7 year ago, by Alexander Korton in
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I decided to write about anal warts because it is an embarrassing problem. A lot of male patients avoid to go to the proctologist not only because it is a very delicate problem, but because also it is a condition most common in gay communities. But because it's a condition that in some cases can lead to anal cancer if untreated, I took the decision to write about this "deep" issue.
Causes of anal warts
The cause of anal warts is the direct contact between your anal/genital skin with an infected surface, in most cases, infected skin. Usually, the contact occurs in sexual contact. The warts are lumps of tissue that grow under the infection with HPV (Human Papilloma Virus).
This virus is very contagious and transmits easily through simple skin contact in 70% of cases. But only 1% of those infected will make the disease, while the other 69% seem healthy. Anyway, even healthy carriers are infected and they transmit the virus.
Even if left untreated, the anal warts may lead to anal cancer, this virus is not the same with the Anal Cancer Virus. The HPV virus can not be treated, so once you get it, you have it for life. You become a carrier, so you have to take care to not infect others.
The virus is very tiny, it penetrates through the skin abrasions and infect the tissues that come in contact with it. Once the cells are infected with HPV, there might be more than 2 years of latency till the clinical signs appear, but in most of cases that happens in the first 6 months.
Symptoms and signs of anal warts
One can't say when they get infected with the HPV. The first signs that make you aware of being infected with this virus are the tiny small lumps of tissue around your anus. They are warm, red-pale and remember somehow cauliflower. You can feel them first in the shower or once they grow they might become painful on bowel movement. The anal warts may grow outside your anus or inside of it. In the last case you will discover them only when they get irritated and defecation becomes a painful process. Only a proctologist can decide if you are having anal warts or other affection, so the specialist's opinion is very important in deciding the definitive diagnosis.
Anal warts treatment (Management)
Our organism has its own defense system, that kill or slow the viruses. The interleukins are anti-viral molecules that slow the viral replication through interferons. But in case our immune system can't handle the viral spreading, the external signs appear (anal warts). The treatment is always aggressive - the main goal is to remove the warts, though there're no guarantees that they will not reappear. Main treatment procedures are:
- Podophyllotoxin (0.15% - 0.5%) usually applied by the patient on the affected area. Generic names: Condylox (0.5%), Wartec (0.15%) or Warticon (0.15%)
- Imiquimod - a drug that boosts the immune response and that might activate the organism to fight by its own against the viral aggression.
- Cryotherapy with liquid nitrogen - this is a method when the warts are frozen with liquefied nitrogen. The recurrence is high - between 30 and 70% of patients will need repeated procedure.
- Topical medication, applied directly on warts: the doctor will "burn" the warts, usually with an acid or another substance. You can't perform this at home, because there're big chance you will drop some medication on healthy mucosa, which can call severe inflammation and burns.
- Electrical cauterization - the method consists in "burning" the warts
- Surgical excision - it is the most popular method, mostly because the majority of patients come to the doctor when the anal warts are too big to be electrically or chemically burned. The recurrence is lower.
Without any intervention, the anal warts don't stop growing and they can reach impressive dimensions. Also, aging anal warts are more susceptible to anal cancer, so in this case, the faster we start the treatment - the better.
In most of cases, no one can remove all existing warts, so there might be tiny wart left uncut and which will need a repeated surgical procedure in about 6 months.
Sometimes, anal warts may regress and disappear, but no one can predict their evolution.
Prevention of anal warts
The prevention of anal warts consists in preventing the infection with HPV. This can be done by using condoms during sexual contact, even though condoms can not protect entirely - there are still genital skin areas that remain uncovered by condoms. Condoms only diminish the chances of HPV infection.
A healthy organism and a strong immune system will prevent you from developing the anal warts even if you got infected. If you have a powerful immune system, you might remain healthy while being infected and you will not develop anal warts.
Vaccines that protect against Human Papilloma Virus are prophylactic, so they have to be taken before you get infected, and not as a treatment. Such vaccine is Gardasil, which is active against some strains of HPV.
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