Anal Warts / Genital Warts
Anal Warts / Genital Warts (also called Condyloma) are non cancerous
growths around the anus and within the anus. They
are caused by the human wart virus. The
spread of this virus is usually by direct
contact.
Symptoms
At first, the warts are tiny. They
become noticeable and can be felt when they reach
the size of a pinhead. They grow to the size
of a pea (Fig 1.) and eventually completely
envelope the anus. (Fig 2.) Individuals
become aware of the warts because of the lump or
because of discomfort, irritation, discharge of
fluid or bleeding when wiped. Cleanliness becomes difficult.
Many patients believe they
have haemorrhoids. Eventually the wart virus
can cause cancers in the anal or genital area.
Treatment
Medication applied to a single wart can be effective but often
results in damage to normal skin in the vicinity. Usually several
applications are necessary.
Treatment with electrical cautery
or by surgical excision is more accurate, quicker and acceptable.
If there are only one or two warts, the treatment is given with
local anaesthesia, injected immediately under the wart. This
prevents any pain caused by electro-cautery or surgery.
When the
warts are more extensive, a
general anaesthetic or alternatively deep sedation given by
an injection followed by a local anaesthetic into the anal area
makes the
procedure free from pain. The patient can go
home immediately afterwards. Overnight hospitalisation is not
required.
Aftercare
Analgesic tablets such as Paracetamol with Codeine reduce the
post operative pain. Another helpful method is to sit in a warm
bath with a small quantity of added salt for 10 minutes.
Repeated
Treatments
It is important to realise that one treatment is unlikely to
cure the condition. The doctor must see the patient regularly
for several months. As soon as a wart reappears it must be treated.
Early treatment would only take a minute and would prevent the
type of spread shown in the pictures below. Should this be allowed
to occur, extensive treatment would again be needed.
Return to
Work
This is often on the next day but with extensive treatment,
several days may be needed.
Prevention
Sexual contact with individuals who
have genital warts must be avoided. Condoms give a partial protection.
Screening
Screening for other sexually transmitted diseases is necessary. This should include sreening for HIV and Hepatitis B and C. As the wart virus is implicated in cervical cancers all female patients should have Pap smears performed.
Caution
Anal symptoms such as bleeding can be
due to other conditions. The most dangerous of these is cancer
of the rectum or colon. The possibility of this may need investigation.
Persons
with genital warts should have tests to ensure no other sexually
transmitted
diseases are involved.
A.I.N (Anal intraepithelial neoplasia)
This is a condition seen under the microscope after biopsy of the anal skin. It shows that this skin is liable to become cancerous.
At first a relatively mild change occurs (A.I.N. 1). It may take years before A.I.N. 2 develops. These changes are unlikely to require surgical intervention. Immiquimod cream may help to alter the immune response to the wart virus and thus prevent the progression of the disease. A.I.N. 3 is more severe and heralds early change to cancer. Excision of the skin in the affected area may become necessary at this stage.
Fig (1) Warts vary from pinhead size to pea size.
Fig (2) The eventual outcome of untreated warts.
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