HPV should not become the new scarlet letter. There is no reason to feel dirty, shameful, or demeaned in any way for being diagnosed with the human papillomavirus. If you’re a man who has sex with men, it shouldn’t restrict you from being a top — or make you any less entitled to be a bottom.
HPV is relatively commonplace among gay and bisexual men, as well as transgender and cisgender women. And its very existence, unfortunately, does lead to medical, emotional, and sexual ramifications. Researchers estimate the prevalence of HPV in men who have sex with men ranges from 60 percent to nearly 90 percent (the latter among those who are also HIV-positive). HPV is the most prevalent sexually transmitted infection in the U.S., with up to 14 million people diagnosed every year. It is transmitted 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 get exposed to HPV at some point in their lives but are never aware of it. A small group of individuals 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 regions, or bleeding and itching that occurs in the affected area. For men, who don’t have the benefit of a gynecologist as most women do, symptoms should warrant a comprehensive internal and external evaluation by a professional who specializes in gay and bi men’s sexual health. That means full anal swabs for better characterization of the subtypes and cancer risk, and a generalized whole-body dermatological examination.
Clearly, these medical ramifications need thorough evaluation and appropriate management. This can consist of localized creams for external disease, freezing or burning of both internal and external lesions, 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 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 buttocks — 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. I cannot stress enough the importance of serial follow-up once one has completed treatment. In the immediate period following infection, standard evaluation should occur every three months for continued surveillance. Then, over time, this can be relaxed to just once a year. Aggressive early management allows for complete eradication, which limits recurrence.
Through all my years as a medical provider, I have found that people are too quick to internalize their HPV diagnosis, feeling guilt and embarrassment that can lead to sexual dysfunction. Once one has fully accepted it while educating themselves on HPV’s method of transmission and various treatment approaches, the most common questions include:
What do I need to disclose to my sexual partners? How can I prevent transmission or prevent clinical symptoms from arising?
First, making sure that all partners are free of active HPV through a full internal and external evaluation with a high-resolution camera by an experienced physician or other medical provider is paramount.
Second, condom use can decrease transmission, so bareback sex should be avoided. However, since one can contract it through skin-to-skin contact, simply engaging in foreplay prior to sex carries a high risk. Post-play showering does aid in reduction of transmission and should be used as another effective prevention method, as it can wash away the virus particles.
Third, another wonderful risk-reducing strategy is the HPV vaccine, especially with the increased amount of recent evidence supporting its validity even over the recommended age of 26. I bet they all tell you you’re too old to get it, but that’s completely false. If during testing, your partner does not have the type that you do, in theory, getting the vaccine could protect them. If you’re under 26 and HPV-negative, getting the vaccine is recommended for men and women, whether they’re cisgender, transgender, or gender-fluid.
We must demand appropriate anal swabs, testing for HPV, and an understanding of the results from our physicians. With this knowledge and understanding, vaccination can be key to a low or no-risk sexual encounter.
There are several methods to aid in risk-reduction, but the most valuable component is open dialogue between partners, taking responsibility for our active engagements, and harboring an educational foundation on the science behind HPV, its treatment protocols, and finally, annual maintenance evaluations.
The initial shock of diagnosis can be mitigated by earlier education on this subject and all sexual health issues worldwide. At least now with a full understanding of its commonality, treatment, and prevention, everyone can be a true advocate for decreasing HPV transmission.
The Advocate’s sexual health expert, DR. EVAN GOLDSTEIN, is the founder and CEO of Bespoke Surgical — a first-of-its-kind health practice specializing in gay men’s sexual health and wellness. (BespokeSurgical.com)