The MVP of Sexually Transmitted diseases!

Right now, HPV, The Human Papillomavirus, is not only the most commonly transmitted STD in the world, but it also sits right across the aisle from HIV as far as public controversy is concerned. Unfortunately, most doctors are not well trained in detecting or treating gay males for this disease, which leaves you to do the heavy lifting on this matter.

This includes regularly checking your sexual organs for abnormal bumps or warts, and asking for an anal PAP smear, if you believe you have developed anal warts. There are no other tests available at this time.

A quick note on pictures for this piece:

Health organizations often enjoy showing pictures of diseases after they have gone to the very extreme on a person’s body after years of neglect. At GMJ, we see no purpose to this. Please get the advice of a trained medical professional at the first sign of any illness, including STDs.

So, with this in mind, we search for photos that show symptoms at the beginning stages to give you a better idea of what to look for before a complex medical situation develops. OK?

What is HPV?

Once again, another virus that is not only contracted through unprotected anal and oral intercourse but also through much of the touching and physical contact that comes with sex. HPV can also be transferred when the infected partner(s) does not show symptoms. 

Condoms may reduce the spread of HPV if the latex covers any bumps or warts, but this is far from a 100% guarantee of protection, considering most males will not ever show any signs of this virus. Education about HPV and knowing your body is your best bet.

The truth is that most sexually active people will contract HPV at some point in their lifetime. But don’t worry! For most, this STD will go away on its own without causing any long-term problems. The bad news is that if you do develop symptoms, they can be pretty nasty, complicated, and time-consuming to get rid of. 

NOTE: Kissing is not known to be a method of HPV infection, so spit swap away! 

Oral Cancer

More research is being published regarding HPV and oral cancer.  Cancer Network.org states: “Although it remains difficult to prove that HPV can be transmitted through oral sex, researchers and scientists believe such transmission is likely to occur.

Since the HPV virus is easily transmitted through skin/mucosal contact, oral sex is a potential vehicle for transmission from the anogenital area to the mouth. In addition to the well-known risk factors like tobacco and alcohol, HPV seems to play an independent role in the development of almost 30% of oral carcinomas, particularly oropharyngeal malignancies.

Perhaps the most vital piece of evidence in support of this is the fact that patients who have had prior HPV infection are 32 times more likely to develop oral malignancies than those who have not.

In comparison, chronic alcohol consumption and tobacco smoking increase the risk of oral cancer by about 2.5 and 3 times, respectively.

Even though HPV is the most common cause of anal cancer in men, those who have the highest risk remain woefully unaware, with studies suggesting that only about 25% of gay and bisexual men are knowledgeable about the relationship between HPV infection and anal cancer.

Anal Cancer

In the general population, anal cancer is a rare disease. Among men who have sex with men (MSM), the incidence of anal cancer is significantly more prevalent and increasing annually.

However, the majority of MSM know little about the disease, have never been tested for it, nor know that screening tests exist. Healthcare professionals, too, remain divided on how and whether to screen for it. A standardized screening protocol for anal cancer does not yet exist.

Anal cancer is caused by the same strains of Human Papillomavirus (HPV) that cause cervical cancer in women. There are over 100 different types of HPV, although only several strains are believed to increase the risk of cancer.

Anal HPV is present in approximately 65% of HIV-negative MSMs and 95% of MSMs who are HIV-positive. Although HAART (highly active antiretroviral therapy) has decreased overall mortality from HIV, it has not reduced the incidence of anal squamous cell carcinoma4. And, since it is spread through sexual skin-to-skin contact, condom use only partially reduces the risk of transmission. Other factors that increase the risk of anal cancer include a high number of sex partners, alcohol, drugs, and tobacco use. 

A growing number of gay physicians and health activists now believe that routine screening, using an anal pap smear, could reduce the incidence of anal cancer as dramatically as it has cervical cancer in women. They recommend that all MSMs, especially those who are HIV+, be tested every 1-3 years, depending on their immunological well-being and CD4 count. They suggest that HIV-negative individuals be tested every 3 years. Still, some clinicians are not convinced that routine screening of all MSMs is warranted. They cite the small number of positive cases, the shortage of facilities for follow-up procedures, and the fear, cost, and pain involved in pursuing small cell changes, called dysplasias. In addition, most health insurance policies do not cover anal pap smears.

What are the signs/symptoms of HPV?

Anal warts: 

 Either one or a cluster of bumps that gather around the outer and sometimes inner canal of the anus. These warts may be small or large, raised or flat, and some forming shapes similar to cauliflower. Sometimes, the warts may go away without treatment.

Other times, treatment by a medical professional may be necessary. For most guys, these warts are painless, but some minor itching may be associated around them.

Penile warts:

The symptoms are the same as with anal warts, but the bumps may appear anywhere from the head of the penis to along the shaft.  Scrotal warts: Just like with anal and penile warts, you may develop bumps along the scrotal sac. Because this area can be more sensitive, depending on the guy, some will notice any changes faster.

How do I get rid of HPV warts?

Ok, remember earlier when we talked about how difficult HPV was to treat and get rid of? Here is the breakdown.

There are several ways to treat outbreaks of genital warts. From the initial diagnosis to how exactly to get rid of these bumps is a conversation to be had with your treating doctor. But your options are pretty good at this point.

One quick point before we move on. It is essential to have your physician take a look at any bumps or growths on your body, especially around your sexual areas. Don’t always believe a bump is just a pimple, as it may be more serious. That said, sometimes a bump is just a pimple and nothing more. Don’t freak out. But do get checked by your doctor to make sure, as outbreaks are not always associated with recent sexual activity. You may have been infected years prior but did not know.

Treatment of genital warts does not cure HPV; it only removes the symptoms! After treatment, reoccurrences are very common. Penile, anal, and even some oral cancers are known to be caused by HPV. Those already infected with HIV are at a higher risk, but all guys should be aware of this fact and take the proper precautions.

Approximately 90% of all anal cancers are caused by HPV. Luckily, penile cancer is sporadic in the United States of America at this time, but phimosis (a tight, restrictive foreskin) and smoking are known to increase the risk factors. If you have a family history of any cancers, you should be extra careful and check with your medical provider if you see any new or abnormal growths or bumps on your body.

The controversy

For years, there has been a vaccine for HPV, but it was not recommended for gay males. The thought process was that if girls were vaccinated at an early age, preferably before becoming sexually active, it would also protect the male population.

Gay males, many of whom have never had sex with a girl/woman, were ignored from the equation. This troubling aspect of hetero-normative medical practices left most gay males at risk unnecessarily, especially when you consider the relatively high rate of anal cancer those on the receiving end of anal sex (bottoms) face.

A change was recommended in the United Kingdom, and young, non-sexually active males have been able to obtain this vaccine. However, things are a bit trickier if you reside in the United States.

The CDC guidelines state HPV vaccines are recommended for the following men:

  • All boys at age 11 or 12 years (or as young as 9 years)
  • Older boys through age 21 years if they did not get vaccinated when they were younger.
  • Gay, bisexual, and other men who have sex with men through the age of 26 years if they did not get vaccinated when they were younger.
  • Men with HIV or weakened immune systems through age 26 years if they did not get vaccinated when they were younger.

This is when we at GMJ recommend that you err on caution and speak with your medical provider about obtaining this vaccination.

One more thing…

As always, the only way to be genuinely confident never to contract HPV or any other sexually transmitted disease is to remain abstinent and avoid all sexual intercourse or contact with others.

Be open and honest about your sexual health and discuss it with your partners. Latex condoms, used properly and every time, are a fine barrier for some level of risk reduction, but as you have read from one piece to another on this site about STDs, they are not foolproof or perfect. And neither are you.

If you find yourself with genital warts, remember how common this disease is. Don’t waste one single moment beating yourself up or feeling ashamed; get your ass to the doctor for treatment…and move on.

Shaming yourself has never been proven to remove anal or penile warts.

Finally, never have sexual intercourse or contact with another guy(s) until after your genital warts outbreak has been treated, wholly cured, and your doctor has given you the ok to get back on the field to play.

STDs are a natural risk that comes with sexual activity. Most can be treated easily and without much fuss. So enjoy yourself and others, but keep your big head in the game at all times; your anus will thank you.

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