What is Human Papillomavirus (HPV)?
HPV is a common virus that men and women get during skin-to-skin and sexual contact. HPV is extremely common and it is estimated that 90% of the population has been exposed to HPV at some point with infection rates exceeding 75% of sexually active adults. HPV is relatively easily acquired, and condoms are about 70% effective at reducing transmission. Many people get HPV from their first few sexual partners. There are over 200 different kinds of HPV but only about 20 or so commonly infect the genital and anal region. Low risk types can cause warts, whereas high risk types have the potential to cause anal, cervical, penile, vulvar or vaginal cancer if not caught early. HPV is the main cause of anal cancer in men and women. In fact, over 90% of anal cancers are caused by HPV.
Anal cancer is relatively uncommon compared with other cancers. But the American Cancer Society estimates that there will be 8,580 new cases of anal cancer in the U.S. this year - 5620 will be women and 2960 will be men. It also estimates that there will be 1,160 deaths from anal cancer, 680 will be women and 480 will be men. Almost all cases of anal cancer are in people 35 years of age or older. When caught early, anal cancer responds very well to treatment.
HPV and anal cancer generally do not cause symptoms in the very early stages. But eventually signs may include:
- Anal bleeding
- Anal pain
- Tenderness around the anus
- Warts that itch or bleed in the anal canal
- A hard lump that appears to increase in size
Anal HPV is more common in those with a history of receptive anal intercourse. However, it is possible to develop anal HPV infection without having receptive anal intercourse, especially in women and HIV positive people. Women with a history of HPV infection of the cervix also have a high rate of anal HPV infection, regardless of whether they have had receptive anal intercourse. The reason for this is not understood. Still some factors may contribute.
Risk factors for developing HPV or anal cancer are:
- HIV infection
- Sexual activity and multiple sex partners
- Lowered immunity
- HIV infection
- Precancerous conditions in anal and genital tract
When to See a Doctor
Since many patients will not have symptoms, it is important for patients who are at risk to be examined regularly with an anal/rectal examination by a medical provider. If a mass, a thickening, an area of hardness, a lump, an area of localized tenderness or an ulcer is found, then the patient must be referred to clinicians experienced in managing anorectal problems who can evaluate and biopsy the suspicious areas.
It is important to seek treatment for HPV. An HPV infection often clears up on its own, but in some cases it may cause further problems. For example, treatment may be required for warts or other symptoms. In rare cases, an anal HPV infection will develop into anal cancer. However, when caught early, anal cancer often responds to treatment which involves:
The foremost diagnostic “test” for any condition is a thorough exam and consultation with a physician, including a review of your individual and family history. In addition, your physician may recommend any of the following tests or procedures, which may provide further diagnostic value:
- Anal Pap Smear
In some cases, standard diagnostic tests are not conclusive and additional testing may be necessary to confirm a diagnosis. These may include:
- High Resolution Anoscopy
Vaccines are currently available for the HPV strains most likely to cause cancer. These vaccines are proving to be effective, but they must be administered before boys and girls become sexually active (ages 9-14). When use of these vaccines becomes widespread it will likely reduce the rates of anal cancer as well as other HPV related cancers. Unfortunately, in the United States, a low percentage of girls are being vaccinated, and even fewer boys.
We are proud to say that Capital Digestive Care is one of the participating sites in a groundbreaking study to determine whether treating certain HPV-related abnormalities early reduces the likelihood that a person with HIV will develop anal cancer. View the ANCHOR study website to learn more about it.
Please read more about HPV and anal cancer through the following resources: