I have a history with adendoum polyps and thus have to get colonoscopy on a fairly set schedule.  I am up for next one in June and before I meet with the gastroenterologist I have a couple of questions for STD experts.  Your site has pretty well informed me on HPV, I understand virtually everyone has it and 90% of time immune clearance.  I am a male, celibate for about 10 years, however about 12 years or so ago I did engage condom protective receptive anal sex a handful of times with two different male partners. I am little confused on the guidelines for anal pap screens (or other test) is it recommended to test given I had anal sex years ago?  I am HIV negative and never any warts - seems more recommended for HIV +?  Seems like some doctors are not as up to speed on these issues and do not want  to encourage a test by my questions if not recommended or get a result that nothing we can do about or testing technology unreliable.  Appreciate your counsel, given cancer risk with polyps I want to make the most out of my next schedule screening.  Thank you 

Welcome to our Forum and thanks for your question.  Thanks as well for using earlier replies on the Forum for information before you asked your question. One of our hopes for the forum is that clients will use our replies to others as a source of information.  I'll do my best to answer your questions but if I miss the point, please use your up to 2 follow-up questions to ask me for clarification.  The topic of anal HPV infections is one where there are currently many more questions than answers and appropriate management of these infections is the subject of a huge, ongoing multi-center study which has been funded by the NIH to clarify the natural history and best management of persons with anal HPV.  Thus at present, all of the desired answers are not available and answers f rom this study are still several years away.

Adenomatous polyps of the colon are potentially pre-cancerous lesions which are different and unrelated to HPV-related pre-cancerous lesions of the anus and rectum.  Management with repeat colonoscopies is recommended for the colon polyps and is proven to be highly effective at finding and removing pre-cancerous lesions.  I know of no data to suggest that colon cancer risk related to adenomatous polyps is related to HPV-related anal cancer risk.  Hopefully, at the time of your colonoscopy, your doctor will also carefully inspect your anus and pay attention to the rectum during the procedure.  This is standard practice.

In your case, your risk for rectal HPV is modest.  Condoms clearly reduce, but do not entirely eliminate, the risk for HPV infection o you may not have been infected during your past exposures.  Further, extrapolating from what we know about genital HPV, it is reasonable to presume that if you were infected, your own immune system would have controlled HPV acquired more than a decade ago if present.  The available data suggest that precancerous lesions and progression are more of a problem for persons with HIV than those who are not infected.  We know that rectal HPV is common (present in >50%) of HIV-infected men who practice receptive rectal intercourse as are anal PAP smear abnormalities.  When such lesions are advanced, therapy is warranted.  While the same processes may occur in persons without HIV, most think it is less common.

Thus, my advice, based on available data which is still incomplete, is that it is probably reasonable to also request that your doctor perform an anal PAP smear, possibly even before your colonoscopy.  If precancerous changes are present, many specialists would then perform biopsies at a later date to guide further decision making.  My guess is that if you have an anal PAP is will be negative but it is also reasonable for you to make sure things are good by checking.

I hope this information is helpful to you.  EWH

I hope my comments have helped.  This is my 3rd response to your questions.  As per Forum guidelines, this thread will be closed later today without further responses.  Take care.  EWH