by Aimee Steinly
Human papillomavirus is the most common sexually transmitted infection in the United States and approximately 90 percent of all anal cancers are attributed to HPV infection. HPV is a virus, like the common cold but, unlike the cold or flu, it can be present without any symptoms.
Some HPV strains can cause genital warts and are considered low risk, with a small chance for causing cancer. Other types are considered high risk, causing cancer in different areas of the body including the cervix and vagina in women, the penis in men, and the anus and oropharynx (throat) in both men and women. In fact, more than 80 percent of sexually active adults are believed to have been infected with at least one strain of the virus by age 45.
In a 1927-29 study, Georgios Papanicolaou and Aurel Babeş determined that cancer can be detected by inspecting cervical cells. Called a Pap test (named after Papanicolaou), it was the first screening widely used for identifying cancer.
In July 1943, Dr. Papanicolaou published a paper explaining how to use the Pap test to screen for cellular changes that could be cancerous. Within the decade, annual screenings with Pap smears began, and the cervical cancer rate in the U.S. dropped to approximately 50 percent of what it was at the turn of the century. Pap smear screenings have saved countless lives by providing early detection and intervention; allowing for treatment early in the process, when the treatment is least invasive and more successful.
While the HPV virus has been a source of screening for over 70 years for women, HPV is also common in men and can be similarly transmitted through sexual activity and/or anal intercourse. Cervical cancer and anal cancer are both associated with the HPV virus, which can easily spread from person to person through sexual intercourse (anal or vaginal), fingers or toys.
What does this mean to you? It means that each time that you have a new partner, you have the potential of exposing yourself to a new strain of the HPV virus; just because you tested negative a month ago, does not mean you weren’t recently exposed. Often, our bodies fight off the virus, but occasionally, it becomes persistent and changes the mucosal cells into precancerous ones.
Additionally, with the increasingly dynamic nature of adult sexual activity, often with changes in participant anatomy, enhancing agents and sex toys, the likelihood of transmission has increased. Quite frankly, sex is a sloppy sport and anywhere bodily fluids may land, even unintentionally, may result in an infection.
This is important to know because the HPV virus is mostly asymptomatic. Some may have anal bleeding or pain, but most will not show signs until the cancer progresses. While you know what to look for to identify skin cancer, without screening for cellular changes in the anal mucosa as a result from the HPV infection, you will not know if you are infected.
Approximately 7,000 cases of anal cancer are diagnosed annually in the US each year; an anal Pap will certainly decrease this prevalence. Furthermore, gay and bisexual men with HIV are even more at risk because they are dramatically more susceptible to a persistent HPV infection, which leads to a 40 fold increase in the risk of anal cancer as compared to the general public.
In prevalence studies, anal HPV infection among HIV-positive MSM, reported prevalence estimates between 87 and 98 percent. Individuals with multiple sex partners, those who have a history of HPV infection (men or women), and those who have compromised immune systems (such as organ transplant) also have a higher risk. However, anyone engaged in sexual activity is at risk for exposure.
Due to the infectious nature of the HPV virus, it is extremely communicable. New evidence suggests that anal HPV can be transmitted among women with cervical HPV, simply by wiping from front to back.
Anal HPV screening is available and accessible in Utah. The screening is done through an anal Pap smear, a procedure that is quick, painless and simple. Then the sample is then sent to pathology for evaluation. The anal Pap provides early identification of high-risk anal HPV strains, so further evaluation and treatment may be determined through a high resolution anoscopy. Early diagnosis allows for less invasive, in-office treatments, while later diagnosis often requires chemotherapy, radiation and even surgery resulting in a colostomy.
Recent HPV vaccinations provide protection against some high-risk strains of HPV, along with the strains that cause warts; however, they offer the most protection to someone who has never engaged in sexual activity. So, for those who have been exposed, a simple screening could save lives.
Contact the LGBTQ friendly providers listed in the QPages directory for a local anal HPV screening facility.