Nobody likes to talk about, or even think about, genital warts . .. Yuck! When I see patients with warts, they are usually embarrassed and think they must be the only one who has them. However, the human papillomavirus (aka HPV or the “wart” virus) is the most common sexually transmitted infection around, with about six-million new cases reported in the United States each year. It’s estimated that 74 percent of infections occur in those ages 15-24.
The good news is we now have a way to prevent most HPV infections. More on that in a minute.
HPV will affect an estimated 75-80 percent of men and women in their lifetime — and in most cases, the body’s immune system clears HPV naturally within two years, so they never develop symptoms or health problems from it; they don’t even know they have it! But, for others who don’t clear certain types of HPV, it can cause significant consequences. Some types of HPV can lead to cervical, vaginal, vulvar, anal, penile and even oral cancer, while other types cause genital warts in all genders.
And there’s no way to predict who will or won’t clear the virus. Anyone who has sex is at risk. Condoms are only partially protective against transmission because the virus can live on so many body parts.
HPV is passed between people through genital contact, most often during vaginal and anal sex. However, HPV may also be passed on during oral sex. Since HPV usually does not cause symptoms, most people can get HPV — and pass it on — without realizing it. People can have HPV even if years have passed since they had sex. Even individuals with only one lifetime sex partner can get HPV.
So there it is: HPV is common. What can be done about it?
Treatments are available for both warts and cancers caused by HPV. There are even screening tests for certain types of HPV-related cancers, like cervical and anal pap smears, but the exciting news is that there is a vaccine available to prevent infection in the first place. The vaccine protects against the four most common strains of HPV that lead to both warts and cancers.
You may have read or heard about the campaign to get adolescent girls vaccinated against HPV, which has received a good deal of publicity — and no small share of controversy — in the past few years. However, there’s been very little discussion of making the HPV vaccine available to young men, although it is both recommended and, more importantly, covered by insurance companies. But from my perspective, this is an important conversation to have with your clinician.
HPV is of particular concern for gay and bisexual men, because men who have sex with men are about 17 times more likely to develop anal cancer than men who only have sex with women. Men with weakened immune systems, including those who have HIV, are more than twice as likely than other men to develop anal cancer. Men with HIV are also more likely to get severe cases of genital warts that are harder to treat.
The Centers for Disease Control recommends the HPV vaccine for all children ages 11 or 12. This time frame hopefully catches people before they engage in sexual activity for the first time. In addition, younger patients develop a better immune response than older patients, so getting it early is more effective. The vaccine is also recommended for all people between the ages of 13-27 (up until your 27th birthday), if they have not received the vaccine as a child. The vaccine is specifically recommended by the CDC for gay and bisexual men (or any man who has sex with men) and men with compromised immune systems (including HIV) through age 27, if they did not get fully vaccinated when they were younger.
This vaccine, called Gardasil, has been shown to be extremely safe and very effective at preventing HPV infection and the health outcomes that follow infection. Again, Gardasil is covered by most insurance plans for patients of the right age. If you are not insured, the city’s Health Department and Mazzoni Center offer the vaccine at no cost.
Merck, the maker of Gardasil, is also researching a new vaccine that protects against nine of the most common strains of HPV, including the four that are in their current product. A study is being conducted at Thomas Jefferson University to learn more about this new vaccine. They are specifically recruiting men who have sex with men to be in this trial.
If you are the right age and have not been vaccinated, you have three options. Contact your primary-care provider to get vaccinated in their office or call Mazzoni Center to ask about our free vaccination program or to be screened for enrollment in the new Merck trial. Our number is 215-563-0658.
Get vaccinated!
Robert Winn is medical director at Mazzoni Center, the region’s only LGBT-specific health center.