Anal paps. I know, what the hell is that?!
Well, it’s something you should at least be aware of.
Anal cancers are relatively rare in general public (approximately 1-2/100,000), but there are some estimates that this becomes 40/100,000 for HIV- men who have sex with men (MSM) and an astounding 80/100,000 for HIV+ MSM. Anal cancer is something everyone should be concerned about. Among men who top, the risk of anal cancer is associated with 10 or more sexual partners and a history of anal warts, syphilis, or hepatitis. So, if you’re thinking “hey, this doesn’t affect me, I don’t EVER bottom!”…think again.
Anal cancers are caused by the human papilloma virus, or HPV. Yes, this is the same virus that is implicated in cervical cancer and genital warts. Within a few years of sexual activity, many people have been exposed to HPV. Many people have been vaccinated against many strains of HPV, and the vaccine is close to being 80% effective. At this point, the HPV vaccine (Gardisil) is given to all males ~11-26 as well as women.
So, do you need an anal pap? Well, maybe. While the rationale for anal pap testing is strong, routine testing for all MSM is not yet recommended by the powers that be- being the CDC, the U.S. Preventive Services Task Force and the American Cancer Society. Why? There isn’t enough existing data to make a firm recommendation. So, essentially, it is subject to change and will be a moving target in the coming years. Now, don’t get me wrong, many people need an anal pap right now; for example, here in NYS, they are performed for HIV+ men annually after a baseline is obtained (HIV makes HPV worse an HPV makes HIV worse!). Also, if a patient were to develop vague rectal symptoms that otherwise couldn’t be explained by other common disease processes, an anal pap would be recommended.
The take-home message: talk to your doctor! Review your risk of common illnesses and STDs. Get vaccinated against HPV. Prevention is both a push and a pull. Protect yourself!
For more info, check out this website that has a handy checklist of things to discuss with your doctor: GLMA - Ten Things For Gay Men
The CDC also has recommendations for thinking about your health here; For Your Health | Gay and Bisexual Men's Health | CDC
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