Watch Your Aüçëüçë: The Deadly STI You May Already Have and Can Do Something About

A 35-year-old working in film production, Geoff Moore had a pretty good sex life with his boyfriend. In fact, you could call it vigorous. Sometimes even exhausting. So when they both noticed fleshy bumps around and inside Moore's anus, they assumed it was just a sign of too much good lovin'.
Until they didn't go away. And grew bigger.
A visit to an LGBTQ-friendly doctor taught them a new word: Condyloma, the term for genital and anal warts, which is caused by certain strains of a virus called HPV. It's the most common STI, and so widespread that if you've had more than four sexual partners (or if any of those had more than four sexual partners), you've almost certainly been exposed at least once.
HPV, a.k.a. human papillomavirus, causes all types of warts, including the unflattering, nubby bastards we develop on hands and feet. About 150 numbered strains exist, around 40 of which specifically affect the genital region, the anus, and inside the anal canal, while a dozen of those strains are classified as "high risk" HPV and can cause cancers of the genitals, anus and even throat. The latter afflicted actor Michael Douglas, who contracted HPV through oral sex.
Not-so-fun fact: gay men acquire twice as many HPV strains as their heterosexual counterparts and have the highest incidence of anal/rectal cancers — four times that of cervical cancer. Condoms do offer some protection, but because HPV can infect skin not covered by the latex — including the entire pubic area, scrotum, inner thighs, ass, throat, and what we lovingly call "the taint" — it can still spread if present, even through kissing.
"I've seen full-blown anal cancers caused by HPV while working in a hospital," says Dr. Latonya Riddle-Jones, medical director of Detroit, Michigan's LGBTQ-focused Corktown Health Center. "You don't want cancer, and that area of the body has lots of functions and cancer there can completely devastate someone's life. There have been cases where we thought it was a colon cancer, but was an anal cancer from an HPV outbreak and got out of control."
The iconic model and actress Farrah Fawcett was a casualty of anal cancer in 2009, bringing mainstream attention to anal cancer and its connection to HPV. And, unfortunately, Moore learned after a biopsy that his breakout was also from a cancer-causing strain and present both within his anal canal and outside. Happily, none of these warts had progressed to cancer, and Moore underwent a surgical procedure to have them removed.
Now for some good news: 2006 saw the arrival of Gardasil, a two or three-dose vaccine that targets both cancer and wart-causing HPV strains and has continued to include even more strains over the years — six when first introduced, now nine.
Initially recommended exclusively for young girls to mitigate cervical cancers, which was a leading cause of death for women, 2011 saw Gardasil also advised for boys age 26 and under. Ideally, it's administered at age 11 or 12, prior to first sexual activity, although most of today's generation routinely receive it during middle school. In 2018 the FDA recommended that anyone under 45 receive the vaccine (insurance covers the cost), since even those who have already been exposed to Gardasil-covered strains receive an immunity boost.
"Especially if you're HIV-positive, it mitigates your cancer risk significantly," affirms Dr. Evan Goldstein, an openly gay surgeon whose NYC practice Bespoke Surgical is dedicated to LGBTQ+ anal-rectal health. "I see a lot of people with anal warts and some are difficult to get rid of, but getting the vaccine can create an immune response that helps resolve the issue. All gay men should get the HPV vaccine."
While HPV is most contagious when physically manifested as visible warts or lesions, which can appear raised, flat, cauliflower-shaped, or like a skin tag or mole, the virus can be passed along even when no visual signs are present. In fact, many of those who contract HPV will never experience a noticeable outbreak, because if one's immune system is functioning properly, the body often cycles HPV out of the body on its own.
Yet once warts have developed, they often will grow and spread since the body doesn't recognize them as an immediate threat. "Think of a whale with barnacles on its tail and it doesn't know they're there and feeding off the whale," Dr. Goldstein explains. "It's the same concept. The HPV develops into a wart and it's on the last cell of your asshole and your body doesn't even know it exists. And when many people deal with other immune issues, whether herpes or HIV, the likelihood your body has to fight all these things and then says, 'Oh yes, I have something anally I have to get rid of,' is very low."
Dr. Rachelle Wilcox, chief of speciality services at University of Michigan's University Health Service, has seen cases where warts were allowed to run wild, including "someone who had their entire labia replaced by condyloma." Dr. Riddle-Jones, meanwhile, recalls an HIV-positive patient in his 20s who, unvaccinated due to their parents' refusing it during his adolescence, allowed an anal lesion to go unchecked when first noticed. About 18 months later, he started to experience intolerable symptoms, including pain and bleeding.
"When we talked about the possibility of it being a precancerous lesion caused by HPV, they were terrified," she recalls. "It was a precancerous lesion, but it could be treated and at that point the patient got the vaccine and has been doing great."
While treatments for HPV breakouts haven't evolved much over the past couple of decades ("still barbaric," Dr. Goldstein opines), external and internal HPV is, nonetheless, highly treatable by simply removing or destroying the tissue containing the virus, fortunately located on the surface. Depending on their preference, physicians will often remove external condylomas through freezing (cryotherapy), with Trichloroacetic acid, or the use of self-applied prescription creams that provoke one's own immune system to attack the affected area and remove wart-y cells (which, according to some, can also help prevent recurrences).
For internal warts, laser surgery is often the optimal route since Trichloroacetic acid, although usable on very small anal condyloma, can highly irritate and scar those delicate tissues.
As far as prevention measures besides the HPV vaccine and routine screening for unusual bumps or growths, Dr. Riddle-Jones recommends rectal pap smears every two to three years for sexually active HIV-negative individuals and annual if HIV-positive.
Dr. Goldstein prefers to conduct annual pap smears for active bottoms who he feels are at higher risk and utilizes two distinct types of swabs. "One tells me which strains of HPV someone has been exposed to, high risk or low risk, and the second looks at the cells and whether they are transforming," he says. He also emphasizes the importance of regular STI tests that include chlamydia and gonorrhea screenings, and if one does experience external condyloma breakouts, they are checked for internal ones as well. "The goal," he says, "is to make sure there isn't an internal issue with a good examination by someone who knows what they're doing, looking inside and out."