HPV is the most prevalent sexually transmitted infection in the U.S., with up to 14 million people infected yearly. Researchers estimate men who have sex with men (MSM) who are living with HPV ranges between 60% of the general population up to 90% for MSM who are also HIV+. Why are these numbers so high? Most people get exposed at some point in their lives, yet are not even aware of it. It is transmitted as easily as through skin-to-skin contact, so abstaining from anal or oral sex won’t necessarily prevent transmission. Traditionally less risky sexual acts—like touching and kissing—are just as risky as oral and anal intercourse, both with and without condoms.
The diagnosis of HPV is not something to be embarrassed about and definitely not something that will change your sexual habits forever (other than when experiencing a flare up). The minority of individuals can develop some manifestations of the infection, the most common being anal or genital warts, which one will notice when new bumps develop in the genital or oral region and/or bleeding and itching occurs in the affected area. These symptoms should warrant a comprehensive internal and external anal evaluation by a professional who specializes in gay men’s health. A full evaluation involves anal swabs for better characterization of the subtypes and cancer risk and a generalized whole body dermatological examination.
So, what happens after you’ve been diagnosed? Treatment can consist of localized creams for external disease, freezing or burning of both internal and external lesions (depending on the extent, either in the office or an operating theatre), or a combination of both. In addition, if you have not already obtained it, you should receive the HPV vaccine, Gardasil (more on this later). These methods of treatment allow your body to create an immune response as a defense against recurrence and the possibility of cancer development. Once treatment has been completed, serial follow-up is critical. In the immediate period following infection, standard evaluation should occur every three months for continued surveillance. Then, over time, this can be reduced to only once a year. Aggressive early management allows for complete eradication, which limits recurrence.
Unfortunately, early diagnosis and treatment, while extremely important for you, is just as important for your sexual partners. Making sure at the onset that all partners are free of active HPV disease through a full internal and external evaluation with a high-resolution camera by an experienced gay-conscious physician or extender, is of equal priority to avoid the ping-pong effect.
Second, condom use can decrease transmission, so bareback sex should be avoided; however, since HPV can be contracted through skin-to-skin contact, simply engaging in foreplay prior to anal carries a high risk. Showering after sex does actually aid in reduction of transmission and should be used as another effective prevention method, as it can wash away the virus particles.
Lastly, another easy way to reduce the risk of transmission is the HPV vaccine, especially with the increased amount of recent evidence supporting its validity even over the recommended age of 26. If during testing, your partner does not have the types that you harbor, in theory, getting the vaccine could protect them. In summary, we must demand appropriate anal swabs, testing for HPV, and an understanding of your results from our physicians. With this knowledge and understanding, vaccination can be key to a low or no-risk sexual encounter.
As you can see, there are a few ways that help reduce the risk of contracting or spreading HPV, which all stem from proper education of the gay science behind HPV, its treatment protocols, and finally, annual maintenance evaluations. Having a full understanding of how to prevent, diagnose, and treat HPV can help reduce its transmission.