Dear Dr Ren,
I’ve had genital warts on my ass before. Sometimes I’ve had them burnt off with chemicals and sometimes they just go away by themselves. I’ve never worried too much about them. But now I’ve tested positive for HIV and I understand this puts me at much greater risk to develop anal cancer because of the genital warts. What do I need to know? What do I need to do?
Needs to Know
Dear Needs to Know,
Although your question seems simple enough, the confluence of HPV (the virus that causes genital warts) and HIV makes both more complicated.
Let’s start with the basics.
Human papillomavirus (HPV) is currently the most common sexually transmitted infection (STI), perhaps because it is so easy to spread through skin-on-skin contact. For this reason, condoms can decrease, but not preclude, transmission of the virus during sex.
Various strains of the virus may cause genital warts on your penis or your ass. Generally painless, they can be occasionally itchy. They are almost always benign, the obvious exception being the strains that cause anal cancer.
The chemical you used to burn off the warts was probably liquid nitrogen. Even with this treatment, warts can reoccur. Depending on your age, you may choose to be vaccinated with Gardasil, but it works best if received prior to exposure to the virus.
Health Canada has approved the vaccine for young men from nine to 26, but oddly, they must pay for this particular preventive medicine, at a cost of up to $300, and it is not always easy to find a dispensing source. Hopefully, one day both boys and girls will be vaccinated for HPV just as they receive polio and measles vaccines, but we are far from that state now.
Though it is true that your risk of developing anal cancer increases if you have HPV and HIV, that risk is actually fairly minimal. That said, you are wise to remain vigilant regarding your anal health. If you notice changes to your ass in the form of bleeding, significant growth of the warts or other lesions in the first inch inside your anal opening — or anything else unusual — get to your doctor. If you can access the Lower Mainland, you can go to the infectious disease clinic at St Paul’s Hospital to get an anal PAP test.
Is there a need to alter your sexual behaviour now that your serological status has changed? Not necessarily. Because condoms cover only your penis, and because HPV rarely limits itself only to this area, they are not entirely protective. However, you want to minimize transmission as much as possible, so if you are with new or multiple partners, glove up.
Because of the incomplete protection condoms afford, you will need to advise new sexual partners of your potentially infectious status even if you engage in protected sex. You may wish to forgo anal sex with casual partners when your CD4 count is less than optimal. You will learn to read your body’s cues and can act accordingly.
If you are in a sexually exclusive relationship, you probably share strains of viruses, so you can relax regarding barrier protection, but, of course, use your best judgment and continue to talk openly about your health. The strains of HPV you have may not be oncogenic (cancer-producing), and you want to keep it that way. Your goal is to prevent transmission and reception of new strains while still enjoying great sex.
If your health is good, your CD4 count is robust and you are doing well on HAART (highly active anti-retroviral therapy), your chances of developing anal cancer are reduced. As horrible as it sounds, anal cancer is less deadly and metastatic (easily spreading) than its sister cervical cancer, which women have learned to manage through routine PAP tests for years now. You guys must now be vocal and persistent in demanding the same good medical care.
HPV is primarily a cosmetic problem, providing you monitor your body for changes. Since it has become ubiquitous in the community, you needn’t fear rejection or embarrassment because of it.
So all in all, though having HIV and HPV is not good news, it is not terrible news, either. Several decades ago, these diagnoses would have threatened far more serious consequences. Now they signal a need for continued vigilance and monitoring of your health status — not such a bad thing, really.
The point is that this is not a death sentence. It is not even news about which you need to panic. You have illnesses that compromise your immune system, and luckily, medicine is catching up with necessary treatments, although, alas, cures are still unavailable.
Political pressure is needed to make Gardasil available for young men. Those in non-urban areas often still lack access to anal PAP tests and dignified treatment. We do not yet live in the world we hope for or deserve.
Still, you can have a long and satisfying life. I encourage you to do so. This is a situation where you can happily celebrate your half-full glass.