Ask the Doc :: HPV Hysteria

Question:
Dear Dr. Jason,

There's a lot of talk going around about anal cancer and HPV. First of all, a doctor friend of mine told me that if I've ever had anal sex, I pretty much already have HPV. Is this true? Can a condom prevent against HPV? And when/how should I start worrying about anal cancer and getting tested?

Scared

Doctor Jason's Response:

Human Papilloma Virus (HPV) infection is one of the most common sexually transmitted infections in the world. There are over 100 different types of the virus, and different types have predilections for different parts of the body causing warts. It is transmitted by skin-to-skin contact, notably by friction.

A condom is only partly protective as it does not cover the scrotum and sometimes it does not always roll all the way down to the base of the penis. The only way you can become infected is by someone else who already is infected. It is estimated that about 2/3 of sexual contacts of an infected person will develop infection.

The risk of acquiring HPV is directly associated with the number of sexual partners; although, you only need one partner to give it to you. If you or your partner has an active outbreak of warts, the risk of transmission is much higher; however, HPV can still be transmitted to another person even in the absence of visible warts.

There are 4 main types of concern with regards to genital warts: 6, 11, 16, and 18. Types 6 and 11 are most common, but types 16 and 18 are most commonly associated with the development of cancer. The only "screening" test that we currently have is the Pap smear, which can be performed on the cervix in women or on the anal canal in both men and women. It is an imperfect test for the anal canal, but it is the only test currently available for screening.

At this time, there are no universal guidelines with regards to screening the general population; however, there are certain subgroups of the population for whom the screening test is warranted--infection with HIV, history of anogenital warts, history of partner(s) with known HPV infection, and other immunocompromising conditions. If you do engage in receptive anal intercourse with more than one partner, or if your partner is known to have HPV, then it would be recommended to discuss screening with your primary care provider.

If you have any concerning symptoms, such as pain, discharge, bleeding, or you feel a bump in or near the anus, then you should seek medical attention. There is a vaccine currently available for HPV specifically targeting types 6, 11, 16, and 18. It is currently recommended for both men and women aged 9 to 26 years. It is available for those outside that age range; however, most insurances will not cover the cost. It is a series of 3 shots given over a 6 month period.

Stay healthy,
Doctor Jason

Dr. Faulhaber is a graduate of Tulane University in Psychology and Cellular and Molecular Biology and received his medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School. He performed his residency training in Internal Medicine and Pediatrics at Saint Vincent's Hospital in Manhattan, where he then served as a Chief Resident in Internal Medicine. He completed his fellowship in Infectious Diseases at New York University, where he specialized in HIV/AIDS, Hepatitis, and fungal infections. Since fellowship, he has been working as an Internal Medicine/Infectious Diseases physician at Fenway Community Health in Boston. He is a Clinical Instructor in Medicine at Harvard Medical School, and he is affiliated with Beth Israel Deaconess Medical Center. He has been the lead author or co-author of several journal articles and textbook chapters on infections with HIV, other viruses, bacteria, and fungi. He is also accredited by the American Academy of HIV Medicine.

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