HPV, Cancer, and You

In the majority of cases, it is an HPV-infected man who starts the precancerous process in susceptible women.

Medical scientists have good evidence that cervical cancer is strongly linked to the highly contagious human papillomavirus (HPV) that can cause venereal (genital) warts or condyloma. There are at least 25 types of this virus that infect anal and genital areas, and they are sexually transmitted from HPV-infected persons to their partners. To prevent cervical cancer, HPV-related precancerous changes must be detected early and eliminated. However, HPV must also be detected and contained in infected men to prevent further spread.

HPV is believed to be the most common viral sexually transmitted disease (STD) in both women and men. It is estimated that more than 40 million people are infected with HPV in North America, and that more than a million new cases will occur this year in the U.S. You may already be carrying the HPV virus. Although genital HPV can cause precancer and cancer of the penis, this is rare. More commonly, a man will have very few signs of the disease and no ill effects. However, when an HPV-infected man has intercourse with a woman, she may experience severe complications.

Like many other sexually transmitted diseases (STDs), genital HPV is pathologically sexist. This means that a woman who contracts genital HPV risks an increased chance of developing cervical precancer and cancer. On the other hand, men with HPV have less risk of ever developing penile cancer. Nonetheless, there is scientific evidence that male sexual partners of women with severe precancer or cancer of the cervix are at increased risk of developing precancer or cancer of the penis. There is also new evidence that suggests that chronic penile irritation, cigarette smoking, HPV infection, and genetic factors are associated with an ever-increasing risk for penile cancer. From this, it is clear that men can be both transmitters and victims of HPV.

An increased risk of anal and rectal cancer has also been associated with HPV infection and anal intercourse. Individuals who practice anal intercourse may benefit from routine anal cytology (Pap smears) and anal examination or anoscopy to detect and treat precancerous change before more serious anal or rectal cancer occurs.

Signs of HPV Infection

You may have infectious genital HPV and be spreading the virus to your sexual partner(s) for many months or years before you can see any signs of it.

It may be several weeks to many months after the initial infection before you will have symptoms, but more often than not, there are no obvious signs. When visible, genital warts are most often flat, whitish spots, but they may also be single, raised, fleshy growths or clusters that are pink-white or gray in color on the penis or adjacent skin areas.

It is impossible to predict what will happen to men and women who have been infected with the virus. Once infected with HPV, a person may carry the virus indefinitely without any signs or symptoms. Warts may appear or increase in number and size at times when the body’s immune system is weakened by stress or illness or smoking. Warts may also spontaneously disappear without treatment.

If you are sexually active, you should obtain routine examinations and encourage your partner to have regular examinations also, including a Pap smear evaluation. An alert clinician can detect the signs of genital HPV and other sexually transmitted diseases with careful examination in the clinic. Laboratory tests can confirm the diagnosis. Moreover, you should discuss matters of sexual concern with your clinician. When you ask your clinician about examining you for HPV, it is very important that you be candid and honest about your sexual activities and health.

Who is at Risk?

You are at high risk for HPV and other sexually transmitted diseases if:

• you have had many sexual partners
• you do not routinely use latex condoms containing Nonoxynol-9 during sexual intercourse, and partners do not use barrier methods of contraception
• you have had sex with a woman who developed cervical cancer, precancer, or genital HPV
• you have a history of previous sexually transmitted diseases, especially genital warts
• you have a history of anal or genital precancer or cancer, especially penile precancer or cancer
• you have had sex with prostitutes
• you are bisexual and live or have lived in an area where HPV infection and other STDs are common
• you engage in frequent and unprotected anal intercourse
• you test positive for HIV, the AIDS-causing virus
• you practice poor genital hygiene, for example, not washing with soap under the penile foreskin after intercourse
• you are uncircumcised and have difficulty in pulling back the foreskin
• you have had frequent penile irritation, rash, or cuts
• you have altered immunity or take drugs that depress the immune system, such as cortisone or drugs used for cancer treatment
• you frequently use mind-altering drugs and alcohol
• you smoke or live with someone who smokes.

Self Examination

There is a home test for genital warts that you may want to try.

Soak a hand towel in equal amounts of warm vinegar and water. Wrap your penis and scrotum in the towel for ten minutes and then examine the areas under a bright light. Genital warts will show as flat white spots or bumps, or sometimes, bumps that are reddish, gray, or brown on the penis. Warts may also be present above the base of the penis, on the scrotum, between the scrotum and anus, around the anus, and just inside the penis (urethral or urinary opening). Not all bumps are genital warts! If you find small growths or suspicious spots, have a clinician examine them to determine if they are genital HPV or harmless "look-alikes." To be certain about the presence (or absence) of genital HPV, you should be examined, after vinegar solution is applied, with a magnifying lens by an experienced clinician.

Testing for HPV Exposure

Your clinician will be sensitive to your possible embarrassment and concerns about confidentiality.

However, s/he will ask questions about your sexual health to determine your degree of risk for STDs and about the presence of any anal-genital signs or symptoms of HPV infection.

The typical examination involves applying gauze dressings that have been soaked in clear vinegar solution to the penis, scrotum, and anal area for 5-7 minutes. These areas will then be examined under a bright light and a magnifying lens. The examination is not painful. If your clinician sees tissue that may be abnormal, s/he may apply a local anesthetic and take a very small biopsy sample for special laboratory studies.

To perform an anal Pap smear, a "cotton" swab or soft brush is inserted into the anal opening 1 to 2 inches. The swab or brush is gently rotated as it is withdrawn. The procedure is relatively painless. After withdrawal, the material collected on the swab or brush is spread onto a glass slide or placed into a preservative solution and sent to the laboratory to detect any atypical cells.

Anoscopy is usually performed after the anal Pap smear and following digital (gloved finger) examination of the anal canal. A small plastic or metal tube, with accompanying lighting and magnification, is inserted into the anal opening. The lining of the anal canal is carefully examined for any abnormality. Any abnormality may again be sampled by brush or biopsy and sent to the laboratory for microscopic evaluation and/or culture, if infection is suspected. Follow-up may involve a repeat examination in 3-4 weeks or, if indicated, treatment of abnormal tissue with medication or removal.

What to Do If You Have Genital HPV

Don’t let your feelings stop you from getting help.

You should inform your sexual partner(s), and each of you should go for medical consultation and treatment. Your use of a condom containing Nonoxynol-9 is highly recommended, but does not entirely protect your partner since infected skin surfaces not covered by the condom may still transmit HPV. The virus is not generally transmitted through bodily fluids like semen, but passes from skin to skin on contact with any exposed wart on the genital area. Remember that a man or woman may be exposed to HPV years before showing any signs or symptoms.

How to Avoid Exposure

HPV is a sexually-transmitted disease (STD), and the guidelines for prevention of all STDs apply:

• limit and/or reduce the number of sexual partners
• maintain a stable, long-term, unquestionably trusting relationship with one partner
• know your partner-ask about HPV, cervical precancer or cancer, or any other STD
• avoid casual sex
• practice disease-preventive measures and protective sex, including use of condoms containing Nonoxynol-9, cervical caps, vaginal sponges, or diaphragms plus vaginal spermicides containing Nonoxynol-9
• avoid anal intercourse and sexual practices that may injure delicate genital and anal tissue
• always wash your genitals with soap and urinate after sex
• refrain from sexual activities in the presence of genital warts, ulcers, sores, discharge, or other unusual genital signs
• get regular medical evaluations and discuss sexual matters of concern with your clinician
• encourage your partner(s) and friends to have regular check-ups
• avoid mind-altering drugs/alcohol and smoking.

Take Charge of Your Sexual Health

The more you can express your concerns and participate in your health care, the better your clinician will be able to help you.

Genital HPV can only be controlled by sexual health counseling, elimination of risk-taking sexual behavior, simultaneous evaluation and education of both partners to disrupt the infection cycle, and an agreement on a proposed course of action for safer sex. You can reduce the threat of cervical cancer for your sexual partner by seeking regular medical check-ups and practicing safe, responsible sex.

This brochure was prepared as an expression of our dedication to high quality Pap smear testing and our concern for your health and well-being.

Used with permission from:

ACCUPATH Laboratory Services, Inc.
10740 Meridian Ave. N., Suite G3
Seattle, WA 98133-9010
206.365.5177
800.222.8727
Fax: 206.362.0943

Ó 1993 R. Hasselbrack, M.D., M.S., F.C.A.P.