Anal HPV?

[KDC13]

Hello, I have a rather unsettling question. Back in April 2010, I had a pap smear and was diagnosed with high risk HPV. They discovered abnormal cells in my cervix (severe dysplasia) and I had a cone biopsy less than 4 weeks later. My question is: What is my risk of having anal or even oral HPV? I noticed that for the past few months I have had a red rash on my inner cheeks and it is literally always itchy. The HPV I contracted was from the first time I had sex and the guy took advantage of me (the first time was in August 2009 and I've only had sex twice total). I don't remember what he/we did but I have a feeling he may have tried anal (I acutely remember feeling soreness there the day after) and oral. One thing I do remember is him telling me he was bisexual. Also, I don't know if this is helpful, but I have gotten sick many more times than usual in the past year. Then again, this could be because I have been extremely stressed out since this happened and it caused low immunity. I would just like to get knowledgeable input. Thank you.

[Edward W Hook, MD]

You are correct, the availabe data are limited.  I would agree with your doctor that it typically takes five or more years for anal cancer to progress and the rates should be similar in women and men.  I would not worry a great deal while you are having this evaluated however.  

Regarding the counseling, you might give a call to a local womens' crisis center and see what they have available.  It sounds like having someone to tlak about this with would be really helpful and they often have low or even no cost counseling available.  EWH

[KDC13]

Thank you for your answer and I appreciate your concern. My doctor did a blood draw and tested me for all other possible STDs. I am happy to say it came back clear. As for the counselor, it is a great suggestion but money is a little tight right now for various reasons. I will just have to make due with the support system I have in place. The reason I inquired about anal and oral HPV though is because said support system is very hesistant to talk about them. They don't mind talking about vaginal HPV since it is so common, but when I even bring up the other two I get a disgusted look from them. However, it still really concerns me. I know my risk for having them is substantially higher so I would just like to be sure. When I said I had a red rash around my inner cheeks I should have been more specific, it is located around and near my anus also. I don't know if this makes any difference. I will most likely try to get an anal pap smear and see how it turns out. Lastly, part of the reason I ask about statistics is because there is a lot less information out there about anal HPV than there is about vaginal HPV. Information such as what are my risks if I am a heterosexual female? if the man I slept with was bisexual? and how long does it take for anal cancer to progress? I have read that it takes long for cervical cancer to progress, but in my case the cells on my cervix progressed to severe dysplasia in less than 10 months. My doctor said there is no reason for it to have progressed as fast as it did. If it normally takes 5 years for anal cancer to progress, could mine be progressing at a faster rate. Sorry for length of this post. Once again, thank you though.

[Edward W Hook, MD]

Welcome to our Forum.  I'm sorry to hear of the hardships you are having, both by having been taken advantage of and then finding out that you had severe cervical dysplasia.  After events of this sort, it is not surprising to hear that you have been carefully examining yourself and wondering if something else is wrong.  I suspect all is OK however.   It would be unusual for you to have HPV on the inside of your cheek. Further, it would be unusual for HPV to cause symptoms.  I doubt that the problem on the inside of your cheek is HPV,  As far as rectal HPV is concerned, Pap smears do work for diagnosing rectal disease as well.  You might ask you doctor about this.

In thinking about your problems however, I also want to be sure that in addition to your Pap smear you have been thoroughly examined for other possible STDs following what may have been sexual assault. Were you also tested for other STDs and HIV?  I doubt that you have them and your doctor should have tested for them at the same time your Pap smear was taken but I just want to be sure. In addition, I wonder if you might not benefit from discussion of your assault with a counselor.  It sounds as though you have had a traumatic event and discussing and working through it with a counselor may have multiple benefits.  EWH