Anal warts are the most common sexually transmitted disease treated by surgeons. These are soft masses (growths) resembling to myrmecia, having the same color as skin, pink or whitish, often cauliflower-like. They are solitary or multiple and are located on the perianal skin and/or inside the anal canal. Over 100 virus types have been identified. Types 6 and 11 are the most common ones in the anal area with low risk of being transformed into cancer. Conversely, the rarest types 16 and 18 involve high risk of dysplasia and malignant transformation. Often there are more than one virus strains in the same patient.
They are transmitted via sexual intercourse but also with self-inoculation from the genital area. Immunosuppression is a particular predisposing factor, since reduced immune response results in higher frequency in the general population and appearance of more rare strains.
The estimated incubation period is usually 2-3 months. The clinical symptoms depend on the wart site, number and size and they are usually mild. They are asymptomatic in some cases while in other cases they cause pain, sensitivity, pruritus, small bleeding and discomfort due to the unpleasant esthetic result. Proctoscopy is necessary in diagnosis to detect any non-visible internal anal warts. Moreover, examination of the entire genital area and sexual partners is necessary. Differential diagnosis includes other similar skin diseases (e.g. syphilis).
Treating warts is necessary for symptom remission, improvement of the esthetic problem and prevention of transmission. Various methods of treatment such as electrocauterization, use of laser in surgery, cryotherapy, the use of toxic substances such as podophyllotoxin or bichloride-trichloride acid. Unfortunately, relapse rates are rather high due to the nature of the disease necessitating more than one sessions. Furthermore, these methods often damage healthy adjacent skin.
Surgical excision ensures the complete removal of the lesion allowing for a histologic examination. Also, it can be performed using local anesthesia. Anal warts should be removed with sparing of the natural mucosa to prevent complications and for faster healing. Histology results are very important in order to rule out dysplasia or malignancy potential and to identify the viral strain.