Warts and all

A friend of mine is trying to start a brown ribbon campaign. He points out – correctly – that diarrhoea fells more people every year than other major killers like cancer and heart disease, and reckons we should all be wearing pooh-coloured ribbons to show our support for the victims.

Human papillomavirus (also known as HPV, or simply genital/anal warts) is the diarrhoea of sexually transmitted infections (STIs). It’s the most common of all STIs, yet gets the least press. Nobody wears coloured ribbons in aid of it or makes Oscar-winning movies about its victims. In fact, nobody even likes to talk about it, as I recently discovered at a dinner party when I mentioned that I was being treated for the virus. The conversation spluttered and jerked, then ground to a complete halt. I reckon I would have received a warmer response if I’d admitted that I shagged goats or was converting to Mormonism. 

Granted, most folk don’t want to discuss anal warts while tucking into their duck a l’orange. But given that up to 80% of sexually active people will become infected with HPV at some point in their lifetime, and that the virus is responsible for almost all cervical cancers in women and an increased risk of anal cancer in men who have sex with men (MSM), clearly this is something we do need to talk about. Perhaps just not at the dinner table.

On a personal level, the humiliation of having doctors peering into my butt, not to mention the torture of the wart removal, first by liquid nitrogen (more painful than being fisted with a boxing glove), then Wartec solution (which stings like hell and turns your asshole blue) and finally surgery, is something I would only wish on the Ugandan government.

With this in mind I spoke with Dr Kevin Rebe of Health4Men to find out more about HPV, how it affects men who have sex with men (MSM) and what you can do to reduce your chances of catching it.

What is HPV?

This is a virus that infects the skin and mucous membranes of humans. There are many different strains, the majority of which are harmless and have no visible symptoms. A few, however, cause warts, both the common type (found on the hands, feet, etc.) and ones that grow in the anogenital area (that’s medical speak for your penis and butt). It’s the latter that is of concern to us. 

Why?

Apart from the yuck factor of having warts down there, it also puts your health at risk. As mentioned, HPV is the leading cause of cervical cancers in women. And in MSM, a group already at higher risk of contracting anal cancer, contracting the HPV can further increase this threat. As always, it’s important not to freak out at stats like this. Anal cancer is still considered rare, and an “increased risk” can still mean your chance of contracting the disease goes up from, say, one percent to two percent. 

How is it transmitted?

It is transmitted through skin to skin contact during sex. Importantly, this is not purely limited to unprotected penetrative sex. Any contact with the anogenital region – including oral sex, rimming, even the sharing of sex toys – can pass on the virus.

Although you can become infected by somebody who has no obvious signs or symptoms, transmission is much higher if there’s direct contact with a wart. Once this happens, the virus gets into your bloodstream where it stays for the rest of your life. Most of the time the body fights it successfully, suppressing it; warts only tend to form when your immune system is compromised (which is why the virus can be much more problematic for HIV-positive individuals).

What can you do to avoid getting it?

There are vaccines, but these are expensive and don’t necessarily cover the strains found in MSM. Limiting your number of sexual partners obviously greatly lowers your risk, but if this is not an option then your best bet – as with other STIs – is still to use a condom during sex. Be aware that this method unfortunately doesn’t provide complete protection from HPV as there may still be contact between areas of skin that are not covered. 

And to test for it?

For something that’s so rife, it’s alarming that there are no protocols or recommendations from the health department regarding the screening and treatment of HPV in men. However, finding out if you’ve got it isn’t too difficult. The first option is a physical inspection, which should pick up straight away if you have any warts (except for ones hidden inside the anal canal which are quite common with MSM – for these a colonoscopy may be required). Otherwise there is also a blood test that screens for the virus. Regular self examination is also recommended.

If you do catch it, what is the best treatment?

As already mentioned, once you’ve got HPV you’re unfortunately stuck with it for life. But if your body is able to control the virus this isn’t a problem. It’s the outbreaks of warts that you need to watch out for, as these put your sexual partners at greater risk and can also develop into cancerous lesions.

It’s important to begin treatment as soon the warts appear. These feel like tiny pimples at first, but left untreated will grow and become more deep-rooted and harder to remove.

Non-surgical treatments include creams, such as Wartec or Aldara, and physically removing the warts, either by laser therapy or freezing them off with liquid nitrogen.

If these don’t work then your only other option is the surgeon’s scalpel. It’s not a pleasant operation, but the anal tissue recovers quickly and it is highly successful (although there’s still no guarantee the warts won’t return).

While medical aids cover the cost of this surgery and provide access to private facilities, going through state hospitals is considerably more challenging, which means – as with many things in South Africa – that there’s still an enormous class divide when it comes to the treatment of HPV. (Leo Stewart, Health4Men, May 2010)

Health4Men provides free sexual healthcare to gay men. Call them on 021 425 6463 (Cape Town) or 011 989 9726 (Soweto).