HPV and men

The human papillomavirus, that causes genital warts and cervical cancer, has historically been a topic only of concern to women.  Recently, however, it’s been discovered that HPV is becoming a much bigger concern to men as it’s leading to a rise in cases of anal and oropharyngeal/upper throat cancers, particularly in men who have sex with men.

HPV has long been one of the most common sexually transmitted diseases.  Most people who are infected do not develop any symptoms and can carry the virus for years without knowing it.  There are more than 40 strains of HPV, each of which can act differently.  HPV can often lead to genital warts, which appear as small white bumps in the genital area.  In other cases, HPV can lead to cancer when the skin that carries the virus mutates and becomes cancerous.  The site of the cancer is based upon the site of the exposure, or the type of sexual contact that occurred.  For years, woman infected with HPV ran the risk of developing cervical cancer, and public health campaigns were solely focused on increasing awareness about cervical cancer and HPV.  Now that we are seeing more and more men developing HPV-related cancerc, the focus of these campaigns is changing, and it’s time for men to understand how the virus works.  Unfortunately, I find that I can sit and talk to a patient one-on-one about HPV, and never get past that “glazed-over” look, so here is a summary of what guys need to know about HPV.

How and what:   HPV is spread through intimate, skin-to-skin contact with someone who is carrying the virus.  Most infected people are asymptomatic, but are still shedding the virus during contact.   The number of cases being transmitted rectally and orally is on the rise and that is leading to many more cases of cancer.  Men comprise between 70-90 percent of HPV-related anal and oral cancers.  According to the Centers for Disease Control and Prevention, MSM are 17 times more likely to develop anal cancer than men who have sex with women.  HIV can severely complicate the treatment of genital warts or HPV-related cancers. Treatment often requires surgery and/or radiation and chemotherapy.  HPV-related cancers can be fatal.  The strains of HPV that lead to genital warts are different than the strains that lead to cancer.

What to look for:  Many of those with anal cancer do not show any symptoms, however some will experience rectal bleeding, itching or unusual discharge from the rectum.  Some cases report swelling in the lymph nodes of the groin or anal area.  Symptoms of oropharyngeal cancer often include a sore throat or hoarse voice that does not go away, difficulty swallowing or a swelling in the neck region.  Also, as is symptomatic of many cancers, people will report unusual weight loss and fatigue.  What is frustrating is that there is currently no test for HPV in men other than a clinical diagnosis of genital warts or cancerous tissue that tests positive for HPV.

What to do:  In 2006, the Federal Drug Administration approved the Gardasil vaccine for girls and women to provide protection against the most common strains of HPV.  In 2010, the vaccine was approved for use among boys and men ages 9 to 26.  This vaccine provides protection against the two most common strains that lead to genital warts and the two most common strains that lead to cancer.   The younger at time of vaccination, the more likely it will provide protection.  It is given in a three-dose series.  The ideal situation is to vaccinate before the first sexual encounter, or essentially before there is any chance of an exposure to HPV.  The vaccine is not a cure for someone who has already been exposed or infected with HPV.  Reducing your number of sexual partners as well as 100 percent condom use greatly reduces the risk of exposure.

For those interested in finding out how to get the Gardasil vaccine, ask a primary care physician.  Some insurance companies will cover the cost of vaccination.   The Salt Lake Valley Health Department also provides the Gardasil vaccine to the public, and for more information call 385-468-4242.

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