Who Treats Anal Warts in Men
External (perianal) anal warts can be treated by primary care providers, while intra-anal warts require referral to a specialist such as a colorectal surgeon or proctologist. 1, 2
Critical Anatomical Distinction Determines Provider
The most important clinical decision is determining the exact location of the warts, as this dictates who should provide treatment:
External Anal Warts (Perianal)
- Primary care providers can manage these lesions using office-based treatments like cryotherapy or trichloroacetic acid (TCA) 1, 2
- These warts are located on the perianal skin and do not extend into the anal canal 1
- Treatment can be initiated immediately without specialist referral 2
Intra-anal Warts
- These require specialist consultation and management according to the American Society of Colon and Rectal Surgeons 1
- Colorectal surgeons or proctologists should treat warts located within the anal canal or on rectal mucosa 1, 3
- Anoscopy is necessary to visualize and treat these lesions properly 3
- Specialist referral is mandatory because these lesions require different treatment approaches and carry higher risk of complications 1, 2
Clinical Examination Requirements
A thorough examination including anoscopy is essential to differentiate external from intra-anal disease 3:
- Visual inspection identifies perianal warts 2
- Anoscopy must be performed to detect intra-anal extension 3
- This distinction cannot be made by history alone and requires direct visualization 1, 3
When to Refer to Specialists
Beyond anatomical location, the following situations warrant specialist referral 4:
- Extensive or refractory disease that has failed initial treatment 4
- Large number or area of warts requiring surgical excision 4
- Suspicion of dysplasia or malignancy (particularly in HIV-positive patients) 5
- Warts that have not responded after 6 weeks of primary care treatment 1
Common Pitfall to Avoid
Do not assume all anal warts in men are external and treatable in primary care. Many patients have both external and intra-anal components, and treating only the visible external warts while missing intra-anal disease leads to treatment failure and recurrence 3, 6. Always perform anoscopy before initiating treatment 3.