There has been a lot of talk about HPV recently with the release of the new vaccine. But most of what I read for women concerns HPV in the vagina and PAP smears. As a girl who’s way more into anal sex than vaginal sex, what do I need to know about HPV? Can a person get HPV in their ass, is there a test for it, and how is it treated?

–Concerned Anal Citizen

There are more than one hundred types of the human papillomavirus (HPV), and more than forty different strains can be sexually transmitted and affect these areas: the vulva, vagina, cervix, penis, scrotum, anus, and rectum. HPV is a virus most closely associated with genital warts, although not all forms of HPV cause warts. Some of the strains of HPV are low risk and resolve themselves without treatment. High-risk types of HPV can cause abnormal cell growth and cervical cancer. According to Planned Parenthood,

At any time about 20 million people in the U.S. have [genital HVP infections]. Between 10 and 15 million have high-risk types that are associated with cervical cancer. HPV is so common that about three out of four people have HPV at some point in their lives.

The most common way to spread HPV is through vaginal and anal intercourse, but it can also be spread through rubbing, fingering, oral sex, or sharing sex toys. Condoms protect against HPV, but HPV may be present in the skin not covered by a condom, which is why gloves and dental dams should also be used.

Yes, you can get HPV in your ass. If it is a kind of HPV that manifests as genital warts, they can appear in as little as three weeks or as long as six months after infection. The warts begin as small pink bumps that look like cauliflower florets in or around the anus and rectum; they tend to spread rapidly, forming clumps of bumps that may be itchy. The bumps could be painful if they are irritated. Their incubation period is usually one to six months, but they can grow more rapidly if you are pregnant or have a compromised immune system. Remember, in many cases, someone with HPV may have no visible symptoms at all; in these cases, a physician will be able to see them during a rectal exam with an anoscope. Genital warts can go away on their own; or, they can be removed from the skin by applying chemicals to them (usually acids), burning them with an electric needle (electrocautery), freezing them with liquid nitrogen (cryotherapy) or with laser treatment. Even after visible warts are removed, HPV remains in your body, and the warts can recur.

The strains of HPV that can cause precancerous lesions on the cervix can be detected through a pelvic exam and PAP test. If you have HPV in your ass, it’s less common to have treatable precancerous lesions present since there is no cervix or cervix-like place for them to develop, though it’s still possible to have pre-cancerous cells which precede rectal cancer. To test for the presence of HPV in the ass when there are no warts, a physician takes a swab of the rectum and sends it for laboratory analysis (similar to a vaginal PAP test). If you regularly engage in unprotected anal penetration and think you have been exposed to HPV, you can request a rectal exam and an anal papilloma screening (also known as an anal PAP test). If the PAP results come back abnormal, then you should have an HPV test which tests the cells for the HPV virus. If the HPV virus is detected, you can have a colposcopy where they take a biopsy and can look closer at the cells. You can spread HPV from your ass to your vagina and vice versa, so if it has been discovered in one place, it’s advisable to get the other place checked. People diagnosed with HPV should have regular exams to monitor recurrences and prevent complications.

In 2006, a vaccine for girls and women was released that can prevent four strains of HPV: two of the strains account for 90% of cases of genital warts and two account for 70% of cervical cancer cases. The vaccine, currently marketed under the name Gardasil is recommended by the FDA for girls and women aged 9-26. However, women over 26 who have never been exposed to one or more of the strains of HPV can also benefit from the vaccine. Researchers still know much less about HPV infection in boys and men, including its long term effects, risk of cancer, early detection, and potential treatments, although several drug companies are (including Merck, makers of Gardasil) are conducting clinical trials on the vaccination of boys and men.