[Question #5293] Anal Warts-No HPV?
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75 months ago
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I went to a PCP about a month ago because I saw a wart near the anal opening after several weeks of feeling itching and occasional blood spots on toilet paper which seemed to originate from where the wart was located. He examined me and found another wart just inside the anal canal.They did a swab on both and sent it off for testing. It came back negative for 6,7,16,18 and then 45PV mRNA E6/E7 w/ RFL 16, 18/45. I was told by the PCP this is not HPV and likely just warts like you can get on your finger. Furthermore, he examined me today with an analscope which was uncomfortable. I had a bowel movement about an hour later and it had blood at the tip of the stool. Is this indeed not HPV? it sounds like he was kind of dismissive and the fact there was blood on the stool has me worried. I am a 33 year old male that was first treated for anal warts 8 years ago after itching was the first noticeable indicator of warts in 2011. I dont practice anal sex. Any follow-ups I should do?
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Edward W. Hook M.D.
75 months ago
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Welcome to the Forum. I'll be happy to comment. To be entirely honest, the symptoms you report, the fact that tests were negative for the most common types of HPV, and your reports of blood on toilet paper are more typical of hemorrhoids than HPV which is most often asymptomatic. The topic of anal HPV is one of considerable and intensive scientific study at the present time. Here are some facts that I heard just last week at a scientific conference:
1. Heterosexual men do get anal HPV infection although rates are far, far lower than for men with other men as sex partners and women. So you are not alone.
2. While the precise rates and best approach is not yet clear (the studies will not be complete for another 2-4 years), it appears that very few infections progress to cancer which is what most people worry about and that progression rates are lowest among HIV non-infected heterosexual men. This should be comforting to you in the off chance that your "warts" (I still am not sure that that is what you have) are HPV
3. Best follow-up mechanisms remain unclear. My advice would be to not worry unless your symptoms continue. if they do, you might get a second opinion from a proctologist.
I hope these comments are helpful. EWH
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75 months ago
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Thank you for your reply. Initially, the provider stated the appearance looked like "classic" HPV warts, tiny, elevated, whiteish papules clustered together near the anus like cauliflower. Would the test he performed be conclusive in determining if it was HPV? My understanding was that the test would rule out the strains that could cause cancer but not test for every possible type of HPV so to hear conclusively it wasn't HPV was a surprise to hear. The analogy he used for the strains the test was looking for was to think about it like the three bears, if Momma Bear wasn't home then Poppa Bear wouldn't be either. He said if Momma Bear was home then we knew that Poppa Bear and Baby Bear would be and that would be cause for concern because all the bear cousins and aunties would be as well. Is that an accurate analogy?
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Edward W. Hook M.D.
75 months ago
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Hmm. I'm not sure about the analogy and will have to think about it. The updated description you provide however does sound more wart-like. Most HPV typing reagents are quite accurate however and I do agree that a negative test for the HPV types you mention make it unlikely that you had one of the "high risk" HPV types. Please remember as well tha when HPV is present, only a tiny proportion (less than 1% ) of all infections then go on to cause problems. EWH ---