Anal Warts (Condyloma Acuminata)

What are anal warts?

Anal warts, known medically as condyloma acuminata, are soft, fleshy growths that appear on the skin and moist surfaces around and inside the anus. They are caused by specific types of the human papillomavirus (HPV), which is the most common sexually transmitted infection in the United States. While the warts themselves are typically benign (non-cancerous), they are caused by the same virus that can lead to anal dysplasia and anal cancer, making diagnosis and treatment important.

The warts can vary in appearance from tiny, flat spots to larger, cauliflower-like clusters. They can grow on the perianal skin and extend inside the anal canal up to the dentate line. Because the virus can be present without visible warts, it can be easily transmitted to sexual partners without knowledge of infection.

Common Symptoms

Many people with anal warts do not have any symptoms, especially when the warts are small. When symptoms do occur, they can include:

• Visible growths: Small, flesh-colored, pink, or gray bumps around the anus.
• Itching: The warts and surrounding skin may be itchy.
• Bleeding: Minor bleeding, especially with wiping after a bowel movement, can occur.
• Discomfort or a feeling of a lump: A sensation of a mass or fullness in the anal area.
• Moisture: The area may feel persistently damp.

What causes anal warts?

Anal warts are caused by infection with the human papillomavirus (HPV). There are over 150 types of HPV, but anal warts are most commonly caused by HPV types 6 and 11. These types are considered low-risk because they rarely lead to cancer.

The virus is primarily spread through direct skin-to-skin contact during sexual activity, including anal, vaginal, or oral sex. It is possible to get anal warts even without engaging in anal intercourse, as the virus can spread from the genital area to the anal area. Because HPV can be asymptomatic, many people who are infected do not know they have it and can pass it on to others. Factors that increase the risk of developing anal warts include:

• Multiple sexual partners.
• A weakened immune system, such as from HIV infection or immunosuppressant medications.
• Smoking.

How are anal warts diagnosed?

The diagnosis of anal warts is usually made by a simple visual inspection of the anal area.

• Physical Examination: A doctor will examine the skin around the anus. Anoscopy, a procedure where a small, lighted scope is inserted into the anus, is necessary to check for warts inside the anal canal.
• Biopsy: If the diagnosis is uncertain, if the warts do not respond to standard treatment, or if there is any suspicion of pre-cancerous changes (dysplasia) or cancer, a small tissue sample (biopsy) will be taken for examination under a microscope.
• High-Resolution Anoscopy (HRA): For individuals at high risk for anal cancer (such as those with HIV), a specialized procedure called high-resolution anoscopy may be used. This is similar to a colposcopy for the cervix and uses magnification and special solutions to identify areas of dysplasia that may not be visible to the naked eye.

How are anal warts treated?

The goal of treatment is to remove the visible warts and address any symptoms. It's important to understand that no treatment completely eliminates the HPV virus, and warts can recur after treatment. Treatment options depend on the size, location, and number of warts.

Patient-Applied Topical Medications:

• Imiquimod cream: An immune response modifier that stimulates the body's immune system to fight the virus.
• Podofilox solution or gel: An antimitotic drug that stops the wart cells from dividing.
• Sinecatechins ointment: A green tea extract with an unclear mechanism of action.

Provider-Administered Treatments:

• Cryotherapy: The warts are frozen off with liquid nitrogen.
• Trichloroacetic Acid (TCA): A chemical is applied to the warts to destroy them.
• Surgical Excision: The warts are physically cut away (excised) with a scalpel or scissors. This is often the most effective method for a small number of warts or larger warts.
• Fulguration (Electrocautery): The warts are burned off using an electrical current. This is typically done in an operating room under anesthesia for extensive disease.

It often takes multiple treatments over several weeks or months to clear the warts. It is also crucial for sexual partners to be examined and treated to prevent reinfection.

Self-Care and Prevention

While there are no home remedies to cure anal warts, you can take steps to manage the condition and prevent its spread.

• Keep the area clean and dry: Good hygiene can help reduce irritation.
• Avoid over-the-counter wart removers: These products are not designed for the sensitive skin of the genital and anal areas and can cause severe irritation and pain.
• Practice safe sex: Using condoms can reduce, but not eliminate, the risk of transmitting or contracting HPV.
• HPV Vaccination: The HPV vaccine is highly effective at preventing infection with the HPV types that cause most anal warts (types 6 and 11) and most anal cancers (types 16 and 18). It is recommended for adolescents and young adults.

Can anal warts turn into cancer?
The HPV types that cause most visible anal warts (6 and 11) are low-risk and are rarely associated with cancer. However, it is possible to be co-infected with high-risk HPV types (like 16 and 18) which can cause pre-cancerous changes (anal dysplasia or AIN) and eventually anal cancer. This is why a thorough examination and follow-up are important.

Do I have to tell my sexual partners?
Yes. Anal warts are a sexually transmitted infection. It is important to inform your sexual partners so they can be examined and treated if necessary. This helps prevent further spread of the virus.

If the warts go away, am I cured?
Treatment removes the visible warts, but it does not eliminate the HPV virus from your body. The virus can remain dormant in the skin, and warts can recur, especially within the first few months after treatment. Recurrence is more common in people with weakened immune systems.

• Cowan M, Schlussel AT. Sexually Transmitted Infections of the Colon and Rectum. In: Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed. Springer; 2022:334-336.
• Centers for Disease Control and Prevention. About Genital HPV Infection. Accessed September 28, 2026. https://www.cdc.gov/sti/about/about-genital-hpv-infection.html
• Mayo Clinic. Genital warts. Published April 21, 2020. Accessed October 12, 2025. https://www.mayoclinic.org/diseases-conditions/genital-warts/symptoms-causes/syc-20355234