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Anal warts first appear inside and around the anus in the form of tiny spots or growths, report doctors at the american society of colon and rectal surgeons 1. Anal warts, also referred to as condyloma acuminata, can start as small as a pinhead and grow to about the size of a pea. anal warts are a form of genital warts caused by human papillomavirus (hpv). Theyre a type of genital wart that occurs inside or around the anus. Genital warts can be external, on the outside areas of your reproductive organs, or they can appear internally where you cannot see them. Internal warts can develop on the cervix, urethra, anus or inside the vagina, according to the new zealand dermatological societys information resource dermnet nz 2. All genital warts are caused by strains of hpv, or human papilloma virus. How long does it take for over the counter wart removal to work. Anal wart removal there are different methods of anal wart removal. Oftentimes, doctors will recommend a topical treatment if the warts are small and located only on the area around the anus. In these cases, there are a few topical medications that remove those small warts. However, anyone with external warts needs to be examined for internal anal warts. Its possible that if the anal warts are internal, topical medications may not work in which case surgery could be required. (burning), surgical excision (removal), or a combination of both, are used to treat larger external and internal anal warts. There is still a high rate of recurrence of anal dysplasia despite a wide removal of tissue and high rates of complications such as.