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Anal Warts: What you have always wanted to know, but were too embarrassed to ask.

Anal warts are definitely not a topic for polite conversation. As an affliction upon one of the more intimate parts of the human body, patients frequently have multiple concerns regarding cosmetic appearance, stigmatization, personal health and sexual relationships. It is also not commonly brought up to their spouses or doctors. We are here to find out more about this extremely common condition and dispel common misconceptions about it.


What are Anal Warts?

Anal warts are common skin growth around or inside the anal canal caused by a virus known as the Human Papillomavirus (HPV). They come in all shapes and sizes, ranging from a small pinhead-like growth to big cauliflower-like lesions. They usually do not cause patients much pain or discomfort and patients might not be aware that anal warts are present because of the nature of the location


What is HPV and how is it spread?

HPV is the most common sexually transmitted disease (STD) in the world. It is a family of viruses with more than 200 types. They are typically divided into low-risk and high-risk types based on associated risk for cancer in any body areas. The low-risk types HPV 6 and/or 11 are detected in around 90 percent of anal warts.

HPV is transmitted through contact with infected skin. Anal HPV infection is almost always acquired through sexual contact. Anal warts by themselves are not required for transmission but are highly infectious.


Common myths about anal warts

Myth #1 – My partner has anal warts, he/she is cheating on me!

This myth is responsible for a great deal of anxiety and anger. HPV infection can lie dormant in the body for months and years before causing anal warts. There is no way to find out when the infection was acquired. 

Myth #2 – Anal warts can lead to anal cancer.

Anal warts are almost always benign. They are caused by low-risk HPV types 6, 11, 42, 43 and 44 and do not develop into cancer. 

Myth #3 – HPV is incurable, and recurrence of anal warts are common.

It is indeed true that there is no known cure for HPV. However, warts and precancerous lesions can be easily treated when detected. Recurrence of anal warts is not a given, and some patients might find recurrence getting less frequent and eventually stopping with time. 

Myth #4 – Condoms use during sex will prevent HPV transmission

Unfortunately, that is not the case. Condom use will prevent transmission of pathogens such as HIV and syphilis that are spread through bodily fluids. They are not so effective against other pathogens such as herpes or HPV as they are spread through skin-to-skin contact. This is because condoms do not cover the entire external genitalia.

Nonetheless, condom use can still lower the risk of HPV transmission and other STDs. They still play an important role in sexual health and STDs prevention strategies. 


Diagnosis of anal warts

Diagnosis of anal warts is normally done at the doctor’s office clinically through a thorough history and physical examination. The majority of anal warts do not require a biopsy for diagnosis.

HPV screening for anal warts is not routinely recommended. This is because all commercial laboratories will only test for high-risk HPV types and not low-risk HPV types that causes anal warts.


Treatment

Anal warts treatment depends on the size, number, site as well as patient’s preference.

Home treatment with preparations such as Imiquimod cream or Podofilox solution are available. However, they are limited in utility due to the locations of the warts which might not be easily reached by the patient. 

Cryosurgery is the use of extremely low temperature through liquid nitrogen to destroy the abnormal anal wart cells. It can be done as an office procedure but will require multiple cycles for treatment depending on the size of the warts.

Radiofrequency ablation is a procedure in which heat, which is generated through an electric current, is used to destroy the abnormal anal wart cells. It can also be done as an office procedure. An injectable pain-killer is commonly given before the procedure to numb the area and commonly a single session will be sufficient for anal warts removal.

Finally, if the anal warts are too large or too extensive, surgical excision under general anasthesia might be considered by a surgeon. 


Prevention 

By observing safe sexual practices such as use of condoms during sex and limiting the number of sex partners, patients can reduce their chance of contracting HPV.

A vaccine (Gardasil 9) is available for males and females to prevent ano-genital warts but it will not treat existing HPV or ano-genital warts. This vaccine can prevent most cases of genital warts in persons who have not yet been exposed to wart-causing types of HPV.

Next read: WHY IS MY SEMEN GREEN OR YELLOW?

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Perianal Warts (Peri-Anal Warts) & Anal Warts Removal

Perianal Warts (aka Peri-Anal Warts, Condyloma Acuminata) are flesh coloured, cauliflower-like growths in and around the anus that is caused by HPV (Human Papilloma Virus).

How Do I Know I Have Perianal Warts?

One of the first occurrences where people note this is new bleeding from the rectum, especially after wiping with toilet paper. Of course, there are many other causes of rectal bleeding, the most common being piles and the most deadly being some form of rectal cancer.
The other way people notice this is when their partner sees it and tells them about it. One would be able to feel the growth with your fingers and also see them with a mirror.

These perianal warts are painless and itchless.

How Can I Catch Perianal Warts?

These cauliflower-like perianal warts are caused by the virus HPV. This is spread through unprotected anal intercourse with a partner who has HPV.
Most often, HPV is symptomless and you can catch HPV from your partner even if he seems completely well.

If I Have Perianal Warts Can I Pass It To My Partner?

Yes the virus which causes perianal warts – HPV, can be passed on to your partner during unprotected anal intercourse.
In the situation, you do not have noticeable perianal warts but your partner develops penile warts after anal intercourse with you, you should also have yourself check for perianal warts and HPV.
Also, you can learn more about symptoms of other STD one can contract from Anal sex

How Do I Check For Perianal Warts?

During a physical examination, what you will tend to notice is “cauliflower-like” growths around the anus. These are usually flesh coloured or a slightly lighter or darker shade.
Other growths that may appear around the anus would be skin tags which can mimic perianal warts to the untrained eye, or even on rare occasions, ulcers which may be red flags of non-benign growths.
The best advice we can offer is to see our doctors to determine whether you truly have Perianal Warts or another condition. We may then take a sample of the growth and send it to the laboratory for confirmation.
All our clinics in Singapore provide Rapid HPV Testing (Next Day Results)
You can learn more about

How is Perianal Warts Treated?

We have covered in this article “How to Get Rid of Genital Warts” some of the commonly used treatments for Perianal warts. We will summarize them here again for your perusal.
The 3 main modalities we use are Creams and lotions, Freezing the wart or “Laser” electrocautery of the wart.

1. Creams and Lotions

Aldara Cream (Imiquimod) is effective for Perianal Warts. The cream is applied 3-4x a week nightly and left for 8 hours overnight. This warts treatment process is repeated for about 6 weeks to get full eradication of the wart. If too much of the cream is applied, some may experience redness and burning of the area as well.
Of course, there is also a small percentage who do not see full resolution and may need other treatments. If too much cream is applied it can cause redness and even blistering of the surrounding skin.

2. Freezing

With a special device that controls the release of liquid nitrogen, we can also freeze the wart. Most people see a resolution after 2-3 freezing treatments over a month. This process is usually painless and no anaesthesia is needed prior.

3. “Laser” Electrocautery

This is usually done in 1 sitting and is enough to eradicate the wart. However, this process often stings and would require some form of anaesthetic to numb the pain prior.

How Can I Protect Myself From Perianal Warts?

One of the best ways to protect yourself is to use a condom if you are intending to have anal sex. This however only confers a rough 30% protection against HPV infection.
There are more than 100 strains of HPV viruses out there, 4 of them are the main high-risk ones causing cervical cancer, anal cancer, throat cancer and penile cancer.
There are new vaccinations available which protect you against these 4 high-risk strains and 5 other low-risk strains which are wart causing. You can read more about Gardasil 9 (HPV vaccination).
Recently the FDA (food drug administration of the USA) announced that Gardasil 9 should be expanded to include Men and Women from 27-45 years of age, thereby providing greater protection against HPV and the risks of those above-mentioned cancers or warts.
You can speak to our doctors to find out more about this HPV vaccination.

Are There Any Other Diseases Associated with Perianal Warts?

Yes as described above there are risks of getting anal cancer, throat cancer, cervical cancer (women) and penile cancer from HPV.

Are There Other STDs Associated with Perianal Warts?

Perianal warts are known to be associated with Rectal Gonorrhoea, HIV, Syphilis and Hepatitis B
If you are interested in HPV Treatment or Anal Warts Removal and Rapid STD Screening for other HPV Strain & other STDs, you can visit any of our clinics.
You can call us or email us for an appointment at hello@dtapclinic.com.
Take Care!


For more information on other STDS.

  1. An Overview of STD by an STD Doctor
  2. Is HPV Vaccine Necessary for Males?
  3. Mycoplasma Genitalium Testing & Treatment
  4. 11 Causes of Penile Itching & Pubic Itch
  5. Sexual Health Advice for Travellers 
  6. HIV & STD in the Singapore Commercial Sex Scene 
  7. What is HIV / AIDS Signs and Symptoms
  8. Ouch! 10 Causes of Penile Pain (Pain in the Penis)
  9. 7 FAQs on HIV PrEP (Pre Exposure Prophylaxis)
  10. HPV Infection & HPV Vaccination For Men Who Have Sex With Men
  11. A Guide to HIV Prevention Pills – (HIV PEP & HIV PrEP)
  12. Do I Have HIV Rash? Or Are They From Other STD-Related Rashes
  13. What Are The Causes of Abnormal Penile Discharge
  14. HIV Window Period – Timelines For Accurate HIV Testing
  15. Herpes Simplex Virus – Everything You Need to Know
  16. The Causes of Genital Blister, Genital Ulcer & Genital Sore