[Question #664] HPV AND ANAL CANCER

48 months ago
If I have had receptive anal intercourse with a guy who has high risk hpv is anal cancer something that could happen in the future?  What should I look for as far as symptoms go?  Is anal cancer common in my situation? 
Edward W. Hook M.D.
Edward W. Hook M.D.
48 months ago

Welcome to our Forum.  I'll be happy to provide some information and perspective.  In the past 15 years our knowledge of the natural history and risks associated with genital HPV infection have moved from virtually no knowledge to a place where we now have far more information which can be used to guide risk assessment and decision making.  With respect to anal HPV we are in about the same place that we were for genital infections about 15 years ago- it is a topic of intense interest and active study but, at present, our knowledge is insufficient to provide assessment and guidance.  I am sure that this will change over the next 5-10 years.  Having said that there is little to worry about at the present time.  Let me give you some facts to help you know why I say this.

1.  I am not sure how you know that your partner has high risk penile HPV.  Currently there are no recommended tests for penile HPV in men.  Having said that what we DO know is that most exposures to infected sex partners (irrespective of the sites of exposure) do not lead to infection and when they do, the infections that occur are self-limited in well over 95% of cases, going on to resolve on there own without treatment.  So, you may not be infected and if you are, the infection will probably go away by itself.

2.  You do not mention your gender or age or whether or not you have had the HPV vaccine. If you have had the vaccine, you have a high degree of vaccine related protection from infection.  Further, while we know far less about anal HPV infection in women than we do in men but we DO know that anal cancer is quite uncommon,  Only about 2 in every 100,000 women in the U.S. will get HPV-related anal cancer.  On the other hand having participated in anal intercourse is common- population surveys reveal that about 1 in 5 women participated in receptive rectal sex the last time they had sex and about 2/3 of all sexually active women have participated in receptive rectal intercourse.  Thus the odds that you will NOT get anal cancer are very much in your favor.

3.  This topic is an area of active study so that in the coming years we will learn much more about the risks and how to follow-up.  You have plenty of time as well since progression from HPV infection to cancer appears to take decades, on average, to occur. 

4.  Finally, anal cancer symptoms are non-specific but include things like rectal bleeding or narrowing of stools. 

Bottom line, this is not something to be overly worried about.  Continue to get your regular sexual health check ups but otherwise I would not worry too much about this.  I hope these comments are reassuring and helpful. EWH

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47 months ago
I am a 33 year old white female.  I have not had the Gardasil vaccine.  He told me that he had the hpv high-risk type of virus and he found out when he was married previously. 
Edward W. Hook M.D.
Edward W. Hook M.D.
47 months ago
Thanks for the additional information.  It does not change my assessment in a major way.  I would not be overly worried and would continue to follow-up on a regular basis with your GYN for reproductive health screening.  EWH
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