[Question #6439] anal hpv

16 months ago
approx two years back, i took a home HPV test, 3 body parts. It tests specifically for 16,18, and then a group of others with no specifics. www.selfcollect.com Oral was neg all, penal neg all, but anal test was only neg for HPV 16,18, but positive for one or more of the following, (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 & 68) . Didn't get the exact.  I saw gastro after the test, and then a year later, who seemed to not know a lot about this, but he did put a tube and a light in my rear to inspect for something each time.

Now, About 20 years back, i did get my anus licked by a man once (unknowingly it was a man who looked like a woman). Is this because of that?  I've never had my rear licked since then, and i'm not gay. The Dr said i need to continue with the yearlies, but is that true? Also, it seemed what he did won't pick up anything pre-cancerous anyways right? Should i take another home test to see if it cleared first?  Did getting my anus licked 20 years ago cause this?

What would you do if it were you in my shoes?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
Welcome to the forum. Thanks for your confidence in our services. I think I can help.

Had you asked two years ago, I would have advised against these tests. You were misled (if not overtly scammed) by a lab or online resource looking to make a buck. The US Food and Drug Administration and its counterparts in other countries have not approved any HPV tests for men, because their accuracy has not been documented. That doesn't mean they are inaccurate, but it does mean that nobody really knows. Positive results might occur in uninfected persons. And even with those HPV tests that have been approved, in particular those used in conjunction with pap smears in women, a negative result never proves HPV is absent. It is well known in the scientific community that latent HPV is intermittently detectable; an infected person might have 10 negative tests and then one day have a positive result, without acquiring new infection.

Accordingly, you may well have had anal HPV, but not necessarily. And probably you have had genital infection as well that wasn't detected on the day you were tested.

Anal HPV is quite common in heterosexual men who hever had anal sexual exposure of any kind -- not as frequent as in men who have sex with men or women, but by no means rare. It probably usually originates with genital HPV infection, either by spread of the virus along the surface of the skin or by auto-inoculation, i.e. touching one's anus after the genital area. Whatever the mechanism, your situation is not all that rare. HPV is uncommonly transmitted by oral sex. While I cannot say whether your single episode of analingus (oral-anal contact) was the source, but probably not; more likely you had genital infection that led to your positive anal HPV test.

Many physicians are unaware of the details of HPV transmission and risks, so I'm not surprised your gastroenterologist scratched his head, not knowing how to advise you. But your negative anoscopy -- i.e. no evidence of warts, cancer, or pre-cancerous changes -- is reassuring.

Almost everyone gets genital or anal HPV (in fact, in the field we often refer to "anogenital" HPV as a single type of infection). At least 90% of all sexually active persons acquire anogenital HPV, often several times. It's a normal, expected, and for the most part unavoidable other than by cellibacy or lifelong mutual mongamy. So assuming you've had your share of sexual experiences, you've had HPV -- which probably was the origin of your probable anal infection.

What to do now? Both professionally and personally (i.e., "if you were in my shoes"), I would do almost nothing. I'd probably finger my anus once a year or so to assure no unusual bumps or lesions, and if uncertain to see a physician about it; or for any unexplained anal bleeding. If under age 26, you should be immunized against HPV, which will protect you against the 9 types of HPV that cause 90% of warts and cancer (not counting any of those types you already have had).  You need not inform current or future sex partners of any of this.

The bottom line (pun intended!) is that nothing bad is likely to come of this. There are millions of men with anal HPV who never know it -- you're at no more risk because you had a possible infection that was diagnosed. This really is a big nothingburger!

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

HHH, MD
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16 months ago
DR, a few facts  i left out. i'm in my 40's and I have been visiting massage parlors for quite a few years, hand jobs only, however i did let licked once there too. Wasn't expecting. In fact it was probably a year or so before my online test. This in combination of the incident with a man-women many years back.
Does this change your opinion about the cause of my HPV and likenesses of it eithr being a persistant one or maybe i'm clearing but getting re-occuring infections?  I know that some people (more men than woman, and in different areas) can get and clear HPV, but without building antibodies and are susceptible to reinfection. How likely would cessation of the massage parlor of a certain period of time be the only controlled variable?
  
Finally, i am concerned about spreading this HPV to my family. Through a shared toilet seat, using the bathroom and forgetting to wash, etc.  I'm careful to wash my hands first, but occasionally forget in the heat of things...  Any thoughts?

It does seem weird that for women and the cervix it seems a crisis, but for all others, and more for men, a more pragmatic attitude is given.... I have read research where they studied HPV people from virus to clearance, length of time, who got antibodies and who didn't. All interesting stuff. 


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
16 months ago
No, this doesn't change my opinion or advice. Oral contact can transmit HPV, but uncommonly:  oral HPV is a lot less common than genital, and when present probably is less transmissible. I don't think changing your massage parlor events would make any difference in your risk of new HPV, and certainly cannot have any effect on existing infection.

HPV is never transmitted except by direct sexual contact. Household members never catch it despite sharing toilets, towels, showers, eating utensils, etc. No risk and no worry. That said, since it is likely you have had genital HPV, and also assuming your wife had sex with other men before you joined up, you can be sure she also has been infected and may still have HPV. As I said above, genital (or anal) HPV is a normal, expected consequence of being sexual.

Cervical cancer kills people -- not very often any more, with proper care -- but cervical HPV certainly deserves attention. Beyond that, I don't really agree with your premise. Most women with abnormal pap smears and other HPV problems, or their doctors, don't view most cervical HPV infections as a "crisis", but matter-of-factly. Cervical HPV obviously deserves attention to assure infections don't progess to cancer. But on this forum, we get more anxiety driven questions -- "crisis" orientation and even panic -- about oral and anal infection, and genital infection in men, than we do for cervical infection in women.
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