Anal warts: why anoscopy matters and what happens if you wait

When someone comes in with anal warts, they have usually noticed one or more lesions on the skin around the anus. But the human papillomavirus does not distinguish between outside and inside: warts also appear inside the anal canal, where they cannot be seen on inspection or felt on examination.

This is why an apparently successful treatment can be followed by a recurrence within weeks. It is not that the treatment failed: lesions were left untreated where nobody looked.

What anoscopy is and why it is always performed

Anoscopy is a simple examination that allows the inside of the anal canal to be seen. It is carried out in the clinic itself, takes very little time, requires no anaesthesia and no prior preparation — no diets, no enemas — and identifies lesions that external inspection does not detect.

Why waiting is a bad idea: from a clinic procedure to surgery

Warts are not stable lesions. They grow and multiply over time, and that is where the real difference lies between coming in early or late.

Few, small lesions

These are resolved by electrofulguration in the clinic itself, under local anaesthesia, in a single session. You walk home the same day and return to your usual activity immediately.

Extensive or confluent lesions

When the affected area is large, the outpatient approach is no longer viable. It then requires an operating theatre, general or spinal anaesthesia and, frequently, several sessions spread over time so as not to compromise healing in such a delicate area. The postoperative period is considerably more uncomfortable and recovery takes longer.

Put another way: what today is a twenty-minute procedure in clinic can, within a few months, become a surgical operation requiring admission. The difference is not determined by the severity of the disease, but by how much time is allowed to pass.

How we do it in clinic

Assessment of the perianal area, anoscopy to rule out internal lesions and, where appropriate, treatment in the same visit. No waiting list and no hospital admission.

Follow-up appointments are part of the treatment: HPV can remain latent in normal-looking tissue, so new lesions may appear later on. Detecting them early means they can be treated simply — exactly the same principle: do not let them grow.