Human Papillomavirus (HPV) and High-Resolution Anoscopy (HRA)
HPV is the sexually transmitted infection that causes “genital” or “venereal” warts. Nearly everyone will get at least one type of HPV at some point, usually without ever knowing it. All men who have sex with men (MSM) and women with a positive cervical Pap smear should be screened for HPV with anal Pap smears, but screening has very low specifity (the ability of the screen to distinguish between the most serious precancerous lesions and the least dangerous legions).
Anyone can give HPV to a sex partner without knowing it, through either oral, vaginal, or anal sex. HPV warts can cause cancer – predominantly cervical, vaginal, penile, or anal cancer. Nearly 31,000 people get an HPV-associated cancer every year. HIV-negative MSM are 20 times more likely than the general population to get anal cancer, and HIV-positive MSM are up to 160 times more likely.
HPV can be prevented with a vaccine recommended for young men through age 21, and the following populations through age 26: women, MSM, transgendered individuals, and young adults with HIV. Many treatment options for genital warts exist, but no treatment 100% eliminates warts or prevents them from recurring. Topical treatments can help treat small outbreaks. Larger outbreaks are treated by burning (electrocautery), freezing (cryotherapy), lasering, and/or cutting (surgery) the warts off.
High-resolution anoscopy (HRA) with electrocautery) or laser therapy is the gold standard and most cost-effective way to detect pre-cancerous lesions (anal dysplasia) and prevent cancer from HPV. HRA has the highest sensitivity (ability to detect precancerous lesions) and the highest specificity. HRA is an office-based procedure that will give you the same results as, but less risky than, undergoing general enesthesia and having a tube inserted into your airway to breath for you in an expensive operating room.
HRA involves examination and evaluation of the anus by inserting a small plastic round tube (anoscope), through which the anal canal is examined with a magnifying instrument (colposcope). Mild painless tissue staining solutions (white vinegar, Lugol’s iodine) are used to see HPV and anal dysplasia or cancerous lesions. Biopsies are obtained to accurately diagnose dysplasia, which is treated by laser or electrocautery through the colposcope to prevent cancer and reduce HPV transmission risk. HRA generally takes 15-30 minutes and is very well-tolerated with mild, if any, discomfort. Significant risks (bleeding, infection) are extremely rare when done by a skilled physician, although some minor rectal bleeding is expected for a few days after the biopsies. HRA and any other taken are fully accepted and reimbursable by all insurances, including Medicare and Medicaid, but this is wholly dependent upon finding a provider that participates with your insurance.
Dr. Blick is Chief Medical Officer of Health Care Advocates International, Co-founder of HIV Advocates, and Founder of the Gary Blick Foundation/BEAT AIDS Project Zimbabwe. Dr. Blick has been serving the LGBTQ and HIV communities for 30 years.
FROM: Connecticut HIV Planning Consortium Newsletter – September 2017