Diagnosis of anal HPV and condylomas

Anal warts are the most common and characteristic manifestation of an HPV-infection in the anus. This virus is usually transmitted through sexual contact. Anal warts are small lumps but, after some time, they can get a large size.

How are genital warts recognized?

• Initially, anal warts are small, flat lumps like pimples or a cauliflower with size which ranges from a head of a pin to a pea.
• They can cause flat lesions to a big extent with a rough surface.
• Usually, they do not cause pain or any other discomfort and they are not immediately apparent.
• In some cases, they cause stinging, itching and fluid discharge.
• Furthermore, warts are often found into the anal canal, about 2-3 cm from the skin. On these warts we have to perform a high resolution anoscopy.
• In a sudden appearance and expansion of anal wart,s or a short recurrence of them after a treatment period, an HIV examination should be performed.

Another manifestation of the HPV infection in the anus (especially some aggressive sub-types) is the observed dysplasia of the skin and the anal canal (precancerous situation). Dysplasia is recognized only with the acetowhitening technique  and High Resolution Anoscopy.

HPV infection in the anus is not uncommon. This virus has been identified in 12-24% of men without anal intercourse and in 27-50% of all women. Many times, the above infection is not diagnosed clinically and for this reason special examinations are required.

• Cutaneous (skin) anal warts can be detected by visual examination after use of acetic acid (common vinegar). Acetic acid clears the mucus and precipitates nuclear proteins giving the infested lesions a pale or dark grey colour, depending on the grade of dysplasia.
• Warts often extend into the anal canal. Intraanal warts and dysplasias can be easily diagnosed with proctoscopy and acetic acid.
• The visual diagnosis of infection can be confirmed with the pathologic examination of resected specimens. Special cells (coilocytes) are very characteristic of viral infection with HPV.
• Anal cytology (pap smear) is mandatory for screening and diagnosis of precancerous dysplasias. This exam should be performed in high-risk people
• When there are no visible warts, HPV infection can be confirmed with HPV-test or PCR. These tests show the subtype of HPV virus that is responsible for the infection.
• If cytology reveals atypic cells, high resolution anoscopy under magnification should follow. Schiller and a acetowhitening techniques help in the diagnosis of minute warts and precancerous dysplasias.

PROCTOLOGY CLINIC- ATHENS GREECE