November 23, 2011 | by Ray Martins
Gay men should be screened for HPV-related cancers

The popular “Movember” campaign, where men grow mustaches and beards to raise funds for cancer, brings a lot of awareness around cancers that affect men. Much of the attention around the campaign is focused on prostate and testicular cancer.

While it is important for all men to be aware of these cancers and take preventive steps, gay and bisexual men and men who are HIV-positive also need to be aware of anal cancer and cancers of the head and neck that can be caused by exposure to Human Papillomavirus (HPV).

Let’s start with the basics. What is HPV? According to the Centers for Disease Control, “genital Human Papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.”

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Half of all men have HPV and most will develop no health problems from it. In fact, in about 90 percent of cases, the body’s immune system will clear the virus within two years. However, some people will develop conditions from it, ranging from genital warts and warts in the throat to cancer of the anus, penis and throat.

With such high numbers of carriers, it is important for gay and bisexual men and men who are HIV-positive to be aware of the risks and take proper precautions.

Currently, there are no accepted medical guidelines for HPV prevention or screening for men. This is due to lack of data about how effective existing methods will be for men and the fact that HPV is easily transmitted from person to person. However, there are some general precautions that gay and bisexual men and men who are HIV-positive can take.

Condom use can lower the risk of contracting HPV. However, since the virus is passed by skin-to-skin contact, condoms will not protect areas that they do not cover.

Lowering the number of sexual partners or only having sex in a monogamous relationship will also reduce your risk of infection. However, it will not completely eliminate the risk, as one person with only one lifetime sexual partner can still get HPV.

The Gardasil vaccine offers some protection against HPV-related cancers in men. However, it is not medically appropriate for everyone. Current guidelines recommend the vaccine for boys and men ages nine through 26. However, it is most effective if administered before someone starts sexual activity.

There are screening tests for anal cancer called anal pap smears. However, the CDC and US Preventive Service Task Force are currently not recommending anal pap smears because more information is needed to see if these screenings and follow-up treatments actually prevent these cancers. Expert opinion recommends yearly anal cancer screenings for HIV-positive men and screening every two-three years in HIV-negative gay and bisexual men. Again, there are no generally accepted guidelines for this screening.

Currently, there are no approved screening tests for either penile or throat cancer.

Gay and bisexual men need to take HPV and the cancers it can cause seriously. With no currently generally accepted guidelines for prevention or screening, it is important for gay and bisexual men to have a conversation with their medical provider about HPV and their risks. Your own provider will be able to give you the best recommendations on what you should and shouldn’t do to reduce your risk from HPV.

Whitman-Walker Health offers screenings for anal cancer in gay and bisexual men, one of the few providers in Washington that has this service. We can also teach men how to do regular testicular self-exams and about the warning signs of prostate and head and neck cancers.

And, for those for whom it is medically appropriate, we offer the Gardasil HPV vaccine.

Make an appointment with your regular provider or with Whitman-Walker and ask for appropriate screenings for HPV-related cancers. Your health depends on it.

Dr. Ray Martins is chief medical officer of Whitman-Walker Health.

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