[Question #1879] HPV concerns

98 months ago

I am a 21 year old female who is concerned about the affects of possible HPV. I am aware that it is inevitable that the sexually active population comes into contact with HPV frequently, but am concerned about a couple of things. I became sexually active before getting the Gardasil 4 vaccine, and had 2 partners (one vaginal and one oral) before the vaccination. The vaginal partner was protected always with condoms (I know this does not necessarily protect against HPV), but the oral exposure was not. From the oral exposure, I remember getting recurrent tonsillitis that caused me to have the tonsils removed (my doctor was not informed about the oral sex exposures as I did not link the two and was too embarrassed at the time). I have recently had my first cervical pap, and am waiting on the results. I have also had anal exposures on 2 occasions in the past, unprotected, since receiving Gardasil. I had to go to my GP for some sort of peri-rectal fissures and a possible fistula, and she has referred me to a gastroenterologist for further evaluation as she wasn’t entirely sure what was going on. I am pretty worried that my previous exposures could have possibly put me in danger for either oral or anal hpv related cancers, and it especially concerns me that these are not routinely screened for. Maybe I should add that in total I have had a total of 7 partners, 5 of which were after being vaccinated with Gardasil. I am currently in a long term committed relationship. My questions are the following:

1. Should I be concerned and spend my time worrying/ trying to check that these exposures could lead to cancer of either the throat or the rectum?

2. Are anal paps or any sort of throat screening recommended?

3. Is it possible that cancer would have already developed?

Edward W. Hook M.D.

98 months ago

Welcome to the Forum. I will try to be, principally by trying to assure you that your risk for infection is low, that if your were infected with HPV (unlikely) the chances are more than 99% that the infection will resolve itself with no consequences and that should you have had the misfortune (and that is all it is- bad luck!), problems can be addressed. You have had a relatively low number of unprotected exposures and have the benefit fo the vaccine. These are all very much in your favor. At this time, the best course of action is to move forward with your life, including your current relationship, without concern and to follow regular sexual and general health guidelines- seek regular care, get your regular PAP smears and should persisting abnormalities occur, ask your doctor to evaluate them.

In answer to your specific questions:

1. Should I be concerned and spend my time worrying/ trying to check that these exposures could lead to cancer of either the throat or the rectum?

No, I would assess your risk as being, statistically far less than average. Even in the unlikely situation that you acquired HPV, most HPV infections resolve on their own in the 6-24 months after acquisition and only a few of those which persist go on to cause pre-cancerous lesions.

There are no recommended screening tests for HPV of the throat but your dentist will look for abnormalities as part of her/his routine evaluation at the time of your periodic check-ups. Rectal PAP smears would not be recommended for you at this time. Evaluation of possible rectal HPV infections and risk for cancer is the subject of an ongoing NIH study which will take several more years to provide results.

2. Are anal paps or any sort of throat screening recommended?

No, see above.

3. Is it possible that cancer would have already developed?

The chances that this has occurred are very, very low. I would simply have your doctor do the routine PAP smear. If it is normal, I would not worry further and just follow routine recommendations for PAP smears going forward.

Finally, I would strongly recommend that you stay off of the internet and not look there for answers. The majority of what you would find there is out of date, mis-interpreted or simply wrong.

I hope my comments are helpful to you. EWH

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