So what's the deal with men and HPV?
It’s a common misconception that HPV pap smears are only available to women*, leading many men* to believe that there’s no reliable testing method for them. However, a full HPV evaluation should be standard during everyone’s yearly physical examination. Notably for gay men and those who engage anally, the virus can be detected with both an anal swab and pap smear.
Since the majority of us are both oral and anal individuals, oral testing should be done as well, and can allow for yearly surveillance with prevention of developing oral cancers. In theory, the vaccine would be protective on this front, as well.
How exactly is HPV contracted and what are common symptoms?
HPV is the most prevalent sexually transmitted infection in the U.S., with up to 14 million people infected yearly. It is transmitted simply via skin-to-skin contact, which means all the things we love to do—licking, rubbing, kissing, and fucking (with or without condoms)—come with risk. Most people do get exposed at some point in their lives, yet are not even aware of it. 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.
Is the HPV vaccination right for everyone?
Understanding one’s subtypes of the virus allows for better characterization of which specific strains of HPV one is harboring. With this, the Gardasil vaccine currently has 9 subtypes of protection, specifically high-risk types 16 and 18—the two that have been linked to the development of anal cancers. If you are tested and negative for any of the subtypes in the vaccine, then the vaccine would be protective and should be obtained.
Other factors that should be taken into account when determining whether or not the HPV vaccination is right for you are as follows:
If you are a bottom, more friction and injury occur where the virus could be spread
How old and sexually active you are to determine not only risk of contraction, but also subsequent development of anal issues associated
If you are in an open relationship in which the risk of new exposure of the different HPV types would be elevated
How much do the vaccinations cost?
Despite the availability of the HPV vaccination, the biggest obstructions to obtaining the three-shot series are lack of both physician and individual knowledge, as it pertains to the subject, as well as cost (between $200-$300 a shot), since insurance companies only cover for the ages of 26 and younger. Although the full vaccination can cost you up to $900, we urge all gay men to take the best preventative measure possible given the prevalence of the disease in the LGBT community.
What should I do if I'm diagnosed with HPV?
A diagnosis of HPV can lead some people to feel as though they should get “HPV” tattooed across their forehead, but there is really no need for such an extreme declaration (this ain’t no Scarlet Letter)! You should not feel dirty, shameful, or demeaned in any way. And, most importantly, you should not feel for one second as if you are restricted to being a top or are in any way less entitled to being a bottom. The human papilloma virus (HPV) is relatively commonplace in our gay community, and its very existence, unfortunately, leads to medical, emotional, and sexual ramifications. Through all my years as a medical provider, I have found that people are too quick to internalize their diagnosis and feel guilt and embarrassment. I cannot stress enough that HPV is not meant to define you or to criticize your sexual habits.
What are the treatment options?
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 modalities. All should be followed by the HPV vaccine, if you have not already obtained it. I tell clients that anal warts are like “barnacles on the tail of a whale.” The whale doesn’t even know that they exist. If it did, the whale would easily flick them off. The same goes for the warts on the top layer of cells of our ass—the body doesn’t know they exist. The above treatment modalities allow your body to create an immune response as a defense against recurrence and the possibility of cancer development. Once one has completed treatment, I cannot stress the importance of serial follow-up. In the immediate period following infection, standard evaluation should occur every three months for continued surveillance. Then, over time, this can be relaxed to only once a year. Aggressive early management allows for complete eradication, which limits recurrence.
* reference to cisgender men and women
Header image illustrated by Marcy Gooberman
Dr. Evan Goldstein is the Founder and CEO of Bespoke Surgical, the leading private practice specializing in an elite standard of sexual health and wellness care for the modern gay male.
As the preeminent leader in the field and with offices in both New York and Beverly Hills, Dr. Goldstein offers concierge-style medical and surgical expertise to the gay community and is dedicated to not only bringing the important issues surrounding gay sexual health to the forefront, but also eliminating stigmas around gay sexuality.