Anal Warts: Symptoms, Diagnosis, and Treatment Options

Cauliflower, anal papilla inflammation?

Hello Doctor, about a month ago, I noticed some white protrusions in the internal anal area at the dentate line, located approximately 2 centimeters inside, near the lower rectal mucosa.
They are not solitary; there is a ring of similar depth all around, varying slightly in size but not too large.
Since I discovered them, I haven't felt any significant increase in size, and they are generally not itchy or painful.
When I clean myself, I can touch them slightly without any bleeding, pain, or itching, and there are no unusual secretions; it just has the normal odor of intestinal fluid.
My bowel movements are relatively normal, with no blood or unusual secretions present.
As a gay man, I suspect they might be genital warts, but I engage in anal intercourse infrequently.
Additionally, I have not found any suspicious warts on the skin around my penis or anus.
The white protrusions have not shown any signs of growing outward from the anal opening since I first noticed them, although I cannot determine when they actually started.
During my first visit to the hospital, the doctor noted that I had an anal fissure and prescribed ointment for it, arranging for HIV and syphilis testing, but did not perform a digital rectal examination to assess the internal situation.
Upon follow-up, both HIV and syphilis tests were negative.
The doctor used an anoscope (a device that dilates the anus) to examine the interior and mentioned the presence of hemorrhoids.
He could not confirm whether the white protrusions were genital warts, only stating that it was a possibility, and said that to confirm, I would need to be hospitalized for electrosurgery to examine the tissue afterward.
He ultimately prescribed hemorrhoid suppositories.
I feel that suggesting electrosurgery without being able to confirm whether they are genital warts is a bit excessive.
I would like to ask the following questions:
1.
If I want to confirm what the growths are, is electrosurgery the only option? Is it not possible to take a small biopsy first?
2.
If they are genital warts, is it possible for my penis and the external anal area to appear normal while the growths develop internally from the rectum?
3.
Since I have had an anal fissure for some time, I noticed that the skin around the fissure appears relatively normal (without growths) when I examine it.
If the infection was transmitted through intercourse, would it be more likely to develop from the fissure?
4.
I have researched online and found that my symptoms align more with "anal papillitis," but there is limited information available on this condition.
Do you think this is a possibility?
5.
If they are genital warts, what is the typical growth rate and what symptoms might I expect? What unusual sensations should I be aware of in my body?
I apologize for the numerous questions, but since my visits to the clinic have not directly resolved my concerns, I hope to seek your advice.
Thank you!

Mr. Hong, 20~29 year old female. Ask Date: 2020/04/21

Dr. Ke Fangxu reply Surgery

1.
Of course, a small piece needs to be excised for testing.
Electrocautery will vaporize the warts, making it impossible to examine.
The physician's intention is to perform electrocautery during hospitalization and simultaneously excise a wart for testing.
You misunderstood; it is not possible to do this without hospitalization because the lesion is located in the lower rectum, which requires general or regional anesthesia for removal.

2.
It is possible that many patients with anal warts do not have lesions on their partner's penis.

3.
Not necessarily.

4.
It is also possible, which is why your physician prescribed a topical ointment for you to use.

5.
The growth rate varies from person to person.
The symptoms typically consist of wart proliferation, with occasional bleeding or pain, while itching is more commonly experienced.

Reply Date: 2020/04/21

More Info

Anal warts, also known as condylomata acuminata, are caused by the human papillomavirus (HPV), a sexually transmitted infection. Understanding the symptoms, diagnosis, and treatment options for anal warts is crucial for effective management and peace of mind.

Symptoms
The symptoms of anal warts can vary. In many cases, individuals may not experience any symptoms at all. However, common signs include:
- White or flesh-colored growths: These may appear as small bumps or clusters around the anal area.

- Itching or discomfort: Some individuals may experience itching or irritation, although you mentioned that you do not have these symptoms.

- Bleeding: While you noted no bleeding, anal warts can sometimes cause bleeding, especially if they become irritated or if there is concurrent anal fissure.

- Changes in bowel habits: Although you reported normal bowel movements, some individuals may experience changes due to discomfort or the presence of warts.

Diagnosis
Diagnosis of anal warts typically involves a physical examination. In your case, the doctor used an anoscope to visualize the anal canal, which is a common practice. If there is uncertainty regarding the diagnosis, such as differentiating between anal warts and other conditions (like hemorrhoids or anal fissures), further diagnostic procedures may be warranted.

1. Biopsy: A biopsy can be performed to confirm the diagnosis. This involves taking a small sample of the tissue for laboratory analysis. It is a less invasive option compared to electrosurgery and can provide definitive results.

2. Electrosurgery: This method is often used for treatment but can also serve as a diagnostic tool if the tissue is sent for analysis post-removal. However, it is not the only option for diagnosis.

Treatment Options
If the growths are confirmed to be anal warts, treatment options include:
- Topical treatments: Medications such as imiquimod or podophyllin can be applied directly to the warts.

- Cryotherapy: Freezing the warts with liquid nitrogen is another common treatment.

- Electrosurgery or laser therapy: These methods involve removing the warts through electrical or laser means.

- Surgical excision: In some cases, surgical removal may be necessary.

Addressing Your Concerns
1. Confirming the Growths: It is not strictly necessary to undergo electrosurgery for diagnosis. A biopsy can be performed to determine the nature of the growths, which may be less invasive and provide the information you need.

2. Location of Warts: It is possible for anal warts to develop internally without visible external lesions. HPV can cause growths in the anal canal, and it is not uncommon for individuals to have warts in this area without external manifestations.

3. Anal Fissures and Infection: While anal fissures can increase the risk of infections, the presence of warts is not directly linked to fissures. However, any break in the skin can potentially allow for the introduction of pathogens.

4. Anal Papillitis: Your self-research regarding anal papillitis is valid. This condition can present with similar symptoms, and it is characterized by inflammation of the anal papillae. A healthcare provider can help differentiate between these conditions based on clinical findings.

5. Growth Rate and Symptoms of Warts: Anal warts can vary in growth rate. Some may remain small and asymptomatic for long periods, while others can grow larger or multiply. Symptoms may include itching, discomfort, or bleeding, but many individuals remain asymptomatic.

Conclusion
Given your concerns and the complexity of your symptoms, it would be prudent to seek a second opinion or consult a specialist, such as a proctologist or a dermatologist with experience in sexually transmitted infections. They can provide a thorough examination, discuss your treatment options, and help alleviate your concerns regarding the growths. Remember, early diagnosis and treatment can help manage symptoms effectively and prevent complications.

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