Warts around the anus: causes, symptoms and testing

Warts around the anus are soft bumps on the skin around the anal opening. They come from HPV, usually type 6 or 11 (Steben, 2014). They rarely hurt, but they often itch, and they can bleed when you wipe.

The biggest misconception first, because it does the most damage. You do not only get anal warts from anal sex.

HPV travels across the skin. While washing, while wiping, or simply through contact during ordinary sex, the virus reaches the anal skin. That is why people who have never had anal sex can get them too.

What are warts around the anus?

They are benign skin growths on or around the anal rim, caused by low-risk HPV. They are skin-coloured to greyish white, firm, and often grow in clusters. They can also sit inside the anal canal, where you cannot see or feel them, except sometimes as itching or a full sensation.

The medical name is condylomata acuminata, same as elsewhere on the body.

They are not rare. Genital warts appear in 160 to 289 new cases per 100,000 people each year (Patel, 2013), and the anal skin is one of the places where they settle most easily.

Do you only get anal warts from anal sex?

No. This is the most important correction in this piece. HPV spreads through skin-to-skin contact and travels across the skin from the genital area to the anal skin. Anal sex raises the risk, but is certainly not a requirement. Women and men who only have vaginal sex can get anal warts too.

We state this explicitly because the assumption runs the other way, and because that assumption stops people from asking for help.

Picture a woman of 34 who has never had anal sex, seeing two bumps of three millimetres beside her anus. She concludes they cannot be warts, because surely you only get those from anal sex. She waits four months. That is the mistake this assumption produces, and it is entirely understandable.

For men who have sex with men the odds are higher. In a pooled analysis of 64 studies covering 29,900 men, 41.2 percent of HIV-negative men who have sex with men carried high-risk HPV in the anal canal, and 74.3 percent of HIV-positive men (Wei, 2021). That concerns high-risk types rather than the wart-causing ones, but it shows how common anal HPV is.

What that means for your testing schedule sits in STI testing for MSM.

How do you recognise warts around the anus?

They are firm, dry and usually painless. Haemorrhoids feel different: softer, they can throb or hurt, and they swell when you strain. Skin tags are floppy flaps of skin without the grainy texture of a wart. The difference is not always visible in a mirror, and it does not have to be: a doctor can see it.

Bleeding with stool belongs with your GP as a matter of course, whatever you think you can see. Not because it is usually serious, but because you should not be guessing.

Does an STI test find warts around the anus?

No. No blood test and no urine test finds HPV or anal warts. Our panels do not either. HPV sits in skin cells, not in your blood. A GP, GGD doctor or dermatologist makes the diagnosis by looking. For men, the Netherlands also has no HPV test routinely on offer.

What a test does do is find the infections you cannot see.

That is not a consolation prize. Chlamydia and gonorrhoea often run completely silently, and those are exactly what a PCR finds well. HIV and syphilis sit in the blood. If a wart has got you thinking anyway, you can check all four at once with the chlamydia, gonorrhoea and trichomonas test and the Viral Infections Package.

What do you do now?

Make an appointment with your GP and have it looked at. That is one consultation and it gives you an answer no test can. Thuisarts.nl describes the treatments possible afterwards, from a cream to freezing with liquid nitrogen. Waiting is also allowed: many warts disappear on their own.

We would not postpone it out of embarrassment about the location. GPs see this weekly.

Rule out the silent infections at the same time if you had a new partner in recent months. The full picture of HPV, including how transmission works and why a wart proves nothing about your relationship, sits in our hub on genital warts and HPV. If there is something on the penis too, read genital warts on the penis.

References

1. Wei F, Gaisa MM, D'Souza G, et al. Epidemiology of anal human papillomavirus infection and high-grade squamous intraepithelial lesions in 29 900 men according to HIV status, sexuality, and age: a collaborative pooled analysis of 64 studies. Lancet HIV. 2021;8(9):e531-e543. PMID 34339628.
2. Steben M, Garland SM. Genital warts. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1063-1073. PMID 25155525.
3. Patel H, Wagner M, Singhal P, Kothari S. Systematic review of the incidence and prevalence of genital warts. BMC Infect Dis. 2013;13:39. PMID 23347441.
4. Giuliano AR, Lee JH, Fulp W, et al. Incidence and clearance of genital human papillomavirus infection in men (HIM): a cohort study. Lancet. 2011;377(9769):932-940. PMID 21367446.
5. RIVM. STI surveillance and sexual health in the Netherlands. Available via rivm.nl.
6. Thuisarts.nl (NHG). I have genital warts. Available via thuisarts.nl.

This information is general and does not replace personal medical advice. Every STI test result at Discreet Test is reviewed by a BIG-registered doctor. Always discuss symptoms or treatment decisions with your GP, the GGD or a Centre for Sexual Health.