Human Papillomavirus (HPV) is associated with anal cancer and has a prevalence of up to 70% in homosexual men, according to a study published in Sexually Transmitted Infections. Men who have sex with men should undergo a proctological visit and annual anal cytology. This simple test could provide early detection of high-risk Human Papillomavirus infection, which causes anogenital precancerous lesions and is responsible for anal cancer.
This type of Human Papilloma Virus has an incidence rate of 60 to 80% among men who have sex with men. In view of these figures, in countries such as Canada, Australia and the United States, the vaccine against Human Papilloma Virus is recommended for boys between 9 and 26 years of age, while in our country it is only carried out in girls between 11 and 12 years of age.
HPV is the most frequent STD in the world.
Infection by the Human Papilloma Virus (HPV) is the most frequent sexually transmitted disease, according to data from the Spanish Academy of Dermatology and Venereology: it affects 20% of the population between 15 and 50 years of age and more than 50% of sexually active people are infected at least once in their lives by HPV through genital, anal and oro-genital sexual contact.
The highest peak prevalence of Human Papillomavirus (HPV) is recorded in women between 20 and 24 years of age and in men between 25 and 35 years of age. More specifically, the highest incidence of HPV infections is found in men who have sex with men, and in men who have sex with men who are HIV-positive it is even higher.
Consequences of HPV in men
HPV has different health consequences depending on the type of virus: in some cases it develops without symptoms and in others it causes pathologies such as condylomas (genital, anal and perineal warts) and anal dysplasia (precancerous lesions) which can develop into anal, cervical and vulvar cancer, or cancer of the oropharynx.
In homosexual men, the incidence of high-risk HPV, the type of HPV that causes anogenital precancerous lesions, is as high as 80%. Therefore, it is advisable for men who have sex with men to undergo an anal cytology every year to detect HPV infection and anal dysplasia early, treat it in time and prevent its consequences.
Early detection of HPV infection in general and of high-risk strains in particular and anal dysplasia would contribute to reduce the more than 1,000 deaths per year from anal cancer caused by HPV in this population group.
Cytology and Anuscopy to diagnose HPV
Cytology, which women already undergo annually for cervical and vulvar cancer, is a painless diagnostic test that detects whether or not an HPV infection is present. If there is infection, it also establishes the type of HPV strain, assessing whether it is a low or high risk infection that can lead to dysplasia: Dysplasia is a lesion on the skin of the genitals and anus caused by chronic HPV infection that penetrates into the cells of the affected area. This lesion precedes cancer and there are several types: low grade which should only be monitored and high grade which must be treated to prevent it from developing into more serious diseases.
Benefits of Anuscopy for HPV detection
The cytology can be negative despite the presence of the infection, which occurs in 20% of cases, so anuscopy is the diagnostic test of great value in high-risk patients. High-resolution anuscopy increases the view of the area up to 40 times to more accurately assess the presence of HPV-induced dysplasias and biopsy or treat them with laser, electrocoagulation, a 15-minute outpatient treatment.
In many cases these controls should be repeated every four to six months until the lesion has completely disappeared, since there is a recurrence in up to 60% of cases.
Human Papilloma Virus risk factors
Annual anal cytology is also recommended in patients who have a history of genital or anal condylomas, as well as a history of genital HPV infection. Risk factors for HPV infection are: the number of sexual partners, smoking -which accelerates the progression of dysplasias-, having a history of condyloma, homosexuality and immunosuppressive factors such as HIV and regular intake of corticosteroids.
HPV vaccine also in men
Currently in Spain the Human Papilloma Virus vaccine is recommended for girls aged 11 or 12 as a measure to prevent cervical cancer and vulvar cancer, but in many countries such as Canada, the United States, Israel and Australia, among others, it is also advisable to vaccinate boys between the ages of 9 and 26.
In the United States, about 11,000 cases of cancer (of the penis, anus, rectum, mouth, throat) are registered each year in men as a result of HPV infections. Thus, in some countries the HPV vaccine is recommended up to 26 years of age for men up to 26 years of age because it has no side effects. It is usually administered to children because they have not yet had sexual intercourse and are thus protected in case of contact with the virus, but some protective effect has also been detected in adults and young people who have already had sexual intercourse.