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Anal HPV

hummingbird10
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If I have tested positive for high risk HPV through a vaginal HPV test will it also show up positive in the anus or are they 2 seperate tests / results? Should I get an anal pap to check for HPV?

Explore topics in this discussion:

Cancer Surgery Genital warts Anal cancer Cervical dysplasia Cervical cancer Skin cancer Pain Vaginal cancer HPV Endometriosis

19 replies

flowershoplady

an hpv test would detect an active hpv infection only from the area that is sampled....whether it's the cervix or vaginal walls or vulva or anus, etc. Having a vaginal or cervical active hpv infection does not mean that it's active in the anus. Keep reading and learning....knowledge is power!

moonsisterinspire

This is what I want to know: I was diagnosed 3 years ago with the most deadly form of HPV in my cervix. They did a Leep procedure. So far my paps are free. But in the last month, I've been experiencing rectal pain. I went into the colo-rectal surgeon and they are doing a colonoscopy because she thinks she may have seen HPV in her office exam. I am very upset that the obgyne never told me HPV could also be located in the rectum or I would have had a colonoscopy every year. I'm petrified to find out the results of this now that years have gone by. I want to know if 1) HPV in the anus can cause pain 2) if it is there if it always will be cancerous 3) why obgyne's don't warn a patient with cervical HPV to get a colonscopy regularly like they do with paps! 4) if everyone with anal cancer has Hpv---i.e. IS Hpv the cause of anal cancer?

jamiegirl

moosisterinspire- read through the "anal" threads in here. We've bee talking about it a lot. An anal pap and ANOSCOPY is what you need. Colonoscopies are for the colon. I just had an anal pap recently and there is hpv in my anal canal. Again, some of us have posted a lot of info, so check the threads!!

jamiegirl

BTW, my gyno didn't advise me about it either - it was my own research that made me think I should do this. When I asked her about it, she agreed that it was a good idea - DUH!!!!

Dragonfly23

Hi Moon. Unfortunately far too many docs are clueless when it comes to HPV. Many tell patients they cannot get the vaccine if they are already sexually active which contradicts Mercks own protocol. As a result most people only associate HPV with cervical cancer and are totally unaware that it can affect not only the cervix but vagina, vulva and anus as well. An anal lesion can indeed result in pain and/or bleeding as well. HPV anal lesions can also produce intense itching. Women are more likely to get anal lesions inside the anal canal whereas with men it is usually outside. It is believed that 90% of anal cancers are caused by HPV.

As was mentioned earlier, only the area from which the swab or biopsy was taken is the area being tested for HPV so if you only had a vaginal swab you would need a separate test to detect anal HPV, basically the anal Pap. Many docs are reluctant to order this but there has been shown to be a high correlation between those with cervical HPV dysplasia also having anal issues. You may have to insist on the test being done or go to another doc who wil perform it.

As Jamiegirl said it's not a colonoscopy you need but a high resolution anoscopy so I would definitely discuss this with your doc. My anal cancer however was not able to be seen during anoscopy or during two surgeries however pathology showed it was indeed right where I told them to biopsy. It is very unusual for HPV to extend beyond the dentate line which is the transition zone from anus to rectum. It can extend a cm or so beyond the dentate line but usually not beyond that. This means it will still be a squamous cell carcinoma or dysplasia as opposed to an adenocarcinoma (glandular).

Hope this helps.

flowershoplady

i wanted to add that if you or your doctor is 'seeing' hpv, particularly when just with the naked eye, then you may be seeing genital warts caused by some strains of the hp virus. these hpv strains are not the same strains that can potentially cause dysplasia/cancer.

moonsisterinspire

Thanks everyone for your replies and information. I guess I should still have a coloscopy because it's been 3 years since the last, and I just turned 50, and I did have polyps (benign) about 5 years ago. I had both my obgyne and colo-rectal doctors tell me "Yes" that endometriosis could be seen in the colonoscopy. But I read that only a laproscopy is the test to show endometrioisis. So that is puzzling. Then like you said the anoscopy is what I need instead of the colonoscopy to look for anal Hpv. So if a colonoscopy would't show either, why am I having one you know? lol! It makes me think they are just doing it for practice or whatever. lol! LIke I don't know if you read in the papers but I was one of those patients in Vegas (40,000) that had a colonoscopy or endoscopy where we were told they didn't change their needles or equipment and so we could have been infected with HIV or Hep C? Talk about aging 10 years in 2 weeks! I got tested but that was horrible. I used to trust my doctors and now I just feel unsure about everything. Anyway...my symptoms are strange. I hav no painful bowel movements cuz I take Magnesium at night and I go in the morn. after breakfast. But its later during the day..just these pains up inside somewhere. I have had those horrible dibilitating ones (there's a name for them) that come maybe once every 6 months--they are horrible! Like anal spasms or something. But this is different...it's always there and it's like being just on the verge of that particular pain. So I'm always on edge--it's horrible. No bleeding and the itching is once in awhile...and I've read it's "uncontrollable and intense" when it's cancer etc. I have always had issues down there though...ever since I was 16. Mainly cuz my life is always a rush here and there--no time to myself. Plus I had 2 kids so I had hemmroids. But the doc said she didn't see that or fissures. It was interesting what one of you replied that she "saw with the naked eye" what she thought was HPV. Yes I do recall reading that those are not the deadly kind--the invisible kind is the #16&#18. But that's what my obgyne told me I had on my cervix. So maybe I have both....who knows. She said she didn't know if it was HPV though....but she was going to remove a skin tag. May I ask--is an anoscopy a test where they put you under? I just can't go through that pain again...I those lower gi's in the past..wide awake and it was horrible. I suppose I should do the colonoscopy and then maybe she'd do the anoscopy at the same time while I"m asleep...I hope so... Also--an "anal pap"--is that painful like a cervical one? I'm surprised she didn't just do that. It couldn't be as painful as the time they did this "rubber band" procedure on my hemmrorids that I was in so much pain for 24 hours. But it did work and I'd recommend it to anyone. I know they found a prevention for HPV...hopefully they are closer to findinga cure now. Did anyone watch the Farrah story?(heartbreaking) It was never mentioned if her anal cancer was caused by HPV or not. They told me that all cervical cancer is caused by HPV---whether that is true or not I don't know. But if so, it would make me think that all anal cancer was HPV too. I didn't really understand the denate line mention--like are you saying that it doesn't usually extend further than the anal area so it can be removed like skin cancer? How did Farrah's travel then to her liver?
Well thanks everyone for your replies and support in this stressful time!

BB33301

Hi Moonsister:

Please get an anoscope and anal pap right away. I had cervical dysplasia and had chryo 20+ years ago. I knew it was HPV related but no one told me about every other type of cancer HPV can also cause back then.

Fast forward to 2005 when I became pregnant at 41. I had suffered lifetime slow motility problems and they worsened while pregnant. I basically couldn't go much and the stools (sorry to be descriptive but it is relevant) were very small when I did. I also had bleeding but many don't. I was told by my gynecologist I had hemis and was given cream. 10 days post c-section delivery I went to a colorectal surgery who did a DRE and proclaimed my problems and symptoms were all do to inoperable hemis. (bleeding, small stools, inability to defecate, feeling of fullness and the need to do, tiredness.) He was very dismissive so I figured it was more of my normal stomach problems. That was early Jan 2006. I felt worse all year and read about Farrah Fawcett and Anal cancer in Fall 2006. I realized I had all the symptoms but did not get diagnosed until seeing a total of 2 gynecologists, 3 colorectal surgeons and 1 gastro. I even had a colonoscopy with biopsy and a false benign result. I was diagnosed in Feb. 2007 with Stage IV Squamos Cell Anal Cancer. I moved to Houston and was treated at MD Anderson where they did some experimental treatment in terms of my radiation field to help with distant mets to my para-aortic lymph nodes. I am now two years post and NED for Anal Cancer. However, I know have Cervical Dysplasia back in spite of twenty three years of perfect paps, no new sex partners since diagnosis.

The majority of people on my two support groups for the cancer also had cervical dysplasia. One fought it for 20 years and also got HPV mediated skin cancer on her finger which resulted in an amputation, vaginal cancer and then Anal Cancer.

HPV is a very tricky and horrible virus and anyone who has had it is at risk for a variety of cancers. Had anyone told me I was at risk, I would have pushed the doctors even more to find answers sooner. The prognosis for SCAC is very good caught early so please continue to pursue your symptoms. I also had a very strong and sharp bend over pain which I thought was in my vagina but in fact was radiating from the anal wall into the vagina when I had my tumor. Please do not wait.

jamiegirl

BB33301 - Wow, your post is pretty scary. Just wondering, what does NED mean?

jamiegirl

moonsister - the anal pap does not hurt. Also, they do not need to put you under for an anoscopy. It's like a colposcopy but in the anus.

Dragonfly23

NED stands for no evidence of disease

Dragonfly23

HPV is not necessarily "invisible". I had vulvar lesions for years which were very visible to the naked eye and were caused by HPV16. I finally had to have a vulvectomy after years of other treatments failed. A lot depends upon just where the lesion is so dont be lulled into a false sense of security if you do see a lesion, it can just as likely be 16 or 18.

HPV is responsible for 99.7% of cervical cancer and believed to be responsible for 90% of anal cancers. As for the dentate line, that is the transition zone within the anal canal where the cells transition from squamous to glandular. Primary squamous cell lesions in the anal canal typically do not extend more than 1-2 cm beyond that. Once a cancer moves beyond that point it would no longer be a squamous cell carcinoma but an adenocarcinoma. This doesn't mean that the primary squamous cell lesion cannot metastasize (spread) through the anal wall into the blood stream to different parts of the body as Farrah's did. This is why it is important to catch it early and not take a wait and see attitude which far too many docs do these days. An anal pap doesn't hurt but then I never found the cervical paps to hurt either and an anoscopy is just an instrument inserted about 2 inches into the rectum to visualize that area. There is no need to be "put under" to have this done, it isn't painful just uncomfortable and over in less than 5 minutes.

jamiegirl

Dragonfly - thanks :)

BB33301

Hi Jamie:

NED means No Evidence of Disease. Once you have cancer you don't really say "cancer free" but if there is no evidence of active disease, the diagnosis is NED. It is the best possible outcome.

With regards to the anoscope, you do not need to be put under. It doesn't hurt. As part of my follow up, I have them every 3 months.

Dragonfly- I am sorry to hear about your persistent disease. Have you had any other HPV disease elsewhere?

BB

BB33301

By the way, one other point of clarification, Squamos Cell Anal Cancer metastisizes via the lymphatic system, not blood.

mp327

Moonsisterinspire--

I am going to back up what BB33301 said--you need to be checked by anoscopy for your symptoms. I, too, was diagnosed with anal cancer, and have this scope done every 3 months. It is not painful, there's no prep, and it's done quickly. Please do not put this off!

Martha

jamiegirl

BB - well I'm glad to hear that there is NED. Thank you and Dragonfly for the explanation! :)

Dragonfly23

BB, Most people aren't familiar with the lymphatic system so I figured it was easier to equate it with the blood stream which most people understand runs through the whole body - no intention to mis-state the facts.

I've dealt with HPV disease as I've mentioned in other posts for 22 years involving the cervix, CIN3, vulva VIN3, vagina VaIN2/3 and invasive SCC of the anus 17 years ago. Now I've been dealing with recurrent AIN3 since 2006 and recently it was found in the anal canal. The docs here said they "dont know how to treat me". I tried to schedule local denuding sx with my old surgeon in NYC but insurance denied it. So now they've approved me to go to Duke Cancer Ctr in NC next month. I also just found out that unlike my NYC doc who was just going to renove the superficial layers in the anal canal, this doc at Duke is going to do a wide local excision removing a portion of the anal canal. I am worried sick and quite scared. I worry about the loss of my sphincter and while it may sound crazy to some, emotionally I cannot handle a colostomy and fully understand why Farrah refused this too. At this point I'm pretty depressed about the whole thing. 22 years living with this virus and yet people question whether or not to get their daughters vaccinated. I'm a living example of why people need to get their daughters vaccinated - my daughter was.

BB33301

Dragonfly:

You poor thing. You have been through so much and I am so sorry to hear you have such persistent disease. I have a ton of questions since I feel we are on a similar path.

Did you have radiation for the anal SCC?
If so, how does the doctor plan to do the surgery on the compromised tissue in the canal? Also, I am not familar with who at Duke does this type of surgery and have not come across them in any of my SCAC research. How did you find this doctor? Also, how did you find the anal AIN? Where have you been treated in NY?

I know UCSF has a very good anal dysplasia program. Have you looked into it?

I agree on the vaccination. It is crazy when it makes such a difference.

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