To become friendly again with the many people who apparently (but mistakenly!) blamed me for undermining condom for prevention, this week I pay attention to something completely different!
It can be quite a shock when you get them, or perhaps even more if you encounter them unexpectedly in a partner, when feeling someone up – they feel like little hard / rough cauliflower-shaped heaps on the surface of the skin. Genital warts often occur in clusters and can be very tiny or can spread into large masses in the genital or penis area, or around the anus. Click here to see an image. Be warned: It's not pretty.)
Genital (including anal) warts are caused by some subtypes of the Human Papilloma Virus (HPV), which is the most common sexually transmitted disease in many countries where data is available, including in the US, where the CDC estimates that over 20 million people are infected. It is easily transmitted, but in most people never leads to complications. This is exactly why HPV is spreading fast among gay men.
A study in San Francisco found that a staggering 95% of HIV infected gay men were infected by strains of HPV; an Australian study found a similar percentage among positive men, and found that among HIV negative gay men still 70% were infected. Unfortunately, there is no reliable diagnostic test for HPV in men (although there is one for women), so you can only be diagnosed by a doctor if the warts show up.
There are many different types of HPV. In case you are looking for clues to buy your lottery tickets, genital warts can be caused by HPV strains 6, 11, 30, 42, 43, 44, 45, 51, 52 and 54; of these, types 6 and 11 are most important, together responsible for 90% of genital warts cases. Other HPV strains (mainly types 16 and 18) are linked to cervical cancer in women; these strains are probably also linked to colon / rectal and certain oral cancers in men and women, but this continues to be studied.
Recently there has been some good news, for a change: it is now possible to get an effective vaccine against HPV – this is effective only if you do not yet already have it! There are two different vaccines now – both of them protect against HPV subtypes 6 and 11 that cause 90% of all genital warts, whereas one of the two – called ‘Gardasil’ also protects against the two subtypes that cause most HPV related cancers. Unfortunately it is quite expensive (about 300 US$).
The best way of preventing HPV is to never have sex. If you do not like that idea, you can get vaccinated, if you belong to the minority of gay men who are uninfected, that is! Regardless if you have HPV or not, using condoms helps to prevent HPV - including during foreplay, as HPV can be transmitted at the surface.
In most countries, including in the US, the Gardasil vaccine is given to girls before they become sexually active (i.e. aged 9-15) to prevent them from getting HPV-associated cervical cancer later in life. Cervical cancer is an important cause of death for women. Research to determine efficacy of the vaccine to prevent colon and oral cancer among boys is still ongoing. Support for vaccination of boys will become stronger if the link between HPV and colon / anal cancer gets clearer. Colon cancer is the third most prevalent cancer type, and the second most deadly, with 665,000 deaths per year annually. Unlike cervical cancer, HPV is probably implicated only in a small minority of these deaths. Factors that have been linked to an increased risk for colon cancer include old age, having polyps, smoking, a diet with a lot of red meat, heavy alcohol use, physical inactivity as well as genetic factors.
So if gay/health activists are looking for another issue to focus on and be angry about, fighting to make HPV vaccine universal for boys, would be an important cause. Public health professionals may be arguing that HPV vaccines for boys are less cost-effective because they prevent fewer cases of cancer than are prevented in girls, but hey – don’t we all deserve a wartless life!? If you want do some good in this world: spread the world to the youngest among us to get vaccinated as soon as they can. It should be the most loving birthday present for 15-year-old gay boys and tranny girls – before they find their first boyfriend…
If you want to get the vaccine (for yourself or for someone else!), inquire at general hospitals or at specialised clinics for sexually transmitted diseases. The vaccine is given in three separate injections over a course of six months. It is not known exactly how long the virus provides protection, but research suggests that it is effective for at least five years.
If you already have warts… You are not alone… You can either wait, because sometimes the warts disappear (but you may still remain infectious – although in some cases the HPV infection clears completely and spontaneously). If you have no time to wait, you can treat them – depending on the number / severity and actual location of the warts. For small/few warts there are certain creams or liquids, which sometimes work and sometimes don’t – often follow-up treatment is needed, as the warts may disappear but the virus may cause new ones to appear. In severe cases they can also be surgically removed, ‘frozen’ or lasered away. Again, there is no guarantee that they won’t grow back.
Of course if you want to avoid HPV, you can stop using your anus (to avoid warts and colon cancer) and your mouth (to avoid oral cancer) to avoid getting HPV, and switch to hand jobs.
Did I just sound like the Pope again?
And again, whether you already have HPV or not, make sure you always – ALWAYS – use condoms and lubricants from the beginning to the end of each intercourse.
Jan is the moderator of MSM-Asia, an information network on men who have sex with men, HIV and human rights, with nearly 600 members from across the region. If you want to become a member of MSM-Asia, or for information requests or comments, pls contact him at jwdlvw@gmail.com.
For more information about the Gardasil vaccine, click here.
For information about how to treat warts, click here.
For general information about both, see the website of the US CDC, click here.