Happily Married, 4 children, made one bad mistake of drunken insertive vaginal sex with coworker. Nearly two weeks later I was sick with high fever, and flu symptoms. Tested positive for Covid, negative on the std panel. Fast forward to 9 weeks out, I tested negative 3rd generation hiv antibody only blood test. 

Since, my doctors said anything from hemorrhoids to possible condyloma. Finally has a 5th colorectal specialist take a look and he said that he thinks I may have condyloma in the canal. After coming to from surgery he said he removed three of them. Months later I go in for a follow up and he said by the way those were benign and they weren’t hpv related. I asked him if he was sure he said, those showed no signs of hpv. 

Fast forward to my family doc. Visit a few weeks ago and they said, “yeah your colorectal specialist said in the notes that these you had squamous cell papilloma.” “He also noted that these weren’t hpv related and that he looked over the pathology report himself.”

This three me for a loop because that is hpv related. 

Can you shed any light? I’ve had no anal sex at all but have touched my penis while in the shower and was putting glycerin medication up in my anus as my doctor ordered it for anal fissure and hemorrhoids. I’d also like to point out I’ve had mouth sores, a spot found on my liver that the radiologist called a benign tumor.  I haven’t been anxious really since my last set of questions. I just recently started experiencing the anal symptoms again with clear jelly like substance during vowel movements and it 

1) Could this have spread hpv from penis to anus? 

2) Do you think I tested too early. For the older 3rd generation hiv test as well? 

Anal and rectal HPV often occur in straight heterosexual men with no anal sexual exposures -- less frequently than in men who have sex with men or in women, but by no means rare. The exact mechanisms of anal HPV inoculation isn't well understood, but it likely involves direct migration of HPV along skin between genitals and the anal area. Auto-inoculation by finger contact with one's own anus, after contacting the genitals, might also have a role -- we just don't know. The important thing here is that you follow your doctor's advice about your rectal disease -- anal fissure, hemorrhoids, and apparent condyloma/papilloma in the rectum. (Condyloma and papilloma are synonyms:  different words for the same thing.) Yes, this is HPV: that is the ONLY cause of papilloma/condyloma/warts. Probably it's just warts, but it is important that you follow up with your doctors to monitor for progression to cancer and treatment as appropriate. These are domains of proctologists and colon and rectal surgeons:  we STD specialists are rarely involved in evaluation or management of such cases.

As for your comment that "this event took place exactly 5 years ago", I urge you to entirely ignore that experience. It is probably not the source of your HPV infection. 90% of all people acquire genital HPV -- it is a normal, expected consequence of being sexually active, and is equally frequent in people with and without multiple or extramarital sex partners. That even probably has nothing at all to do with your anorectal issues.

Finally, there is nothing in any of this that even hints at HIV. If you tested more than a few weeks after your last possible exposure, a negative HIV test is conclusive and should be trusted.

Those comments cover your two numbered questions, so the answers should be obvious:  1) Yes, it is likely your anorectal HPV problem resulted from spread from your genital area. 2) No, you didn't test too early. Your HIV results are to be believed; the third generation HIV antibody tests are conclusive after 8 weeks.

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

HHH, MD

My wife had elevated liver enzymes and jaundice. She was diagnosed with hemochromatosis. 

I was told I have elevated liver enzymes and have had terrible pain in the liver area which is when they discovered what they think is a hemangioma of the liver. 

Should I get a baseline hep a b and c test? 

Also, in your opinion, should I request high resolution anoscopy to further evaluate my recital issue or at least get a swab/pap of that area? 

You should also follow your doctors' advice about anal Pap smear or high resolution anoscopy. Probably they should be done, but this is a somewhat controversial area under active research. I have never performed either one -- these are not (yet?) standard procedures for STD clinicians, mostly done by knowledgeable proctologists and colon/rectal surgeons. Discuss with your doctors. Sorry I can't be more helpful.

You’ve really covered my main concerns and questions. There is a relief on finally knowing what I have through my doctors diagnosis but along with that is the fear of malignancy. Thanks for your clarity. 

In the last reply, I would like to ask the following since I know it’s my last question. 

I have been my wife’s only partner and her my only partner. We dated since freshman in high school. I know this had to come from that one instant. The girl told me later after reaching out she thought she had hpv and was sorry for not disclosing. 

Questions: 

1) is it safe to assume I will not clear this virus since it’s been so persistent the past 5 years? 

2) does the completion of the 3 series vaccine provide any type of response? Historically I know the answer is no, but recent evidence shows there might be some slight benefit for those that are already infected. 

3) if these are high risk types of hpv, is that normally the case that they will turn into malignancy? (My wife has had all normal paps with negative hpv test) do low risk types ever linger for such periods of time or can i assume this is a high risk strain due to the nature of it being persistent.  

4) I had a sigmoidoscopy where they removed a precancerous lesion/polyp.  Then a colonoscopy where they removed 6 precancerous lesions from my colon (I am only 31 years of age). Seems pretty uncommon.  I’ve seen research suggest that there have been hpv found in colon polyps and colon cancer. Is this accurate? I didn’t think it would affect your colon. 

5) lastly, is there any idea of how many straight males actually go on to get anal cancer? I have yet to see one story or testimony of a straight male with anal cancer. I know it happens. 

That does it for my 3rd and final post. I will no longer post any more questions but I do want to thank you for your time. 

I am going to follow up with my colorectal doctor to get a for sure confirmation on the pathology as there was obviously some confusion on his interpretation of squamous cell papilloma. 

I’d think 5 years is a little early for these types of changes as I have read it takes decades. 

1) I am unaware of data on clearance after so many years of continued HPV detection. Sorry, I just don't know.

2) Recent data suggest the HPV vaccine may reduce the risk of recurrent detection of HPV -- in contrast to initial beliefs. However, it's not a strong  effect:  it  can't hurt to be vaccinated, but won't necessarily make much difference.

3) I would assume the HPV strain(s) causing this problem are high risk. But even with high risk HPV, the large majority do not progress to malignancy. "High risk" is misleading in relation to HPV:  think of "higher" risk, but still fairly low. On the other hand, having that statement is pertinent primarily to persons with newly acquired HPV. The risk of malignancy may be higher in those, like you, who have already had documented anorectal papillomas. Here too, your own doctors probably are more up to speed on this than we are.

4) Colonic polyps and malignancy are not generally believed to be related to HPV. Occasional identification of HPV in some polyps doesn't imply a widespread or common problem, and most likely this an entirely separate problem from your anorectal papillomas and HPV. However, research in this area could change.

5) I don't know the actual rate of anal cancer in straight men. It's a lot lower than in men who have sex with men, and lower than in women. You might explore data provided by the American Cancer Society, but this is not an area of expertise for most STD experts such as me and Dr. Hook.

Thanks for the thanks. I'm glad to have helped. Best wishes to you.