By Dr. Kevin Wang
Before I start my column, IÕd like to remind everyone of a survey IÕm conducting. IÕm starting a research project in my program to increase awareness of the LGBT community in the medical community. These surveys ask you what you wish or would like your primary care physician to know about our community. For a more detailed explanation, please visit the site: https://www.pridesource.com/article.shtml?article=17789. Please e-mail me at the address below and IÕll send out the materials. IÕd like to thank those of you who have responded. Your help is much appreciated. Now on to this monthÕs column!
So this month, weÕre going to continue with our series discussing the various STDs along with their symptoms, signs and treatment. For the previous columns on STDs, please visit https://www.pridesource.com.
ThereÕs an STD thatÕs been prevalent for years but only recently received attention in the general public and media in the last year or so. Has anyone seen that commercial with women asking, ÒDid you know that cervical cancer is caused by a virus? A virus? I didnÕt know that!Ó Now this virus isnÕt your typical cold that eventually disappears or your body will eventually eradicate. This virus, known as Human Papilloma Virus, is something that will stay in your body forever.
Now this commercial only comments on the female perspective relating to cervical cancer. There are multiple strains of HPV that result in warts (and not just the ones on fingers but genital warts — remember the picture with cauliflower growing out of someoneÕs ass or vagina?), skin cancer in the non-genital regions and skin cancer in the anogenital regions (meaning cervix and vagina for women, the rectal area for men).
But how does this relate to being an STD? With any STD, we always worry about transmission and what we can do to treat the disease. HPV isnÕt like the typical virus we encounter — the flu or cold where if we sneeze on someone (cover your mouth!), get the cold/flu, get sick and get over it. HPV is transmitted through close, personal contact (warts) or sexual intercourse (cervical cancer).
Like in my previous columns, letÕs break it down to cases, shall we?
In medical school, I learned that the risk of getting HPV in women is directly related to the number of male sex partners. Talking about this with my lesbian patients, they look at me with absolute shock telling me, ÒIÕve never had sex with men!Ó Well, thatÕs all said and good but we donÕt know if their partners have had sex with men, were bisexual or had any genital warts. Vaginal penetration isnÕt even required to transmit the virus. And even is someone is infected, this person most likely wonÕt know sheÕs infected and may transmit the virus to every partner. Complications associated with HPV infection are pretty much what I stated above — genital warts and the most dreaded, cervical cancer. WeÕll talk about prevention and treatment below.
Now with HPV in men, all I ever learned about the virus in men were related to genital warts and how weÕre the nasty bug that transmits HPV to every woman we have sex with (like that will ever happen to me!). But in our community — gay, bisexual or transgender — we need to worry about genital warts (of course) but cancer in the rectal/anal region.
Now what the hell do we do about all of this? Warts are usually easily treated — removal in the office, at home or for those warts that just wonÕt go away — laser surgery to burn them off. But itÕs sort of hard to treat cervical/anal cancer since we canÕt perform anti-cancer treatments in everyone just to prevent them from occurring.
So thankfully, someone came up with the idea for screening tools to help detect the early stages of cervical and anal cancer. Most people know about the Papanicolaou Smear (Pap smear) that women should get annually. New guidelines state that we should screen all women at the age of 21 or 3 years after the onset of sexual activity. The Pap Smear is the absolute best screening tool we have in the medical field and to not take advantage of it would be a horrible waste! I do tens of Pap Smears a month and this isnÕt to say I would know how comfortable or uncomfortable it feels. But what I can say is that itÕs certainly important!
And what about men? Believe it or not, there is a Pap Smear of sorts for us men who participate in anal sex. But for men, thereÕs no use of a speculum or anything but simply a Q-tip like tool and we swab the inside of the anus and rectum.
Now on to prevention. Well, itÕs a bit difficult to say how to prevent transmission since recent studies have shown that itÕs unclear if condoms help to prevent transmission of HPV. HPV can be transmitted even during foreplay without any sort of vaginal/anal penetration. What I can say is to play it safe and smart — avoid active lesions (warts) and play safe and smart.
One last word — the HPV vaccine that recently came out called Gardisil. It is currently indicated for girls age 9-12 to prevent infection in the future. Has it be indicated for adult women and men? Not yet but there are studies under way to help determine that since I just canÕt give it to all my LGBT patients without them having to pay out of pocket for the vaccine.
Now IÕm way outside my word limit so I think IÕll end this column here this month. As always, if you have any questions, donÕt hesitate to ask me or your primary health care provider. Next week, weÕll talk about another STD and if you have any particular interest in one, let me know. I hope this column finds all of you in good health and spirits and IÕll see you next month!