Even though anal sex is widely considered to be the only sexual act gay men engage in, we all know that it is just part of our sexual lives, and for some, not a part of it at all. This focus on anal sex can have it’s advantages, such as a good deal of healthcare information disseminated to our community about HIV and some other sexually transmitted diseases. The down side is that this singular focus creates an environment where healthcare professionals only stress attention on the major STDs that may be life threatening and/or diminished with the usage of condoms. Which brings us to anal warts.

Most sexually transmitted diseases do not require the exchange of bodily fluids, such as semen or blood. They can and are usually transferred by touch and skin-to-skin contact. This includes contacts that may or may not be associated with anal sex, such as frottage and the sharing of sex toys!

NOTE: Genital warts, including anal warts can also develop in the mouth or throat of a person who has had oral sexual contact with an infected person.

What are they?

Anal warts (condyloma acuminata) are caused by the human papilloma virus (HPV), the most common sexually transmitted disease (STD). The warts affect the area around and inside the anus, but may also develop on the skin of the genital area. They first appear as tiny spots or growths, often as small as a pin head. They can grow quite large and cover the entire anal area. 

HPV really is the most common sexually transmitted disease, and probably the one you have either never heard of, or know much about. The honest truth is that most sexually active people will contract HPV at some point in their lifetime. “About 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that almost every person who is sexually-active will get HPV at some time in their life if they don’t get the HPV vaccine”.

But, don’t worry! For most guys, this STD will go away on its on, without causing any long-term problems. The bad news is that if you do develop symptoms, they can be pretty nasty, complicated and time consuming to get rid of.

Anal warts are one of the symptoms of HPV that gay men may develop.Those most likely to be infected with anal warts are those who are the receptive partners in anal sex, for obvious reasons.

Anal warts, so named because they are found inside and around the anus, are small bumps that may be very tiny when they first manifest. They may even be too small to notice with the naked eye. Without proper treatment, they can develop a cauliflower-like appearance as they grow, or when several are clustered together. Warts may be peach-colored, yellow, pink, or light brown, and may blend in with your skin color.

Anal warts are usually painless or provide little if any discomfort. But there are more severe symptoms which may present overtime, including itchingbleeding and/or a milky discharge from the anus.

How are they transmitted?

As stated earlier, anal warts may be transmitted without any sexual intercourse! All that is needed is direct contact with the mouth, anus or penis of a person with HPV. Skin to skin contact is necessary for infection but your partner does not need to have visible warts to be contagious. This is a very important fact for those of you who believe simply wearing a condom will protect you from each and every STD in existence. In the real world, sex is much more complicated and you must use both of your heads for proper and full sexual enjoyment.

Because of the simplicity in which anal warts may be transmitted, including by any contact exposure to the anal area (hand contact, secretions from a sexual partner) basic hygiene before and after sex is important. But, before you go blaming your latest sexual partner for infecting you, SLOW YO ROLL, because exposure to the virus could have occurred many years ago or from prior sexual partners, even though you may have just recently developed the actual warts.

In the real world, sex is complicated and messy. There is no getting around these facts. Anal warts are a perfect example of an STD that does not fit neatly into the traditional STD prevention handbook. But that’s ok, because one of the wonders of being a gay man is our ability to learn, grow and adapt to situations. In this case, the first step is being aware that this STD exists and that you can contract, or even transmit it, very easily, without even knowing it.

What do I do if I think I have them?

We often stress the value in having a doctor that you see regularly and have a good relationship with. Most guys would not be comfortable having their first appointment with a new physician and having to literally show him his ass. Your first step in any STD prevention and treatment plan is to secure yourself a doctor that you trust, not just with your basic physical health and yearly flu shots, but also your sexual health and history. We can promise you that at some point in your life, you will need to share this information with them. Also, as a sexully active gay man, you are at risk for every STD and should be getting tested every three months ANYWAY.

Self diagnosis is usually how most guys will discover that they have anal warts, but a sexual partner may also tell you. It is always a good idea to be very familiar with your anal region, inside and out, for causes such as anal warts. Your body has natural bumps and divots that have nothing to do with HPV, and if you are familiar with your butt, you will know this, and not freak out. But if you do feel some form of growth, that does not go away within a few days, you might have a case of anal warts. So, of to the doctor you go.

The American Society of Colon and Rectal Surgeons (ASCRS) let’s you know exactly what you can and should expect during your examination.

“Although potentially sensitive and difficult to talk about, your doctor may inquire as to the presence or absence of risk factors to include a history of anal intercourse, a positive HIV test or a chronically weakened immune system (medications for organ transplant patients, inflammatory bowel disease, rheumatoid arthritis, etc).”

“Physical examination should focus primarily on the anorectal examination and evaluation of the perineum (pelvic region) that includes the penile area to look for warts.  Digital rectal examination should be performed to rule out any mass.  Anoscopy is typically performed to look within the anal canal for additional warts.  This involves inserting a small instrument about the size of a finger into your anus to help visualize the area.”

How, if at all, are they treated?

There are two pieces of great news when it comes to anal warts. For some guys, the warts will go away on their own within a short period of time. But this is a chance you do not want to take. If you have, or believe you have anal warts, you should seek out your doctor for medical advice. Most often, you will be informed about the removal process which is the prefered form of treatment. ” If they are not removed, the warts usually grow larger and multiply. Left untreated, warts may lead to an increased risk of anal cancer in the affected area. Fortunately, the risk of anal cancer is still very rare.”

Again, we look to the ASCRS to give guidence about the types of treaments available to you.

Topical Options for Treating Warts

Medications:

 If warts are very small and are located only on the skin around the anus, they may be treated with a topical medication in the office and sometimes at home. Common topical medications applied directly to the warts are podophyllin, trichloroacetic acid and bichloroacetic acid. These office treatments do not require anesthesia and only take a few minutes to apply to the warts. Minor burning or discomfort may be experienced after treatment and, thus, most patients can return to work after the procedure. Your physician will recommend when to wash off the medication after treatment. Topical agents that can be applied at home on small warts include Imiquimod or 5-fluorouracial (5-FU), although how well they work to eliminate anal warts completely is unknown. Side effects include skin irritation, burning and painful ulcerations of the skin. If you develop severe side effects, immediately stop using the cream and contact your physician.

Cryotherapy: 

Anal warts may also be treated in the physician’s office by freezing the warts with liquid nitrogen. Similar recovery as the topical agents mentioned above is expected.

SURGICAL OPTIONS FOR TREATING WARTS

Surgery provides immediate results, but must be performed using either a local anesthetic – such as Novocaine – or a general or spinal anesthetic, depending on the number and exact location of warts being treated. Fulguration (burning), surgical excision (removal), or a combination of both, are used to treat larger external and internal anal warts. Surgical treatment of anal warts is usually performed as outpatient surgery.

Most people are moderately uncomfortable for a few days after treatment, and pain medication may be prescribed. Depending on the extent of the disease, some people return to work the next day, while others may remain out of work for several days to weeks. Pain, discomfort and slight bleeding are expected in the recovery period and may last at some level for several weeks. Excessive bleeding is abnormal and your physician should be informed immediately if you experience large amounts of bleeding.  Clear, yellowish or blood tinged drainage or moisture will be expected for days to weeks after the procedure. Placement of a pad and frequent dressing changes will help lessen the moisture and itching associated with the drainage.

When warts are extensive, your surgeon may wish to perform the surgery in stages.  Additionally, recurrent warts are common in over 50% of patients. The virus that causes the warts can live concealed in the skin that appears normal for several months before another wart develops. As new warts develop, they usually can be treated in the physician’s office. Sometimes new warts develop so rapidly that office treatment may not be possible or could be quite uncomfortable. In these situations, a second, and occasionally, third outpatient surgical visit may be recommended.

Follow-up visits are necessary at frequent intervals for several months after the last wart is observed to be certain that no new warts occur. It is important to see your physician on a routine basis as recommended by her/him or if you notice any new lesions or new symptoms (pain, rectal bleeding).

In some cases, warts may recur repeatedly after successful removal, since the virus that causes the warts often persists in a dormant state in the skin. Discuss with your physician how often you should be examined for recurrent warts.

Real talk

In our article on testicular cancer, we speak about the benefits of being a guy who has sex with other guys. For the most part, you should have a good understanding of what a healthy penis or anus looks like. You should, after reading this article, also have an idea what you should be on the look out for in your partners to avoid anal warts as much as possible. Our best piece of advice, besides creating your own, real world, STD prevention guidelines is to always take a few moments to “inspect the goods” before they get near your body. Like you mother always said,” if it looks weird, don’t put it in your mouth.”

Before you go….

We understand that for some of you, this was an uncomfortable topic to read about. But we need to start discussing these healthcare issues more openly and honestly so that we can slow down their transmission and reduce the spread of STD stigma. For this reason, we hope that you take the time to read about one man who had his own battle with anal warts, including many of the issues we discussed earlier.

If you have found yourself with a case of anal warts, remember that STDs are as normal and natural as sex itself, and that you are neither the first nor will be the last guy on earth to catch anal warts. Here is Micheal from Berlin‘s story

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