A colonoscopy for perianal acromegaly has the potential to cause viral dissemination. Perianal warts are a sexually transmitted disease caused by human papillomavirus infection. A colonoscopy when there are perianal warts may result in localized skin damage which in turn may result in the spread of the HPV, which may lead to the virus entering the intestinal tract and causing rectal warts. When there are perianal warts, it is recommended not to do a colonoscopy, but to treat the perianal warts first. There is a risk of viral dissemination with colonoscopy for perianal acromegaly, and appropriate treatment options should be chosen under the guidance of a physician.