Anal cancer and dysplasia due to infection by HPV, is a major problem for gay and bisexual men, especially those who are HIV-positive. The rectal cancer is induced in a high rate by HPV virus, which is often transmitted by anal intercourse. This virus is extremely common- it is the most common sexually transmitted virus.
FREQUENCY OF anal HPV-INFECTION
In gay men, the frequency of an anal infection by HPV is fairly high (60%), while the virus is found in the anus of straight men at a rate of 15%. The virus is carried into the anus during anal intercourse, touching or sexual games, but can be also transferred from the penis (genitalia) during washing. Full anal intercourse is not essential for infecting the skin or the anal mucosa. In opposition with HIV, the condom does not protect completely against the infection. If HPV coexists with HIV, then the frequency of an HPV infection reaches an amount of 90%.
There are approximately 150 types of HPV, but few of them cause symptoms and about 40 infect the genitals. Often, there are more than one type of HPV which are responsible for an infection. Usually, the body’s immune system manages to cause a regression of the virus.
Most often, the infection by HPV is not perceived and does not cause any problems. Some types of HPV cause warts inside and around anus and genitals. Although, they are annoying, warts do not develop into cancer and they are not life-threatening.
ANAL DYSPLASIA DUE TO HPV
Some dangerous types of the HPV remain in the body, especially if it is weakened. Hazardous types can cause precancerous lesions classified as a high grade anal intraepithelial neoplasia (HGAIN). 10-15% of HGAIN lesions develop into cancer within 3-5 years.
The major risk factors for developing anal cancer, are anal infection with HIV, immunosuppressive drugs, low CD4 (in the past), smoking, multiple sexual partners and limited use of condoms.
In HIV-positive people, the elimination of the virus is more difficult and the infection is more aggressive because the immune system is weak. The use of antiretroviral drugs will not prevent from the appearance of dysplasia and anal cancer.
PROGRESSION TO ANAL CANCER
The frequency of gays susceptible to anal cancer is growing, particularly in those who are HIV-positive. Gay men have an incidence of developing anal cancer 20 times greater than the general population. Approximately 50% of HIV-positive gays will appear in their lives pre-malignant dysplasia in the anus and finally 10% of them will develop anal cancer.
Progression to cancer occurs in many years, perhaps decades. In the early stages of the disease, there are no symptoms. Later, the most common symptoms are itching, discharge of liquids and pain which is continuous or appears during defecation or anal intercourse. Swelling or bleeding from the anus are also by anal cancer. For this reason, it is often misdiagnosed as a hemorrhoid. The anal cancer is treated by surgery, or by a combination of chemotherapy and radiotherapy.
PREVENTION OF ANAL CANCER IN GAYS AND THOSE WHO ARE INFECTED BY HIV
The prevention of anal cancer is easy, as long as there is a holistic information from the state and the responsible authorities. In Greece, the prevention of anal cancer in gay men and those who are HIV-positive is very limited because of bad or even no information. In our clinic, there is a permanent examination of the anal dysplasia and a cancer prevention for more than four years. Gay men are examined once every three years and those who are HIV-positive once a year for immediate diagnosis and treatment of any possible dysplasia. Gay men should be checked regularly because very often intra-anal warts appear and become not easily perceived. The treatment of warts is easy, while at the same time anal cytology (pap-test) is performed in order to discover any dysplasia. If there is a diagnosis of major dysplasia, then they are easily treated without anesthesia and the results are very encouraging. With continuous checking per year, the probability of anal cancer is dramatically reduced.
- Prevention of anal cancer in high risk population, Apostolos Stamatiadis, 34o Panhellenic congress of Gastroenterology
- HPV and anal intraepithelial neoplasia: the importance of High Resolution Anoscopy, Apostolos Stamatiadis, 4o Panhellenic congress of medical studies
- Anal cancer screening with high resolution anoscopy ESCP Meeting- Dublin September 2015 Apostolos Stamatiadis