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Can HPV Infection In Oral Mucosa Cause Anal Cancer?
Question: Dear Dr.
I have been in High risk sexual activities with multiple partners for years. I am bi-sexual but have had receptive and insertive anal sex "Protected and Unprotected" with more than 10 random guys in my lifetime.
I am not having sex with men any more and I am really afraid of anal cancer as I found in oral biopsy for persistent lumps I am infected with HPV as the pathology report showed viral cytopathic changes "Koilocytosis"
I am feeling fullness in my anal canal and swollen in the anal verge and mainly in the interior side of the anus. Besides, I feel mild pain and irritation inside the anal canal anteriorly.
I have also mild pain in my lower back associated with the anal pain.
I uploaded pictures for the verge for your evaluation and advice.
Thank you
I have been in High risk sexual activities with multiple partners for years. I am bi-sexual but have had receptive and insertive anal sex "Protected and Unprotected" with more than 10 random guys in my lifetime.
I am not having sex with men any more and I am really afraid of anal cancer as I found in oral biopsy for persistent lumps I am infected with HPV as the pathology report showed viral cytopathic changes "Koilocytosis"
I am feeling fullness in my anal canal and swollen in the anal verge and mainly in the interior side of the anus. Besides, I feel mild pain and irritation inside the anal canal anteriorly.
I have also mild pain in my lower back associated with the anal pain.
I uploaded pictures for the verge for your evaluation and advice.
Thank you
Brief Answer:
I suggest hpv typing from persistent oral lumps and a Pap smear from anus
Detailed Answer:
Hello. Thank you for writing to us
I am dr.kakkar(dermatologist). I hsve gone through your query and i have noted your concern. I have also reviewed the images.
You seem to have haemorrhoids. That might be the reason for anal fullness.
Moreover hpv is a local infection. Hpv infection of oral mucosa would not cause anal cancer in any case! Anal cancer is a risk only in those with hpv infection of anal musosa! Not oral mucosa!
Moreover viral cytopathic effects like 'koilocytosis'is indicative of hpv infection however not all hpv is associated cancer. Only high risk genital hpv types 16,18,32,33,45 are associated with risk of cancer. Low risk Hpv types like 6,11 are not associated with cancer.
Therefore though koilocytosis does indicate hpv infection it does not indicate hpv types. You may undergo hpv typing from oral mucosa to determine whether you have infection with high risk or low risk hpv types. Only if you have infection with high risk hpv types there might be a risk for oral cancer. Not anal cancer.
You may also also be a candidate for a Pap smear from anal mucosa to detect any viral cytopathic changes.and dysplastic cells in anal mucosa. If you have any such changes then the next step would be hpv typing.
Regards
I suggest hpv typing from persistent oral lumps and a Pap smear from anus
Detailed Answer:
Hello. Thank you for writing to us
I am dr.kakkar(dermatologist). I hsve gone through your query and i have noted your concern. I have also reviewed the images.
You seem to have haemorrhoids. That might be the reason for anal fullness.
Moreover hpv is a local infection. Hpv infection of oral mucosa would not cause anal cancer in any case! Anal cancer is a risk only in those with hpv infection of anal musosa! Not oral mucosa!
Moreover viral cytopathic effects like 'koilocytosis'is indicative of hpv infection however not all hpv is associated cancer. Only high risk genital hpv types 16,18,32,33,45 are associated with risk of cancer. Low risk Hpv types like 6,11 are not associated with cancer.
Therefore though koilocytosis does indicate hpv infection it does not indicate hpv types. You may undergo hpv typing from oral mucosa to determine whether you have infection with high risk or low risk hpv types. Only if you have infection with high risk hpv types there might be a risk for oral cancer. Not anal cancer.
You may also also be a candidate for a Pap smear from anal mucosa to detect any viral cytopathic changes.and dysplastic cells in anal mucosa. If you have any such changes then the next step would be hpv typing.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your answer Doctor.
Does the anal verge in the uploaded picture look Abnormal? Does it look only haemorrhoid or could be STD or Dysplaisa ? I mean can haemorrhoid be mistaken for other lesion?
How accurate is the anal pap smear? Can it give false positive or negative?
How is HPV typing done ?
Can dysplastic lesions look like haemorrhoid and has the symptoms of pain, itching and burning?
Thank you doctor
Does the anal verge in the uploaded picture look Abnormal? Does it look only haemorrhoid or could be STD or Dysplaisa ? I mean can haemorrhoid be mistaken for other lesion?
How accurate is the anal pap smear? Can it give false positive or negative?
How is HPV typing done ?
Can dysplastic lesions look like haemorrhoid and has the symptoms of pain, itching and burning?
Thank you doctor
Brief Answer:
Answeres to specific queries
Detailed Answer:
Hi.
Apart from the haemorrhoids the anal verge looks normal to me. Anal dysplasia (Anal intraepithelial neoplasia; AIN) may be visible clinically only as erythematous or whitish patches and there are usually no palpable bumps since it is confined only to the epidermis and therefore it is flat. The skin may in fact look almost normal.
On physical examination, haemorrhoids are easily differentiated from other lumps or bumps.
Anal Pap smear is a screening test for anal dysplasia in high risk individuals e.g those who practice anal sex or those are are Hiv positive. It is usually perfomed serially i.e every 6 months and can detect dysplastic changes quite early. False positives or negatives can occur but if the changes are persistent on serial testing they are most likely to be dysplastic rather than inflammatory.
HPV typing is done from material taken from anal mucosa i.e either swab or tissue and tested for HPV DNA types by PCR.
Haemorrhoids are soft and compressible whereas lumps are firm to hard in consistency and are not compressible like haemorrhoids.
Regards
Answeres to specific queries
Detailed Answer:
Hi.
Apart from the haemorrhoids the anal verge looks normal to me. Anal dysplasia (Anal intraepithelial neoplasia; AIN) may be visible clinically only as erythematous or whitish patches and there are usually no palpable bumps since it is confined only to the epidermis and therefore it is flat. The skin may in fact look almost normal.
On physical examination, haemorrhoids are easily differentiated from other lumps or bumps.
Anal Pap smear is a screening test for anal dysplasia in high risk individuals e.g those who practice anal sex or those are are Hiv positive. It is usually perfomed serially i.e every 6 months and can detect dysplastic changes quite early. False positives or negatives can occur but if the changes are persistent on serial testing they are most likely to be dysplastic rather than inflammatory.
HPV typing is done from material taken from anal mucosa i.e either swab or tissue and tested for HPV DNA types by PCR.
Haemorrhoids are soft and compressible whereas lumps are firm to hard in consistency and are not compressible like haemorrhoids.
Regards
Note: Consult a Sexual Diseases Specialist online for further follow up- Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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