INDULGENCES health lab by dr. joel
The 411 on HPV
The Gay and Lesbian Medical Association held their annual conference in San Diego this year. One of the hottest topics was the human papilloma virus (HPV) and its multiple impacts on LGBT health. HPV is actually a family of viruses (each virus gets a number, e.g. HPV-16), and they were first found as a cause of warts. At the time, warts were more thought of as an annoyance: unattractive, uncomfortable, but hardly threatening. The viruses that cause genital warts were considered sexually transmitted diseases, but they weren’t really seen as a critical target for public health intervention.
That changed in the 1980s and 1990s, when it became clear that HPVs were associat- ed with most cervical cancers. While the use of the “Pap” smear (short for Papanikolaou, the Greek doctor who developed it) had already decreased the incidence of invasive cancer, HPV offered a target for treatment and prevention. Prevention of HPV associ- ated cancers got a big boost in 2006, when the FDA approved the Gardisil vaccine against HPV. When given between the ages of 9 and 26, Gardisil is proven to decrease the rates of cervical cancer and genital warts in women, and genital warts in men. For gay men, the problem is what to do. Genital warts were believed to be the worst thing HPV did to men, even after the link to cervical cancer was established. More re- cently, studies have shown that HPV likely plays a similar role in anal cancer, an increas- ingly recognized problem in gay men. Because of the similarities, doctors are looking at using an “anal Pap smear” to look for cancer cells in men, and whether Gardisil might prevent anal cancer in gay men. The Q and A sessions on the use of anal Pap smears in gay men were about as close to a cage match as you’ll see a bunch of researchers get. Some doctors don’t think the anal Pap smear works, or that it depends too much on who does it. Some believe it works, but don’t believe the treatments help, unlike the proven therapies for cervical cancer. (Testing for a disease isn’t considered helpful if you don’t have a good treatment. In fact, some people consider it mean, because you end up saying, “You have this disease and we can’t do much about it. Have a nice day!”) Others believe that the Pap smear and vaccine worked so well in preventing cervical
cancer that we should err on the side of using them for anal cancer. They argue that while we need better studies, there doesn’t seem to be much of a downside to the test
and vaccine. And even if we can’t treat anal cancer earlier, gay men who know they have HPV may take precautions to protect others. For the lesbian community, the question isn’t what to do. It’s getting it done. There is
general agreement that the vaccine and Pap smears are both important in continuing to decrease the rates of cervical cancer. Unfortunately, some lesbians turn down the vaccine and stop getting Pap smears, believing they can only get HPV from men, and that their risk for cancer goes away if they stop having heterosexual intercourse (or if they never have). Turns out neither is true. Experts believe any sexual contact with an HPV-infected
person can lead to transmission, even just sharing sex toys. While the risk may be lower for women who exclusively have sex with women, Pap smears are still recommended. Also, as with HIV, there can be lag time between infection, symptoms, and diagnosis. So your risk for HPV associated diseases is based more on what you’ve done than what you are doing. A negative Pap smear only shows you there aren’t cancerous or precancer- ous cells NOW. It doesn’t say that they won’t develop later. This becomes an important issue for the transgender community. Depending on where they is are in transition, particularly related to surgery, female to male transgender people may need to con- tinue getting cervical Pap smears. The information and recommendations about HPV can be confusing, but there are
two very straightforward things you can do. First, talk to your doctor honestly about your sexual orientation, gender identity, and sexual practices, so you can determine what testing and treatments are appropriate for you. Second, use condoms. HPV is an STD, and barrier protection can decrease your risk.
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RAGE monthly | NOVEMBER 2010
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