatment

Anal warts are caused by the human papillomavirus (HPV). They are small, often flesh-coloured, lumps that appear in or around the anus. Anal warts can also affect the skin around your genitals (genital warts). They often do not cause any pain, so many people are unaware they have them. They may first appear as tiny as a pinhead bump but may grow to the size of a pea.

Often anal warts do not cause symptoms because the virus that causes them can remain dormant in your body for a long time. If you do experience symptoms, you may notice:

• soft lumps in or around your anus
• bleeding
• itching
• pink, brown, yellow, or flesh-coloured lumps that may group together
• discharge from your anus if the warts are internal

Anal warts are caused by HPV, the most common sexually transmitted infection (STI) in the world. There are over 100 types of HPV, with more than 40 capable of affecting the genital and anus area. The most common strains known to cause anal warts are types 6 and 11.

In some people, HPV can cause:

• genital and anal warts
• abnormal cell changes, which may turn into cancer

Any type of HPV that is linked to causing cancer is called a high-risk HPV. These types can cause cancer of the:

• cervix
• anus
• penis
• vulva
• vagina
• head and neck

How is HPV spread?

HPV infections are spread through skin-on-skin contact and sex, making them easy to catch. You do not need to have penetrative sex to become infected.

You can get HPV by:

• skin-to-skin contact of the genital area
• unprotected vagina, oral, or anal sex
• sharing sex toys

You can get HPV even if you have only had sex once. Most people will be exposed to HPV at some point in their lives.

A doctor can diagnose anal or genital warts usually just by looking at them. If the warts are inside your anus, a doctor may need to look inside using a small tool called an anoscope. You can physically visit your GP or a sexual health clinic, or you can get a diagnosis from Superdrug Online Doctor by using our online service.

You’ll simply need to answer a short questionnaire and upload 2 different photos of the affected area.

The treatments available for anal warts will depend on your symptoms, size, and location. Treatments can include topical ointments, freezing, surgery, or a combination.

Topical treatments for anal warts include:

• Aldara - a prescription-only cream that can be used to treat external hard or soft anal warts. It contains the active ingredient imiquimod, which stimulates your immune system to kill the wart cells. Aldara is applied 3 times per week, and most people notice their anal warts have disappeared within 16 weeks.
• Trichloroacetic acid - is an over-the-counter topical solution that is applied directly to external anal warts by a nurse or medical professional. It works by destroying the proteins within the warts, breaking them down until they eventually disappear. Some studies show that only 5% of people who receive trichloroacetic acid complain of side effects.

Cryotherapy or freezing is another relatively inexpensive treatment option that is safe during pregnancy when topical treatments are not recommended. It involves a medical professional applying liquid nitrogen to the individual warts 3 to 5 times, usually for 6 to 10 weeks.

For warts that do not respond to treatment, surgery may be necessary to remove them. Surgery is the only type of treatment that has an almost 100% clearance rate and can include:

• electrosurgery
• curettage
• scissors excision
• laser therapy

A doctor can discuss the benefits and risks of each type of surgery with you in more detail.

How effective is anal warts treatment?

The only treatment that is almost 100% effective at clearing anal warts is surgery to remove them from your skin. However, studies show that topical treatments such as Condyline can be up to 92% effective at treating anus and genital warts.

Imiquimod 5% cream, like Aldara, is associated with lower rates of recurrence compared to treatments containing podophyllotoxin (another warts treatment). Further research shows that Imiquimod 5% cream achieved complete clearance of warts in 51% of patients, and in 72% of patients, the wart area had reduced by half.

How long does it take for anal warts treatment to work?

It can take weeks or months for anal wart treatment to work. Here is a suggested timeline for each of the anal wart treatments:

• Podophyllotoxin may clear lesions after 4 weeks if applied twice daily for 3 days followed by a 4-day break
• Imiquimod cream can clear anal warts within 16 weeks
• Trichloroacetic acid is usually applied for 4 to 6 weeks
• Freezing can clear warts after 6 to 10 weeks

Can anal warts come back after treatment?

Yes, anal warts can come back after you have received treatment or got rid of them. This can happen weeks, months, or years after your first infection. That’s because the virus may have infected normal or healthy-looking areas of the skin around your anus, lying dormant until it is activated. According to research, all types of therapies are linked with recurrent anal warts, with rates around 20 to 30% or more. This is due to the nature of the virus itself.

You can help to prevent the recurrence of anal warts by keeping yourself healthy, such as:

• eating a well-balanced diet
• exercising regularly
• giving up smoking if you smoke

What’s the best treatment for anal warts?

The best treatment for anal warts will depend on their size and location. Small warts around the anus may be best treated with topical ointments. If warts are large or located inside the anus, then surgery may be the preferred option. Your doctor will discuss the best available treatment for you.

Most anal wart treatments are associated with mild pain and discomfort for a few days after. In severe cases, your doctor may prescribe pain medication, but most people who have surgery or cryotherapy can return to work immediately.

The side effects associated with topical treatments can include:

Very common side effects:

• skin redness
• flakiness
• hardness
• itchy sensation
• burning sensation

Common side effects:

• headache
• feeling sick
• erectile dysfunction
• pain during sex
• tiredness
• dizziness
• pins and needles
• difficulty sleeping
• loss of appetite
• flu-like symptoms

How long do these side effects last?

Any mild pain or discomfort you experience should only last a few days following treatment. If you experience skin reactions when using topical treatments, then these should go away within 2 weeks of stopping your treatment.

What to do if you get side effects?

If you experience side effects after anal wart treatment, you should let your doctor know. They may be able to prescribe painkillers or recommend a more suitable treatment option for you.

Yes. There are treatments available that can help to relieve the symptoms of anal warts and make them disappear. Some treatments can also stop them from coming back. You should avoid having sex while you have anal warts or are receiving treatment for them to help stop their spread.

The NHS has an HPV vaccination programme, and you may be entitled to a vaccine if you are:

• a girl or boy aged 12 to 13 and born after 1 September 2006
• gay, bisexual, or a man who has sex with men up to the age of 45