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AIDS Watch: One More Pain in the Butt

HPV can lead to anal cancer? You bet your ass.

Kelly McCann

By Kelly McCann

“Put your heels in the stirrups, scoot down to the end of the table, and let your knees fall loosely to the side.” Those instructions, issued by gynecologists far and wide, are familiar to every woman who’s had a Pap smear. But it is men who have sex with men, especially if they are infected with HIV, who may need to become familiar with those words (or something like them) in order to protect themselves from a life-altering and potentially deadly disease.

Once a rare illness that primarily impacted elderly women, anal cancer rates have increased sharply in men in recent years. According to the American Cancer Society, about 2,000 men will be diagnosed with anal cancer this year. Moreover, the risk for developing the disease is 17 times higher for gay and bisexual men than for heterosexual men. In fact, the rates of anal cancer in men who have sex with men is equivalent to the rates of cervical cancer we used to see in women before the advent of routine Pap testing, or about 30 to 40 cases per 100,000 persons. No surprise, but the news for HIV-positive men is even worse.

Rates of anal cancer are twice as high among gay and bisexual men who are living with HIV/AIDS when compared to their HIV-negative counterparts, especially if the men are long-term survivors. This can be explained in part by the effective HIV treatments that allow people to live longer, and, thus, develop previously uncommon cancers and other illnesses.  

As with cervical cancer in women, most cases of anal cancer in men are caused by Human Papillomavirus (HPV). There are many viruses within the HPV family; some are harmless and some cause warts, but a few can lead to serious cellular changes. It is those high-risk strains of HPV that are linked to anal cancer.

It should be noted that infection with HPV, even the high-risk strains, most often does not result in cancer. Rather, the infection goes away on its own. However, infections that do not resolve and are not detected early and treated can lead to anal cancer.

The HPV lives in the skin (of an infected partner’s genitals, for example) and is transmitted through simple skin to skin contact. Men become infected with anal HPV through unprotected receptive anal intercourse. Some studies suggest as many as 65 percent of gay men (and 95 percent of HIV-positive gay men) have HPV in their anal canals or surrounding tissues.    

While no standards exist for routine testing in men, and the CDC does not yet recommend yearly examination, more and more experts are suggesting annual anal (say that five times fast) Pap smears for men who have sex with men, particularly those infected with HIV. The Pap test detects abnormalities or precancerous changes in cells of the anus by examining them microscopically. Cell samples are collected by inserting a swab into the rectum. No biggie, right? You can handle a swab.

If the Pap smear shows anal dysplasia (cellular changes), treatments are available that prevent progression to cancer, and most of those procedures can be conducted on an outpatient basis. But early detection is essential for successful prevention.

Symptoms of anal cancer include anal bleeding or discharge, swollen lymph nodes in the groin area, and changes in stool and/or bowel habits. The most common treatment for anal cancer is surgery. In the early stages of the disease, surgical treatment usually provides a cure, but it comes with a price tag that includes fecal incontinence or a colostomy bag. On the brighter side, doctors are currently investigating a treatment strategy that includes chemotherapy and radiation and reduces the need for the life-changing surgery.

Obviously, the better alternative is to avoid anal cancer altogether. In order to do that, avoid being infected with HPV by limiting your number of sex partners. Fewer partners mean less potential exposure to HPV.  

Condoms can also help reduce the risk of HPV infection, but be forewarned. Wearing a condom, or having your partner wear one, doesn’t necessarily protect against HPV because the virus can be in skin not covered by the latex. However, condoms do prevent transmission of HIV, and that’s always a good thing, especially for folks infected with HPV.

Finally, annual anal Pap smears may allow for early detection, treatment, and, thus, prevention of anal cancer. If you are living with HIV/AIDS, or if you have ever been diagnosed with anal warts, lesions, or fissures, talk with your doctor about anal Pap testing.

Remember, the test takes only seconds, but it could literally save your ass—and your life.  

For more information about HPV and anal cancer in gay and bisexual men, visit

Kelly A. McCann is the chief executive officer of AIDS Foundation Houston. For testing information, call AFH’s Prevention Services Department at 713/623-6796 or log on to


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