Dear Dr. Bruce,

IN your response of 12/29/02 regarding anal pap smears, hemorrhoids and HPV, you said if you it is more likely one is HPV infected if the Pap smear is normal. I'm not a doctor but I always thought it was the other way around. That is, you are more likely to be HPV infected if the Pap smear is abnormal. Was this a typo? Thanks for all the hard work you do for all.

Thank you so much for your careful reading of my posts (you have a job waiting for you in some editorial department). You are correct in that there was a typo. It is more likely to be HPV infected if the Pap smear is ABnormal. I am repeating the edited 12/29 post in this response. (I also fixed the typo). Here it is.

The reader had asked some excellent questions about Pap smears and hemorroids--

1) Do hemorrhoids interfere with the Anal Pap test-- probably not. However, if the hemorrhoids are inflammed, then inflammation can indeed affect the Pap test. Although hemorrhoids will not cause a PAP test to read cancer, it may prevent a Pap smear from being read as completely normal. When I have a patient with inflammed hemorrhoids, I tend not to perform a Pap test until the inflammation subsides.

2) Because of sampling error, one negative PAP smear is reassuring, but may miss some abnormal cells. I usually recommend two negative Pap smears, one year apart, before I tell a patient that we can let down our guard a bit. After two negative Pap smears, in the absence of receptive anal sex, the frequency of the Pap smears can be spaced out. Please note that condoms are NOT completely protective of HPV infection, so that even if a patient has receptive anal sex (i.e. he's a bottom) with condoms, he is not completely protected from HPV and therefore anal Pap smears are recommended.

3) A normal PAP smear does NOT mean a patient is HPV-free. I am sorry to say that it is indeed possible to harbor an HPV infection even with negative Pap smears. That said, it is more likely that you are HPV infected if the Pap smear is abnormal