[Question #7292] HPV Questions - ASCUS Result on Anal Pap Smear

58 months ago

Dear Ask the Experts,

I recently received an atypical squamous cells of undermined significance (ASCUS) result after an anal pap test. Since this result is often associated with HPV, I’m concerned that I contracted it even though this seems unlikely given my sexual and medical history.

I’m an HIV negative 38-year old gay man with a prior history of negative anal pap tests results who has been in a monogamous relationship for 10 years. I was immunized with Gardasil-9 in 2018. I received unprotected anal sex from my partner a small number of times during the 2017-2018 timeframe but otherwise received anal sex only one time from a prior partner and he was wearing protection. I should mention that my current partner is also monogamous, HIV negative, and has a history of negative anal pap tests. Due to HPV fears and a lack of information, we’ve temporarily stopped kissing and having sex.

Though I’ll be undergoing high resolution anoscopy (HRA) as a next step in treatment, I have some immediate questions.

[1] Since I’ve read that HPV typically clears within two years following infection, how could I have contracted it from my partner given that we’ve been in a monogamous relationship for 10 years?

[2] If we assume that I somehow have anal HPV, would I put my partner at risk for HPV by kissing him? By penetrating him? Are HPV infections localized or do they spread within the body?

[3] I know that anal HPV tests are available from reputable labs like Quest Diagnostics even though these tests aren’t cleared or approved by the FDA. Are you aware of any providers in Washington, DC who make these tests available to male patients?

[4] My partner hasn’t had an anal pap test this year. Would you recommend that he gets tested given my ASCUS test result?

Looking forward to your guidance. Thank you.

H. Hunter Handsfield, MD

58 months ago

Welcome to the forum. Thanks for your confidence in our services.

I really don't think you should be worried at all. ASCUS doesn't necessarily indicate HPV infection and is not a pre-cancerous conditions. If you have anal HPV, it's not a health issue in absence of either visible warts or overt pre-cancerous changes, which apparently you don't have. Anal HPV occurs pretty commonly in strictly heterosexual men who have have never had anal sexual contact, perhaps occurring by migration of the virus from genital infection (which almost everybody has or has had) or from fainger-anal contact (e.g. with anal itching) after genital contact. All that said, since you're set up for HRA, undoubtedly you have a doctor who understands these issues, probably much better than I do. You should discuss all your conerns with that doctor. To your specific question, to the best of my ability and knowledge:

1) You don't necessarily have HPV. That said, genital (or anal) HPV is just as common in monogamous as non-monagamous partnerships. It's rarely possible to know when or from whom any particular HPV infection is acquired,

2) You cannot transmit anal (or genital) HPV by kissing. Oral HPV isn't rare, but isn't present in most people with anogenital infection. It's also not frequently sexually transmitted. Nothing to worry about.

3) Sorry, I don't know any particular providers who provide anal HPV testing. However, I'm a bit surprised you haven't been tested already. Most clinics and doctors doing anal paps probably include HPV testing routinely. Discuss with your HRA provider.

4) Your partner's anus undoubtedly has not been in contact with yours. You don't know you have anal HPV -- but if you do, any implications for your partner are for his possible genital HPV, not anal.

Having genital or anal HPV is a normal aspect of human sexuality. There is nothing in your story (so far) that suggests any serious health risk. Once again, please discuss this with the doctor or clinic doing the anoscopy.

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

HHH, MD

---