Anal pap smear; Could I have picked up HPV infection from my girlfriend with cervical precancer

Question

Dear Dr.

A few years ago, I had a girlfriend with cervical precancer. I am assuming that I am at risk for HPV because of this. For the past year I have had intermittent burning/itching around the anal opening and went to a gastroenterologist. He performed a flex sigmoidoscopy and found hemorrhoids. I asked him about cancer and he said that he didn't find anything related to that. But I have read that burning and itching can also be related to anal precancer and I am very scared about this. I suppose it is likely that I could have spread the HPV virus inadvertently to the anal region with my fingers. I dont even know if i have contracted it or not since I have no visible warts and I always used protection with my past girlfriend. My HIV status is negative. My question is: Should I get an anal PAP smear, and if so, what kind of doctor would be able to perform this procedure for me? I live in Chicago and dont know of any doctors who are familiar with this procedure, so I really dont know where to go. I'm very sorry for the long message and thank you very much for your time.

Answer

You've raised some very interesting points.

HPV, also known as the wart virus, can indeed spread from the cervical region of a woman to both your genital and your anal areas. So it is conceivable that you have HPV infection in either or both of these areas. That said, it is also quite likely that you don't have such an infection. Here's why.

First, if your girlfriend is HIV-negative, then she may not even be harboring active HPV infection. Most HIV-negative women develop immunity to the HPV infection. (This is much different than HIV infection, in which it is most unusual to develop immunity from the disease). In other words, most HIV-negative woman who get HPV infection clear it and don't pass it on. So, it's highly likely that you have not picked it up from your girlfriend.

You do not state whether or not you partake in receptive sex or not. If you do not, then although HPV can spread from your genital region to your anal region, it would be unusual to do so given your HIV negative status. Your HIV negative status basically means that your immune system is intact and should be able to fight off such an infection.

As for the anal PAP smear, one of the major purposed of the anal PAP smear is to screen for HPV changes to help decide which patients need to have anoscopy (a procedure by which a health provider looks up butts). Since you've already had flexible sigmoidoscopy, I'm not sure that an anal PAP smear is necessary in your case.

HOWEVER, should you wish to have an anal PAP smear, you would need to call around to locate who does them. Many HIV clinics have such resources and should be able to guide you. I realize that you are HIV negative, but in many of the cities, the anal PAP smears rose as a need first in HIV positive patients. Perhaps your internist or gastroenterologist could help you. Chicago has several centers of excellence in HIV care; I'm reluctant to recommend one over another.