HPV and anal cancer

[Nextdoor_guy]

hey guys I have a question. How long it take to develop anal cancer from HPV?
here's my short story..

Got infected with HPV in april '10 and in may got a small wart in the anal area. Because I live in a eastern european country, and I am already HIV+ going to a Dr with HPV was very hard for me, cause of the judgemental attitude of the Drs. Finally in august went to see a Dr. when the lesions spread and got internal warts too.
She was very tough with me, so I didn't went to the second appointment.

In september I started the ARV treatment and thought that my immune system will recover and will be able to fight HPV  but it didn't and now the warts grown in number and size and am scared that I will develop anal cancer.
At the end of the month I scheduled a meeting with a rectal surgeon but I am very scared to go, and of course VERY ashamed..

Please give me some advices. I feel so down now, cause I have to fight not  only with HIV but with this new problem. I am falling into depression again, and am afraid this will affect my treatment adherence.
was thinking to suicide several times..

[roy100]

It is too soon to worry about rectal cancer. Theres is always the  risk , but put that behind your mind at this point.
You need treatment now, as warts tend to come back very often, and if internal sometimes it needs surgery. I know it because I was in your shoes 25 years ago, even before I had AIDS, no cancer at this point.

You need to focus in finding a good gay friendly DR in your area, usually a proctologist  is the specialist of these procedures, I had a wonderfull Chinese DR in Fort Worth , TX, which was great at the time of  my wart operation. He was very sympathetic.

After the operation you will need many Dr's visits to cauterize the emerging warts, sometimes they prescribe a cream which has to be applied very careful as it burns or kills the surrounding area.

Remember the key to your wart problem is finding a sympathetic DR, and forget about guilt and fear as your first goal is to heal.

I hope the best for you !

[monmon]

Hi there.  I have a question.
I am poz.  My current partner just found out that he had abnormal cells that need to be removed from the anal canal.

I asked if he has HPV.  He said no.  I am just wondering if the above abnormal cells was triggered by HPV.

We did not have anal sex yet.  But I gave him a complete fellatio several days ago, is that a high risk behaviour for transmitting HPV.

I read some articles online saying 95% of poz gay guys who was a receiving partner has HPV as well.  Is this really true?

Any precaution I need to make now?  Any comments?

Thanks.

[Tim Horn]

Monmon:

First off -- and not to cause trouble here -- but the discovery of "abnormal cells" in the anus is almost always associated with HPV infection. HPV infects squamous cells, which make up the epidermis (our skin and tissues lining our respiratory and GI tracts), and can cause them to multiply in unhealthy ways, leading to things like warts and pre-cancerous growths.

HPV infection is nothing to be ashamed of, especially when you consider that the virus is so incredibly common and is so easily transmitted during sexual activity, including anal, vaginal and oral sex. Unfortunately, condoms aren't all that effective in terms of preventing HPV.

It's important to keep in mind that HPV infection itself isn't usually a major cause for concern. Many people who become infected with the virus don't experience any problems whatsoever -- their immune systems are able to clear the virus and abnormal squamous cells before the situation becomes a bit more serious. And, unfortunately, people living with HIV (notably men who have sex with men; women who engage in anal sex; or women who have a history of cervical HPV disease, even if they've never had anal sex) are more prone to anal disease caused by HPV.

As unfortunate as it is, being vigilant about abnormalities caused by HPV is a basic component of sexual health. Just as all sexually active women need to receive annual cervical Pap smears to look for squamous cell abnormalities that can lead to cancer, many people living with HIV should also be checked regularly for anal disease. While the jury is still out regarding the best ways to look for anal disease -- many experts think that annual "direct visualization" performing by a proctologist or anal surgeon using an anoscope is best -- it's the best way to guard against anal cancer.

Tim   

[monmon]

Thanks Tim for the clarification.

HPV.com states that HPV could not be tested for men, is this true?

I am going to have anal pap smear soon, will that be able to tell whether I have the infection?

[Tim Horn]

Monmon:

HPV testing -- looking for the actual virus -- is sometimes ordered by gynecologists when a cervical Pap smear comes back with an "ASCUS" result, meaning cells that aren't necessarily pre-cancerous but aren't normal either. Another swab can be performed and sent to a lab for HPV testing -- if the virus is present, the gynecologist knows to keep a close eye on the woman using slightly more specific testing.

This process hasn't been validated in men and, even if it was, it's not used to simply find out who is positive for the virus (like we do HIV), given that many people infected with HPV don't experience problems. In turn, even if it was to become a validated and approved test for men, it would only be conducted as a follow up to an abnormal anal Pap smear.

Again, the big question here isn't whether you've been exposed to HPV -- many of us have -- but whether you have any signs of active disease, such as warts or pre-cancerous growths (called dysplasia). Anal Pap smears are a good first step to look for these problems and to determine if you need more advanced testing.

Tim 

[edfu]

Some further info is here:

http://forums.poz.com/index.php?topic=35296.0

[monmon]

Thanks Tim and edfu for the detailed info.

One more question, when someone has abnormal cells in the anus, does it mean that it is definitely caused by the "bad" strain of HPV that won't be "cleared" in 1-2 years for most people?

Monmon

[edfu]

Abnormal anal cells are almost always caused by one of the "bad" strains of HPV.  Those strains can indeed sometimes be "cleared" by an individual's immune system, but if they were, it would be before the abnormal anal cells developed.  The abnormal cells are an indication that the HPV has not been "cleared." 

[monmon]

Thanks Edfu:

Please advise the following:

So does it mean that different people react differently to "bad" strains of HPV?

Is being poz has lesser ability to "clear" bad strains of HPV then a negative person?

It really open my eyes when I learn about HPV that could cause cancer and not a lot of gay people are aware of this epidemic.

[edfu]

So does it mean that different people react differently to "bad" strains of HPV?

Yes.

Is being poz has lesser ability to "clear" bad strains of HPV then a negative person?

It would definitely seem so, according to Dr. Joel Palefsky's research:

http://www.thebody.com/content/confs/croi2009/art50604.html

Unfortunately, this would not necessarily constitute definitive proof.  As with all issues regarding the diagnosis and treatment of HPV and anal abnormalities, including cancer, medical practice has not been standardized.  And the connection between HPV and HIV, especially a potential synergistic effect, has not been scientifically proven yet.  This is an area of research that needs much more attention.   

[monmon]

Thanks edfu.

I have been studying a lot of these articles.

I have scheduled for the anal pap smears this March 30th.

A little surprise how long is the wait, a little paranoid now, hopefully I will get less paranoid in the coming weeks.

[northernguy]

I'm really fortunate in that there is an anal dysplasia clinic at the main "HIV hospital" here in Vancouver, but as the OP reminds us this is far from the standard of care.  Even in North America its not that common.  I go for check-ups every two months.  The female doctor who does the treatment is excellent, and very good at letting me know any concerns etc.  If there are any internal warts she removes them using IRC (infrared coagulation).  Warts are hard to predict.  Sometimes one treatment is enough and they don't come back. Other times, they may disappear only to resurface a few years down the road.  From what she told me, progression to cancer is usually slow.

Quite frankly the worst part for me is the embarassment of thinking that my rectal area may not be sparkling clean for the very nice doc doing the procedure.  They specifically tell you not to use an enema or such before the app't.  Best thing for you to do is swallow your embarrassment, ignore your doc's disapproval and get started with treatment.  Don't let their attitude stop you from nipping this in the rosebud, so to speak!  

[monmon]

Northernguy

Yes, it's true.  Even the hiv docs do not automatically screen patients for anal pap test.
I think it should be done for all poz patients.

You go for check ups every two months?  That's very frequent. Can you go back to work right after the treatments?

[surf18]

I had butt wart surgery and it sucked shit
It still hurts 4 weeks later
What is this infared method?

[edfu]

"Another surgical method of wart removal is called infrared coagulation, or the use of an infrared coagulator. Infrared radiation is a part of the electromagnetic spectrum with a slightly greater wavelength than red light (hence the term infrared). Infrared is not visible to the naked eye, but is responsible for heat energy. In an infrared coagulator, a noncoherent, multispectral light infrared source delivers infrared radiation to an affected area, which causes the temperature of tissues to rise about 100 degrees C. Intracellular fluids literally boil and proteins are destroyed, ultimately burning off the wart tissue....

"Studies have shown infrared coagulation to be as effective as electric curettage and may even be safer, with lower risks for bacterial infections after the procedure. In addition, infrared coagulation is a very versatile method of wart removal because the depth of tissue destruction can be tightly controlled by simply adjusting the length of time a tissue is exposed to infrared....

"Infrared coagulation causes less pain than other methods of wart removal. A sharp, stinging sensation may be felt on the affected area as the infrared hits the skin. With infrared coagulation, only the areas exposed to the finely focused beam of infrared are coagulated. Sparing of surrounding tissues means that there is very little risk for scarring.  Since coagulation time is very short, sessions can easily be done on an outpatient basis. However, it may be necessary to undergo multiple sessions to achieve complete cure. It is also important to have follow-up consultations with your physician to ensure that there will be no complications or recurrences."

[surf18]

Thank you for posting that. Sounds better than trad methods. I urge anyone needing this surgery to seek other options.

[leatherman]

Infrared coagulation causes less pain than other methods of wart removal.

I urge anyone needing this surgery to seek other options.

it's all about persceptive. nothing could be as bad as this Imiquimod (Aldara) crap
I've been living through some sort of hyper-"immune reconstitution inflammatory syndrome"-like hell for the last few days. who would have imagined that such a tiny amount of cream could produce such effects! (fever, extreme fatigue, herpes zoster outbreak, diarrhea, mild rash, nausea, vomiting, weakness, muscular aches and pains. Lordy! I thought teh aids was coming back! ) I emailed my doc this morning telling her I was going off treatment and to start arranging some sort of surgical alternative for when I call into the office Monday morning.

[edfu]

Aldara can have a horrific side-effect profile, especially for HIV-positives.  Another problem with its use for anal warts is that it must be applied extremely minutely and very specifically only on the wart and not on any surrounding skin tissue (like with a Q-tip) to minimize the side effects.  This is obviously impossible or very difficult without the assistance of a willing applicator     or good mirror control.  And then this needs to be done for rather a lengthy period of time. 

[monmon]

Edfu:

I have a question, I dated this guy who had abnormal anal cells and need to have surgery.  He is negative

We only had oral sex so far.  I am going to meet with him again tomorrow.

Does it make any difference to me?  Should we still have oral sex?  Can I assume I am infected already?

I know HPV could be latent for a lengthy period of time, or I might just get it from others long time ago.

When he has abnormal anal cells, does it mean that he has acute symptoms and the HPV is hightly transmittable?
If so, it is going to be from what area?  Will that be from his penis?  He has always been a top for the past 10 years.
He only had bottoming experience twice according to him.

The thing is he is not aware the the abnormal anal cells is HPV related.  It's hard for me to bring up this subject....
Are the abnormal anal cells all casued by the bad strain (cancer causing) HPV?

I am very worried about the result of my anal pap test this March 30th, I read articles stating being poz has a harder time to fight HPV off.

Please kindly advise.

[surf18]

i did sixteeen weeks with the cream. ill take that over surgery any day.though i wouldnt have said that before the surgery though. ha
yes i had many a days of intense butt burning.

[northernguy]

Northernguy

Yes, it's true.  Even the hiv docs do not automatically screen patients for anal pap test.
I think it should be done for all poz patients.

You go for check ups every two months?  That's very frequent. Can you go back to work right after the treatments?

Sadly yes, I could go back to work right afterwards, so no sick days taken. 
The most painful part is the slight prick of the needle when they freeze the area that the IRC is goign to be applied to.  Sometimes there's a very slight feeling of warmth for the couple seconds the IRC is applied, but not always.  I would highly recommend that anyone with internal warts see if IRC treatment is available in your area, rather than surgery or even laser.