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STDs (Expert Forum)
HPV
Answered by
University of Washington
Seattle - WA
This forum is for questions and support regarding STD issues such as: Chlamydia, Crabs (pubic lice scabies), Gonorrhea, Hepatitis (viral), Herpes, HPV, Molluscum Contagiosum, PID, Rectal Infections, Syphilis, Trichomoniasis, Warts, Yeast Infection.All questions will be answered by H. Hunter Handsfield, M.D. or Edward W Hook, MD.
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HPV
by t1234, Mar 28, 2007 12:00AM
I have a lesion on my anus (being biospied),
Information on the net indicates this can be caused by HPV
just as cervical cancer and anal pap smears may be a good
idea for sexually active men (in my case hertrosexual, but
single for over 20 years). Of course I got this from the net
and have no idea if the information is correct.
But should sexually active men be advised to have anal pap smears and are young men candidates for the new HPV vaccine.
Information on the net indicates this can be caused by HPV
just as cervical cancer and anal pap smears may be a good
idea for sexually active men (in my case hertrosexual, but
single for over 20 years). Of course I got this from the net
and have no idea if the information is correct.
But should sexually active men be advised to have anal pap smears and are young men candidates for the new HPV vaccine.
Doctor's Answer
by H. Hunter Handsfield, M.D., Mar 28, 2007 12:00AM
, Mar 28, 2007 12:00AM
Thanks for the opportunity to comment an important issue. Anal cancer is a serious concern for men who have sex with men. The overall rate of anal cancer in MSM is just as high as it was for invasive cervical cancer in women in the pre-pap era, and in developing countries today where cervical pap smears are not done. High-risk HPV infection is always the cause, just as in women with cervical cancer; this has been known for 15-20 years.
This suggests that anal pap smears for MSM make sense, and some researchers and clinicians (and activists) concerned about gay men's health strongly recommend them. On the other hand, no public health authority or prevention agency recommends anal paps at this time: not CDC, the US Preventive Services Task Force, the American Cancer Society, nor any state or local health department, to my knowledge. This isn't anti-gay bias. There is true scientific uncertainty about it: the best specimen collection methods are unknown (external only? anoscopy for internal specimens? and other details); the natural history isn't known (i.e., what proportion of precancerous lesions actually progress to cancer and how long does it take?); the best (or any) treatments for precancerous lesions are unknown (surgery? cautery? freezing? other?); and it is unknown if treatment of early anal lesions makes a difference in later cancer risk. All these things are pretty well known for female paps. For now, this remains an area of intense research interest, but no more. I agree with most experts that it is not (yet) time to recommend anal paps routinely in MSM.
Research is underway to determine the efficacy of the HPV vaccines in men, both heterosexuals and MSM. Probably they are effective, at least in HIV negatives. But even if effective, practical utility is uncertain. Maximum benefit comes from vaccinating before a person becomes sexually active, i.e. in the pre-teen or young teen years. This is one argument in favor of immunizing all boys, even if most of the benefit of HPV vaccine is in preventing disease in girls. Immunization would help protect the few percent of boys who are gay but don't yet know it (or cannot talk about it) against future anal cancer. But whether it is worth immunizing all boys in order to protect only 5% of them is not uncertain. This isn't anti-gay bias, just a reasonable question of health economics.
Some currently sexually active MSM would be protected from HPV by getting vaccinated, but for many, once sexually active at all, it probably is too late. On the other hand, the vaccine is harmless; if someone wants to pay $500 (since it isn't yet covered by insurance for males), there is no strong reason not to do it.
I hope that helps.
HHH, MD
This suggests that anal pap smears for MSM make sense, and some researchers and clinicians (and activists) concerned about gay men's health strongly recommend them. On the other hand, no public health authority or prevention agency recommends anal paps at this time: not CDC, the US Preventive Services Task Force, the American Cancer Society, nor any state or local health department, to my knowledge. This isn't anti-gay bias. There is true scientific uncertainty about it: the best specimen collection methods are unknown (external only? anoscopy for internal specimens? and other details); the natural history isn't known (i.e., what proportion of precancerous lesions actually progress to cancer and how long does it take?); the best (or any) treatments for precancerous lesions are unknown (surgery? cautery? freezing? other?); and it is unknown if treatment of early anal lesions makes a difference in later cancer risk. All these things are pretty well known for female paps. For now, this remains an area of intense research interest, but no more. I agree with most experts that it is not (yet) time to recommend anal paps routinely in MSM.
Research is underway to determine the efficacy of the HPV vaccines in men, both heterosexuals and MSM. Probably they are effective, at least in HIV negatives. But even if effective, practical utility is uncertain. Maximum benefit comes from vaccinating before a person becomes sexually active, i.e. in the pre-teen or young teen years. This is one argument in favor of immunizing all boys, even if most of the benefit of HPV vaccine is in preventing disease in girls. Immunization would help protect the few percent of boys who are gay but don't yet know it (or cannot talk about it) against future anal cancer. But whether it is worth immunizing all boys in order to protect only 5% of them is not uncertain. This isn't anti-gay bias, just a reasonable question of health economics.
Some currently sexually active MSM would be protected from HPV by getting vaccinated, but for many, once sexually active at all, it probably is too late. On the other hand, the vaccine is harmless; if someone wants to pay $500 (since it isn't yet covered by insurance for males), there is no strong reason not to do it.
I hope that helps.
HHH, MD
HHH, MD
Even if the risk is low, I think sexually active hertosexual men should be informed by their physicians. It doesn't take many sexual partners to (I understand three or more) to have a statisical probability approaching 100 per cent of contracting the virus.
Regardless of how this comes out, had I known I would have paid for
the test "out of pocket."
Thanks again for all the good work you do.