[Question #2376] Anal-Oral, HPV and Anal Cancer

43 months ago
I am a straight male 29 years old. About a year ago I had one exposure receiving oral anal (which led to rectal gonorrhea and severe proctitis).

I also wasn't vaccinated to HPV. I actually got the HPV vaccinations a month to five months after my one and only exposure. 

I know that Anal cancer comes primarily from anal HPV so my question is am I at risk for future Anal cancer? Is this something I need to check on 10 years from now?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
43 months ago
Welcome back to the forum. With no further mention of your rectal gonorrhea and proctitis, I assume all is well in that regard. But I would still be interested to know what transpired with the delayed proctitis a few months after the initial gonorrhea diagnosis, if you'd like to share it. Presumably no recurrence since then, right?

Although oral-genital sex can transmit HPV, it's a far less common source of genital HPV than insertive vaginal or anal sex. There are no data for analingus, but since oral HPV infections primarily involve the throat and not the tongue, I would consider the risk for any single exposure like yours to be very low, probably on the order of one chance in many thousand, perhaps 1 in a million or lower.

All people get genital HPV (at least 90% of us), often several times. Anal HPV and cancer are most common in men or women who are the receptive partners in penile-anal sex, and thus most common in men who have sex with men. But they are also quite frequent in heterosexual men who have never had sexual activity involving their anorectal area. In absence of anal sexual exposure, anal HPV is believed to occur both from auto-inoculation (e.g. anal scratching or toilet wiping after contact with one's own genital area) and by migration of the virus from the genital area to the anus. Given the frequency with which this happens (up to 10% of straight men have anal HPV at any one time), your risk of someday having anal HPV is far higher from your current or future sexual activity than it is from this single episode of analingus.

Further, the vast majority of HPV infections, whether genital, anal or oral, never progress to cancer -- even with the high risk HPV types most likely to cause cancer. Finally, although your HPV vaccination followed the anal gonorrhea and of course could not protect against HPV during that exposure, it is highly protective against about 90% of all subsequent HPV exposures that could someday lead to cancer. So you are highly protected -- against a problem that is extremely unlikely anyway.

As for future health risks, all humans should be aware of their anal health in general terms. Get checked if you ever develop anal soreness, ulcers, bumps, protrusions, pain, or bleeding. But your risk of these, or of anything serious, is no higher than average. This isn't something to be worried about.

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
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43 months ago
Hey Doctor,

I'm so glad you remembered! Unfortunately, that previous incident is still not fully fixed and has perplexed my general practitioner as well as my new gastroenterologist. 

Just a quick recap and update on the incomplete evacuation issue - 3 months after my proctitis was immediately ended after taking the shot+antibiotics fixing the rectal gonorrhea (I know a few doctors are hesitant to believe that the oral-anal incident caused gonorrhea and believe it could have been a false positive), I started having incomplete bowel movements again and has been that way for a year now. I haven't had full evacuation for a whole year. I re-tested all the STDs (twice) and it all came back clean, even HSV1). I even had a sigmoidoscopy with a biopsy and it came back normal - no inflammation nothing out of the ordinary. I've had stool tests and nothing came back positive. My gastro wants to re-do the sigmoidoscopy to make double-check and make sure nothing is weird there. 

I've spoken to another gastro online and he thinks it's H pylori but my current gastro doesn't think so and hasn't ordered that test. 

I've been put on a high fiber diet, on magnesium supplmenets, probiotics and 2 servings of metamucil then citrucel. My stools have been VERY soft due to this, sometimes even watery, but even with that I still feel incomplete after every evacuation so I read it wasn't a "physical" issue with the stool. Sometimes I can go again an hour later and a bit would come out. I feel a bit bloated, gassy and my rectum sometimes full at the end of the night and I wake up having another incomplete bowel movement.

Anyways, I appreciate it so much for answering my HPV question, you've settled my nerves down a lot. I'm still doing all I can to fix this incomplete bowel movement problem and I hope to be healthy once again.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
42 months ago
Sorry I didn't respond sooner to this follow-up comment, although it has no new questions. But glad to hear things are going well.

Normall threads are closed after 4 weeks of no activity, but I'll leave this open a few more days in case you have any final comments or questions.
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