Author’s note: This article contains information on the human papilloma virus (HPV), its treatment, and its vaccine. The author in no way intends the information to be used to diagnose, treat, or cure any condition and should not be construed as an attempt to practice medicine. All medical conditions should be evaluated on a case by case basis by a licensed medical practitioner. The facts presented in the article were obtained from the U.S. Center for Disease Control, the Gay/Lesbian Medical Association, the American Medical Association, the Board of Obstetrics and Gynecology, the National Cancer Institute, and the Food and Drug Administration. Any opinions made are those of the author and do not necessarily reflect the opinions of GayFresno, its owners, affiliates, and/or subsidiaries. Again, you should ALWAYS consult a licensed medical practitioner before making decisions about your health.
A few months back I saw a video of a woman giving this ridiculous speech about “homosexuals.” After watching it, I remember thinking to myself that this woman must be insane. She made several ludicrous points which included: gays convert children by touching them, the “sin” attracts natural disasters, and we spread colon cancer. Now, make no mistake that I still think the woman is nuts, but I did find that she may have been close to an actual truth with the last of her comments. First of all, let me make this very clear: You cannot spread colon cancer with anal sex. However, I did say she was close. This article should help to clarify things.
In recent years there have been a growing number of cases of anal cancers directly related to the human papilloma virus (HPV). For decades HPV has been linked to female reproductive cancers, and it’s no secret that anal warts have been around for some time, but these latest findings are telling a new story. Before we get into the details of the findings, let’s take a moment and define some terminology.
There is some misconception about the anus and what it is. Most people think it’s just the “exit” hole and sphincter. The fact is the anus is actually a much larger area than just the external exit. The anus starts at the bottom of the rectum, the last portion of the colon (large intestine.) The anorectal line separates the anus from the rectum, making up the last 2 to 4 centimeters of the lower gastrointestinal tract. For the purpose of this article, when I refer to anus, I am referring to the entire area. A papilloma is generally a benign epithelial tumor, resembling a skin tag or “nipple.” With that said, let’s move on to the condition.
The human papilloma virus (HPV) is a DNA virus (meaning that it uses DNA to replicate) that typically infects the mucous membranes. There are more than 150 known types of HPV though the majority does not cause symptoms in humans. More than 30 of those cause benign papillomas, genital warts, and infections that can lead to precancerous lesions and invasive cancers of the cervix, vulva, vagina, penis, oropharynx, and anus. Fifteen of those have been classified as carcinogenic “high-risk” sexually transmitted HPVs. Additionally, HPV has been linked with an increased risk of cardiovascular disease.
With those numbers in mind, I began asking myself who was at risk. Can we do anything about it? Are there treatments or preventative measures? A little research turned up some even more disturbing information. The U.S. Center for Disease Control reports that “Anyone who is having (or has ever had) sex can get HPV. HPV is so common that nearly all sexually-active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime.” (I have to admit that seems a little scary.) It can be passed from person to person through oral sex, genital to genital contact, anal sex, or vaginal intercourse. The virus can be spread with or without symptoms and affects both heterosexual and homosexual couples. In rare cases, pregnant women may even pass the viruses on to an infant during delivery. An individual can contract more than one type of HPV. HPV infections are the most common sexually transmitted infections in the United States. The statistics for females having HPV and HPV-related cancers are staggering, but what is less commonly known is that more and more men are experiencing complications from these infections, including cancer. Each year an average of 1900 men are diagnosed with an HPV-related cancer of the penis or anus, and the numbers are growing exponentially. Gay and bisexual men are 17 times more likely to develop HPV-related anal cancers than men who only have sex with women. Additionally, individuals with compromised immune systems (those with HIV or those who take immune-suppressing medications) are at an even higher risk. In 2010, there were 5300 new cases of anal cancer directly related to HPV and a little more than 700 deaths by the same. Those numbers have increased by 73% in the last 3 years. Of the men in those cases, more than half were gay and bisexual men.
I’m blown away. I remember hearing my parents talk about the “big VDs” when they were in school: gonorrhea, syphilis, herpes, and chlamydia. Then, when I was in elementary school and junior high, the terminology changed from venereal disease to sexually transmitted disease, and the focus had shifted to HIV/AIDS. We’d have 10 or 15 sentences in a textbook about the ones from my dad’s generation, and then page after page about HIV. Now, with the advances in medicine and better understanding of conditions, we’ve become almost as casual about AIDS as we have the clap. Here we are in the 21st century, and I’m looking in my son’s health textbook, and the chapter on STDs is miniscule. Looking at the numbers for HPV, I have to wonder if we did this to ourselves. Our casual outlook on sex and the infections associated with it has without a doubt contributed to the rise of something more sinister: a disease that can lay dormant for decades while innocuously being transmitted by minor sexual contact; a disease that can lead to cancer. Genital warts have been around for centuries, and people looked at them as…nothing, a simple blemish. Misconceptions about their fungal counterparts and a primitive school of thought have allowed this virus to grow and evolve into a new monster. We are engineering the icon of our destruction through complacency and foolishness. My readers might find that a bit extreme, but consider this: a virus that nearly all of the human population is infected with can mutate and evolve over a very short span of time to establish a potentially lethal cancer in an otherwise healthy body. I believe it is that serious.
Apparently, there are those in the medical field who share my concern for the growing number of cases of HPV in this country. New treatments are becoming more available and preventative measures are being established and debated. The newest of these prevention tactics allies with the FDA’s green-light for a vaccine that not only helps protect women from reproductive cancers related to HPV, but also helps to prevent anal cancer. Gardasil has been approved for children and young adults from ages 9 to 26. The administration of the vaccine is proving to lower the number of cancer-related HPV infections in those age categories. The vaccine, while still in its infancy, is essential to bringing an end to the spread of HPV. As more and more individuals are vaccinated, we should see a gradual shift downward in the numbers. Dr. Karen Midthun of the FDA’s Center for Biologics Evaluation and Research said, “Treatment for anal cancer is challenging; the use of Gardasil as a method of prevention is important as it may result in fewer diagnoses and the subsequent surgery, radiation or chemotherapy that individuals need to endure.” Currently, 90% of anal cancers are related to HPV, but this vaccination is expected to reduce that percentage considerably over the next decade. This is of course directly dependent on individuals being properly vaccinated within the appropriate time period. We, the people, are responsible for ushering in an HPV-free era by being vaccinated and utilizing safer-sex practices. Gardasil’s ability to prevent anal cancer and the associated precancerous lesions [anal intraepithelial neoplasia (AIN) grades 1, 2, and 3] caused by anal HPV-16/18 infection was studied in a randomized, controlled trial of men who self-identified as having sex with men (MSM). This population was studied because it has the highest incidence of anal cancer. At the end of the study period, Gardasil was shown to be 78% effective in the prevention of HPV 16- and 18-related AIN. Because anal cancer is the same disease in both males and females, the effectiveness data was used to support the indication in females as well. The New York Times recently reported that the American Board of Obstetrics and Gynecology has been engaged in debate involving the allowance of Ob/Gyn medical professionals to treat men. The Board had previously disallowed its members from treating male patients, but a panel of experts in anal cancer petitioned the board to reconsider its position. Patient advocacy groups also got involved, pointing out that the board’s initial decision could interfere with research and make it harder for men to find screening and treatment. The board had stated that it wanted to preserve the profession’s female specialty and limit the non-gynecological work performed by its members. Dr. Kenneth Noller, the board’s director of evaluation, said the reconsideration came from the long tradition of gynecologists treating sexually transmitted diseases in women and men, and that HPV and its associated problems fell into that category.
Where does that leave us? What steps do we take toward prevention? A new type of screening has become available in some areas. Similar to the Pap smear used by gynecologists for the last several years for the early detection of cervical cancer in women, the Anal PAP is now being recommended for gay and bisexual men. The test is simple and involves collecting cells from the anus and rectum which are then studied under the microscope to identify certain structural changes in the cells. The procedure is painless and quick. The preparation time is 24 hours and basically requires that the individual not put anything into the anus for that period (no sex, no toys, no lubricants, no enemas, etc.) The Harvard Board of Public Health that sponsored the initial studies in Anal Paps recommends testing once every three years. I believe a few hours (appointment and procedure time) out of every three years are worth it; it could save your life. The testing process should begin when an individual becomes sexually active. In addition to the Anal PAP, the vaccine, Gardasil, is available for those in the appropriate age category. Gardasil is safe for both males and females, and it is recommended that vaccination begin between ages 9 and 11. The vaccine is given in 3 doses over the course of 6 months. Individuals between the ages of 9 and 26 who have not been vaccinated should strongly consider the vaccine. The vaccine and Anal PAP are covered by most insurance plans and eligible children may be able to receive the vaccine through Vaccines for Children.
So, the crazy lady who said gay men were giving people rectum cancer wasn’t far off. Even though it isn’t the rectum that is affected by HPV, the reality is anal cancer is undeniably connected with anal intercourse. So what’s “the good, the bad, and the ugly”? The good here is that we are making strides in the prevention and treatment of HPV. The bad news is that unprotected sex isn’t just about STD/STIs anymore. It can cause cancer! And the ugly…squeezing an Anal PAP into my schedule. You should too.