It’s possible that you may have been seeing more news items about HPV recently. That’s because doctors and scientists are learning more about how HPV affects men. It’s also likely that you’ve read about the new HPV vaccines and how these vaccines could be really important ways for us to prevent HPV. But many gay men don’t know much about HPV, and that may complicate efforts to prevent HPV disease in our communities. So here’s a little background about HPV and gay men.
HPV, or human papillomavirus, is the most common sexually transmitted disease. It’s known now that almost all people, gay and heterosexual, will get HPV at some point in their lives. It’s just part of being a human being. But most of us will never know we had HPV because we won’t have any symptoms, and our body will clear the virus within a few months, or maybe as long as a year or two (in this way, it’s very different from HIV).
While most of us will never know we had HPV, a small percentage of men will get a wart (or more than one) on the genitals, in the anus, or on skin nearby. While some men may be embarrassed to have these, they can be treated (or they often will go away by themselves), and there’s no long-term physical danger from them. They ARE infectious and if another guy’s penis, scrotum, etc., touches these warts, it’s very easy for him to get HPV infection too, and possibly a wart himself. Unfortunately, HPV can be transmitted even when warts aren’t present – it just takes close physical contact with skin that is HPV-infected. By the way, did you ever get a wart on your hand when you were a kid? Or did you ever get a wart on the sole of your foot after walking barefoot in a gym locker room? Those are caused by HPV too. They’re just different types of HPV.
Unfortunately, HPV doesn’t just cause warts. Certain types of HPV can also cause cancer. HPV causes cervical cancer in women, and several hundred thousand women worldwide die of cervical cancer every year. In the United States and other countries that are rich enough to have widespread screening for cervical cancer, there are far fewer deaths from cervical cancer. But still, several thousand U.S. women die every year from cervical cancer. Most of these women would not have died if they had had regular Pap tests to screen for cervical cancer. Lesbians and bisexual women can get cervical cancer, too, and it’s just as important for them to get regular cervical cancer screening as for any other women.
HPV does cause cancer in men too. And gay men are at especially high risk for cancers caused by HPV. When I’ve talked about HPV with some of my friends, more than once a guy has said, “HPV -- That’s the infection that causes cancer in women. And men are the carriers, right?” Well, HPV causes cancer in us, too. In fact, in the United States, gay men are more likely to get HPV-caused cancer than women are to get cervical cancer. It’s stunning, but one of your gay male friends is more likely to get anal cancer than your sister or mother is to get cervical cancer.
Anal cancer usually starts with an HPV infection in the anal canal that isn’t cleared by our immune system. The infection may start in us after receptive anal intercourse with a guy who has HPV on his penis -- although you don’t have to have receptive anal sex to get HPV in your anus. (See heterosexual men below.) Once, a guy said to me, “So anal sex causes anal cancer?” The answer is that just as a penis is responsible for transmitting HPV to a woman’s cervix, it can also transmit HPV to the anal canal. For the record, women also get anal cancer; in fact, more women in the U.S. will get anal cancer this year than will men, and you may have seen the reports that Farah Fawcett had anal cancer. But gay men are at much higher risk for anal cancer than are women. In fact, at any given point in time, maybe 50% or more of us have HPV in our anus. But remember, most of these infections will clear up all on their own. So only a very tiny percentage of gay men with anal canal HPV infection will be at risk for cancer down the road. Interestingly, our own research here at Moffitt Cancer Center shows that about 10% to 15% of heterosexual guys also have HPV in their anus – how it got there in heterosexual guys is still unclear although it’s probably not because these guys had receptive anal sex.
But for gay men, there’s another perspective that’s critical for us. We are much more likely to get HIV infection than we are to get anal cancer. Best estimates are that about 5 to 10 in 1,000 gay men in the U.S. will get HIV this year. Estimates for anal cancer are nowhere near as good as the much more studied HIV, but best estimates indicate that probably no more than 1 in 1,000 gay men may get anal cancer this year. But if you have HIV your risk for anal cancer is greater (see below).
So what can we do to avoid anal cancer? Quite a bit, in fact. The Gardasil HPV vaccine effectively prevents infection with the types of HPV that are most likely to cause not only anal cancer but also warts. The vaccine is approved for use in men until age 26, but older guys can still probably get it although it may be less effective. It is expensive – several hundred dollars – and it may not be effective if you already have the type of HPV prevented by the vaccine. (Remember, HPV is very, very common.) If you’re lucky enough to have a health care provider, talk to him or her about the vaccine to see if it could help you. Also, if you have health insurance, check to see if they cover the vaccine cost.
HPV cannot penetrate a latex condom so these may reduce the risk of anal canal HPV infection (and given their ability to prevent HIV infection, they make a lot of sense). Several studies also show that men who have fewer sexual partners are less likely to have anal canal HPV.
Finally, men with HIV who have a suppressed immune system are at greater risk for anal cancer. (This is also the case with people who have a suppressed immune system due to drugs given during an organ transplant.) For men with HIV, it’s important that they get regular screening for changes in their anal canal that could precede anal cancer. Just like screening for cervical cancer, screening for anal cancer can prevent most cases of anal cancer. In fact, some health care providers feel that all men who have receptive anal sex should talk to their doctor and seriously consider regular screening for anal cancer. Screening can identify changes in the tissue of the anal canal that, if not treated, could lead to cancer.
HPV causes other cancers, too, including cancer of the penis and throat cancers. But there is less known about these cancers than there is about anal cancer.
For more than 25 years, gay and bisexual men have been dealing with the threat of HIV. We’ve always known this wasn’t the only threat to our desire to live lives uncomplicated by disease and disability. We knew that other issues like threats of violence against us because we’re gay, discrimination in the workplace, and drug and alcohol dependence were thorny issues that are just part of the reality of being a gay man in the United States. And for the most part, we’ve been successful in navigating our way through this minefield. We got through it because we learned how to avoid it, and then took active steps to do so, or one of our brothers helped us get through it. And sometimes we were just lucky. It’s no different with cancers caused by HPV.
Questions? Alan Nyitray can be reached at
. Alan Nyitray is a post-doctoral fellow and epidemiologist at the Moffitt Cancer Center and Research Institute in Tampa, Florida.
Comment by Donald on 2012-11-29 09:37:33 All the time the bacteria can get in there (and the kind of sex, but anal is even more likley), you can get a urinary tract infection. If you really, the only way to ensure that he left is to go to the doctor and get antibiotiques.Dans the same time, there are two products you can buy just about anywhere (and UriStat Azo both are the same drug) that will keep symptoms under control until you can get antibiotiques.On not mess with her left untreated UTI can lead to urinary tract infections and kidney!