WHAT IS HPV?
The human papillomavirus (HPV) is a group of over 150 related viruses that cause the most common sexually transmitted infection (STI) in the world. These viruses cause anal and genital warts and have the potential to lead to precancerous changes to the affected tissue (dysplasia). If left untreated, anal dysplasia can lead to anal cancer. These viruses also cause nearly all cases of cervical cancer in women, a significant percentage of head and neck cancers in men and women and most anal cancer in men and women.
HPV is spread by skin-to-skin contact, and by bodily fluids, which is why is so easily spread. Vaginal, anal, and oral sex all allow spread of the virus, and non-sexual direct contact can also be a source of transmission of the virus. Up to 90% of patients will come into contact with the HPV virus during their lifetime, although chronic infections and long-term effects do not occur from every contact.
PREVENTION
There are two main ways to prevent HPV infection and its long-term effects. Vaccination with a HPV vaccine, and general preventative measures such as safe sexual practices and hygiene.
VACCINATION
There are several different HPV vaccines, which are indicated for all children starting before first sexual contact, to give the most protection from the virus. The vaccine prevents infection of the major HPV types associated with warts and anogenital cancer, and is best given before exposure to the HPV virus. The vaccination is very safe, with no known long term side effects with decades of follow up data. It prevents a high percentage of both warts and cancers when given at the indicated times before sexual contact. No vaccine is perfect, and it does not fully cover every subtype of the HPV virus.
Vaccination Recommendations
- HPV vaccine is recommended for routine vaccination at age 11 or 12 years. (Vaccination can be started at age 9.)
- The CDC also recommends vaccination for everyone through age 26 years if not adequately vaccinated when younger. HPV vaccination is given as a series of either two or three doses, depending on age at first vaccination.
- Vaccination is not recommended for everyone older than age 26 years. Some adults ages 27 through 45 years might decide to get the HPV vaccine based on discussion with their clinician, if they did not get adequately vaccinated when they were younger. HPV vaccination of people in this age range provides less benefit, for several reasons, including that more people in this age range have already been exposed to HPV.
- For adults ages 27 through 45 years, clinicians can consider discussing HPV vaccination with people who are most likely to benefit. There is some evidence that the HPV vaccine may be indicated even after exposure is certain high-risk populations.
GENERAL PREVENTATIVE MEASURES
- Do not have unprotected sexual contact with people who have anal or genital warts. Even with protection, there is a high risk of spread if the partner has active warts.
- Limit sexual contact to a single partner at a time and discuss STI exposures prior to intercourse.
- Always use condoms—this reduces but does not eliminate the risk.
- Sexual partners should be checked for HPV and other STIs even when there are no symptoms.
- Cancer prevention: Removal of anal warts can prevent them from developing the precancerous Anal Intraepithelial Neoplasia (AIN) and cancer and decreases the chances of spreading the virus. HPV-positive patients at high risk of developing AIN and anal cancer can be screened by anal cytology (anal pap) or high-resolution anoscopy. AIN and anal cancer can occur even in the absence of warts.
- Stop smoking – data shows that condyloma and HPV related disease recurs more often in people who smoke tobacco products. If you stop smoking, you will decrease your risk of recurring anal warts.
WHAT IS A COLON AND RECTAL SURGEON?
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases, as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions, if indicated to do so.
DISCLAIMER
The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive. Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.