[Question #3671] Very concerned about anal HPV
87 months ago
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Hello. I am a 51 year old gay man. HIV negative. Non-smoker. I have recently been diagnosed with anal HPV type 33. I am currently awaiting the results of a PAP smear. I am now thinking that I should just pay for a HR anoscopy as the PAP can produce false negatives and false positives. I have also read that the high risk types of HPV are more persistent than the low risk types and this concerns me greatly. I don't know what percentage of high risk anal hpv infections progress to cancer but I'm worried it could be high. Even if the PAP smear comes back with no abnormal cells, would you recommend regular screening with HR anoscopy every few years? I have read that this is the 'gold standard' of screening for anal cancer.
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Edward W. Hook M.D.
87 months ago
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Welcome to the Forum. I will be glad to comment but as I begin to comment, I need to let you know that at the moment, one of the great unknowns about anal HPV infections or even abnormal anal PAP smears is how to use the information these tests give. It is the subject of an ongoing multi-million dollar prospective study.
It is no suprise that a "high risk" ( even most so called high risk HPV infections do not progress to concer) HPV infection was found. More the 60% if men with male sex partners do. Most such infections resolve without specific therapy although, as you point out, the higher risk types do take longer to resolve. Since there are no good data on how often these infections progress or how to best manage the infections, recommendations tend to vary, even within experts. If your test in totally norlal, i would follow with repeat PAP smears but not push for high resolution anoscopy. If the PAP is abnormal, HRA (which you correctly identify as the current gold standard for determining the presence of anal pathology) whether to set a baseline or for treatment which would vary depending on what is seen is more reasonable.
I wish I had better answers for you. I hope these comments help. Take care. EWH
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87 months ago
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Hello, the anal PAP smear came back with no abnormal cells detected. My doctor suggests repeating in three years' time. In your opinion is that soon enough? I've heard some doctors recommend every two years. Thank you.
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Edward W. Hook M.D.
86 months ago
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Sorry for the delayed response. I would wait two years and re-check the recommendations for testing. They may have changed by then however the negative PAP is good news and in general means that re-testing intervals can be longer than if the PAP was abnormal.
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