Did you know that doctors can now test your DNA for the human papilloma virus (HPV)? That you need to get your anus tested for HPV if you have a sexually active back door – and yes menfolk, that goes for you too? That Farrah Fawcett passed away due to a cancer caused by HPV? I was relieved to learn all this from Dr. Stephen Meeneghan, a naturopathic doctor at the San Francisco Natural Medicine clinic who also happens to be my disturbingly perfect significant other. The other day this wonder of the world was preparing to deliver a public talk about HPV (November 4th at San Francisco’s LGBT Community Center, 7-8pm if you’re in town) and I was like, wait I have a feeling that all the sluts who read Slutist need to know about this. And surely there is nothing more alluring than talking with your partner about sexually transmitted infections, am I right? Read on for our extremely elucidating and sometimes surprising chat about America’s #1 STI.
CAITLIN: It seems like HPV is EVERYWHERE. Please confirm or deny this.
DR. STEPHEN: Human papillomavirus (HPV) is almost everywhere! In fact, it holds the heavyweight title for the most commonly sexually transmitted infection (STI) in the United States. Three out of four women and men will become infected with HPV in their lifetimes. But despite how prevalent this STI is in our sex lives, it’s not very prevalent in the public’s mind, or the mind of many medical professionals for that matter.
And there’s a lot of misconceptions out there about HPV! Maybe the most disturbing of these is the mistaken view that it’s only serious for those who have a cervix (cis-gender women and transgender men), and that HPV doesn’t affect most men. Not only does this gender bias have real ramifications on the allocation of resources for education, testing and treatment, it’s also not true! Men get HPV in equal rates as women and the rate at which HPV is leading to cancer in both men and women is on the rise. Most men don’t realize that they could be catching and spreading silent-but-deadly strains of HPV. Men have a responsibility to themselves and their partners to know their status. It’s really no different than knowing your status on other STI’s.
CAITLIN: What are the symptoms of HPV?
DR. STEPHEN: Fortunately, most people who test positive for HPV have no symptoms and their immune system will clear the virus before it causes any problems. It’s like the common cold in some ways –– most of us get exposed to the viruses that cause colds, but only a small fraction of us will actually get cold symptoms. But if you get infected with HPV and your immune system doesn’t fight it off, you may develop warts, dysplasia or even cancer. Lemme explain each of these things in more depth:
Everyone knows what a wart is (though you may not have heard their medical name, condyloma!) They can show up on your hands as a common wart, on your feet as a plantar wart, or downtown as a genital wart — though we should really call them anogenital warts, as they can appear on your butt too.) The upside of having warts is that they’re generally benign lesions, meaning they won’t become cancerous. It’s estimated that 1 in 100 people have genital warts in the United States.
Dysplasia is not readily visible to the naked eye and you may not have heard of it unless you’re among the 250,000 to one million people in the United States who get diagnosed with it each year. Dysplasia refers to the microscopic changes that take place in the cells of the mucous membranes that HPV prefers to live in. The concern with dysplasia is that when left untreated, 50% of it can develop into cancer. But dysplasia doesn’t just occur in the cervix. It occurs anywhere HPV likes to live.
Cancer is the worst case scenario and the real reason we should take HPV infection so seriously. Warts are an unsightly STI symptom, but cancer is a killer. Cervical cancer is the most common HPV related cancer, but anal and throat cancers related to HPV infection are on the rise in the United States. Some 17,500 women and 9,300 men are diagnosed with HPV related cancers each year. Farah Fawcett fought and lost a battle with HPV-related anal cancer. Her death has been characterized as unnecessary by advocates of regular HPV screening and helped to raise awareness of it’s importance on a national level.
CAITLIN: How do I know I have it?
DR. STEPHEN: There are a couple different ways you can find out you have HPV. One is by visible symptoms. Most people can tell when they get the warts that are associated with HPV (though I’ve had to break the news to more than a few patients.) Warts are usually flesh colored bumps and may be singular or exist in clusters. I don’t usually recommend medical consults with Dr. Google but if you think you might have warts, Google image search these guys and compare to what you’ve got. Another way is by the oldie but goodie, the pap smear. They’ve been used for decades to test for cervical dysplasia and cancer. Relatively recently, paps have been used to detect dysplasia and cancer in other at-risk tissues like the anus and throat.
Yet another way is by testing for viral DNA. This is a relatively new method, but it has been gaining popularity in the medical community over last few decades. HPV DNA is usually tested at the same time as a cervical pap now. This test is very helpful because it tells you and your doctor what strains of the virus you’ve been infected with. It will tell you if you if those strains are more likely to cause warts or cancer or none of the above. This is essential information when determining how to treat an HPV infection.
Your doctor should be including HPV DNA testing as part of your routine STI testing. They should also be asking you if you’re the receptive partner in anal sex (i.e., do you put dicks, fingers, or toys up your butt?). If ass play is part of your sex life, you should get an anal pap and anal HPV DNA test. This is especially true if you have tested positive for high risk HPV in your cervix and/or have cervical dysplasia. And if you enjoy ass play but don’t have a cervix (talking to all the cis-gender men and transgender women out there), you should be getting this test also.
CAITLIN: What do I do if it turns out I have it? Will it be in my body forever or is it something that goes away? What treatments are available for HPV?
DR. STEPHEN: If you’ve been infected with HPV you should get treated. About 90% of the time your immune system will take care of HPV all by itself with two years. In my practice as a naturopath, I help patients strengthen their immune system to speed this along. (You can talk to your own holistic health provider about this.) If your immune system needs help, or you have warts you want gone ASAP, or you’ve been diagnosed with a high grade dysplasia or cancer, there are prescription medications and surgical options you can consider with your doctor. Unlike other bacterial STI’s like gonorrhea, chlamydia, and syphilis, HPV is a virus and can’t be treated with antibiotics. But warts can be frozen, chemically burned, or surgically removed. And tissue that tests positive for dysplasia or cancer is most often removed surgically. Scientists are still debating whether or not HPV ever truly goes away or if it just becomes dormant. This is why retesting throughout your life is important, not to mention taking care of your immune system.
CAITLIN: Do I need to tell my sexual partners I have HPV? It seems like everyone has it, so why go there at all?
STEPHEN: YES, PLEASE, TELL THEM RIGHT NOW. Ignorance is not bliss. This applies to getting tested yourself (or examined, in the case of warts) and to sharing those results with your partners. If you’ve tested positive for a high-risk strain of HPV, it’s especially important to tell this to your sexual partners and encourage them to get tested too. You’d tell them if you had a STI like gonorrhea or HIV, right?
CAITLIN: If someone already has HPV, what’s the best way to keep from transmitting it to their partners?
DR. STEPHEN: Knowing is half the battle. If you or your partner test positive for HPV, it’s important to use condoms to reduce the risk of transmission. Condoms are associated with lower rates of cervical and anal cancers. So keep wrapping it up. There is also a vaccine approved for use in men and women that lends some protection against the most common strains of HPV that can cause warts and dysplasia/cancer. Optimizing the function of your immune system is the most important thing you can do to ensure you’re part of the 90% of people who eliminate the virus in their own body. Take care of yourself! And the ones you love.