June 14-20^th is National Men’s Health Week and June 20^th is Father’s Day.

Lets celebrate both by sharing the gift of knowledge.  Here are some key facts about STD/STI’s that every man should know.

STD/STIs are certainly a critical piece of the sexual health puzzle but being sexually healthy is about much more.

Our most basic advice is:

• Abstinence is good and can happen at different times in life
• Talk to your parents, they were your age once
• Talk to your partner (before you have sex)
• Make sure you and your partner know how to use a condom correctly
• Find a good healthcare provider and talk to them
• Get help if you don’t think you’re in a healthy relationship
• Get yourself tested and make sure your partner gets tested (before you have sex)
• Take advantage of the vaccines that will help protect you
• Learn what you need to know–and keep learning
• Your sexual health is important–-you have a right and a responsibility to protect it!

Changing sexual practices have led to a dramatic rise in throat cancer in the United States over the past two decades, and experts say they fear an epidemic of the disease.

The comments were made Wednesday at a news conference held by the American Association for Cancer Research to discuss research into the role of the sexually transmitted human papilloma virus ( HPV) in head and neck cancer.

Increasing rates of HPV infection, spread through oral sex, is largely driving the rapid rise in oropharyngeal cancers, which include tumors of the throat, tonsils, and base of the tongue, said Scott Lippman, MD, who chairs the thoracic department at the University of Texas M.D. Anderson Cancer Center.

Studies of oropharyngeal tumor tissue stored 20 years ago show that only around 20% are HPV positive, Lippman said. Today it is estimated that 60% of patients are infected with the virus.

“The percentage of oropharyngeal cancers that are HPV positive is much higher now than it was 20 years ago,” he said. “This is a real trend, and that is why there is concern of an epidemic given that fact that oropharyngeal cancer is increasing at an alarming rate.”
Changing Face of Throat Cancer

Smoking and alcohol abuse were once considered the only major risk factors for these cancers, but this is no longer the case.

American Cancer Society Chief Medical Officer Otis Brawley, MD, said as many as half of the oropharyngeal cancers diagnosed today appear to be caused by HPV infection.

“Changing sexual practices over the last 20 years, especially as they relate to oral sex, are increasing the rate of head and neck cancers and may be increasing the rates of other cancers as well,” he said.

He added that there is some evidence that oral HPV infection is also a risk factor for a type of cancer of the esophagus.

“The paradigm is changing,” Lippman said. “The types of patients we are seeing now with oropharyngeal cancers are not the patients we have classically seen who were older, smokers, and have lots of other problems. These are young people, executives, a whole different population.”
Oral Sex Not Safe Sex

The experts agreed that it is critical for the public to understand that oral sex doesn’t equal safe sex.

The message was unofficially promoted in the early days of the HIV epidemic and it is still widely believed by many, especially teens.

Studies suggest that teens are often unaware of the risks associated with unprotected oral sex, including the transmission of HPV, chlamydia, and gonorrhea.

“There is a huge public health message here,” Brawley said.

source: http://www.webmd.com/sexual-conditions/hpv-genital-warts/news/20090729/oral-sex-cause-throat-cancer-rise

as a urologist i see a lot of patient with growths or bumps on the penis

some patients ask do I have cancer? do I need a biopsy? 

Most patients with a classic wart or HPV do not need a biopsy, patient who are uncircumcised or recurrent growths may consider a biopsy.

Freezing a wart with liquid nitrogen, cauterization, or topical treatments like aldara (imiquimod topical cream)

if you have a wart get to a doctor and have it treated.  A biopsy is not a  bad idea but no always necessary

thanks for all of stories and questions I hope this site can help you fight your personal war on warts. 

the wow team is committed to helping you with the most sensitive topics!

click find a physician for a team member physician in your area!

I’v been living with hpv and my girlfriend for 4 years. I had treatment once for several non cauliflower looking warts. I didn’t notice them for a while because they were so small. They just looked like zits to me. After the initial treatment there has been no recurrences except last week I had one but in 3 or 4 days it went away. Today I noticed a very small rash on the head of my penis. So my questions are:
1. Can warts just go away?
2. How should I get my girlfriend to care about getting a pap smear? (she doesn’t even knowing the connection to cervical cancer)
3. Can hpv be contained in a small area (the head) and be so small it is barely noticeable?

Thanks for writing.  Great questions.

1. Visible warts can resolve on their own – but the HPV virus is not cured.  This means that even though you may not see any growths on your penis, you can still transmit HPV to a partner.

2. It is important that every sexually active women receive gynecological care and pap smears.  You may want to share with her this information so she can learn about this important medical test.

3. Yes, it is possible for the visible manifestations of HPV to be located to one area.
I encourage you to establish a relationship with a physician so that you can get checked.  This is the best way to take care of yourself, and anything less is a disservice to both you and your girlfriend.  You may want to bring your girlfriend with you to the visit so that your doctor can talk to you both.

Best of luck.

Pearly penile papules are small raised nodules (bumps), usually 1-2 mm in size, which are located around the rim of the penis head in the form of string of pearls.  Usually developing during adolescence, they have been reported in up to 35% of males. Uncircumcised men are more likely to have pearly penile papules.  Very often these lesions are confused with genital warts, although there is no known link between warts and pearly penile papules.

Pearly penile papules are NOT cancer and are NOT spread via contact or sex. Most men with penile papules do not seek medical treatment.

Men do not need to have them removed but some men feel uncomfortable having spots or dots on the penis.  Some men are worried that a partner my not have sex with them because they look like warts or other sexually transmitted bumps such as herpes.

Many treatment methods have been tried, including circumcision and freezing. But these methods had proven to be either ineffective or have side effects.

Until recently,burning and carbon dioxide laser were considered the most effective treatment options.

Radiofrequency surgery was introduced into dermatology, it became a great option to remove unwanted papules effectively, safely, and with no scarring or bleeding.  Originally used to remove papules on the nose or other small bumps radiofrequency removal is an effect technique.   Because radiofrequency uses radio waves and not electricity, there is less damage to surrounding tissue and its small and light hand-piece allows for more precise and complete removal.

Usually one treatment is enough to remove all penile papules.

Treatment area is numbed with lidocaine cream making the area not sense pain or heat.   The skin takes a week to ten days to heal.  Patients can resume daily work activities that same day but we encourage no sexual relations until the healing process is finished

Genital infection with low-risk types of HPV is associated with genital warts in men. Infection with high-risk types of HPV is associated with a proportion of preinvasive squamous lesions of the penis (penile intraepithelial neoplasia or PIN) and with penile cancer, as well as with preinvasive squamous lesions of the anus (anal intraepithelial neoplasia or AIN) and with anal cancer.

Invasive penile cancer is quite uncommon, especially in circumcised men.

In 2002, the age-adjusted incidence rate for penile cancer in the U.S. was 0.8 per 100,000 men (985 new cases). The age-adjusted incidence rate for anal cancer was 1.2 per 100,000 men (1,453 new cases). However, the risk of anal cancer for MSM is significantly higher.

Because of the increased incidence of anal cancer in MSM, especially HIV-infected MSM, some specialists recommend screening for AIN by cytology in this population. However, there are limited data on the natural history of AIN, the reliability of screening methods, the safety and response to treatments, and the programmatic considerations that would support this screening approach.

Until more data are generated on screening for AIN, this screening approach is not recommended.

There is currently no FDA-approved HPV DNA test for males, nor is HPV testing of males recommended. There is no clinical utility in testing men for HPV; infection does not indicate increased risk of disease for the man or his partner. While HPV is common in men, HPV-associated cancers are rare.

There are no routine methods for culturing HPV. Serology tests are available for HPV, but these tests are used only in research settings. Many persons with detectable HPV DNA do not have antibodies, so these tests are not a good method to indicate infection with HPV.

While it is possible that vaccination of males with the HPV vaccine may offer direct health benefits to males and indirect health benefits to females, there are currently no efficacy data available to support use of HPV vaccine in males. Efficacy studies in males are ongoing.

Additional information is available on the CDC website at:

http://www.cdc.gov/STD/hpv/hpv-clinicians-brochure.htm

To access treatment guidelines for HPV and genital warts, please review CDC s 2006 STD Treatment Guidelines available online at:

- HPV Infection

http://www.cdc.gov/std/treatment/2006/hpv.htm

- Genital Warts

http://www.cdc.gov/std/treatment/2006/genital-warts.htm

In a study published in The New England Journal of Medicine, gay and bisexual men were found to have a significantly higher risk for developing anal cancer, over thirty-five times greater than the general population. HIV-positive men were estimated to be eighty times more likely to get it. Although anal cancer accounts for less than 5 percent of all digestive and intestinal tract cancers, the rates have increased 160 percent over a thirty- year period. Gay African-American men have the sharpest increase and the lowest survival rates. Interestingly, anal cancer in gay men is as common as cervical cancer was in women before the use of the Pap smear, the test that screens for precancerous lesions on the cervix. Both types of cancer are caused by the human papillomavirus (HPV), which also causes anal and genital warts. HPV is one of the most common STDs in the world. Fortunately, anal cancer is highly preventable and treatable if caught in time.

There are more then one hundred different subtypes of HPV, and some are the source of common warts as seen on the hands and feet. HPV affects approximately 65 percent of HIV-negative gay men, and nearly 95 percent of HIV-positive gay men carry HPV in their anal canals. Most do not even know they have it. Subtypes 6 and 11 cause 90 percent of genital warts, while subtypes 16 and 18 are far more dangerous because of their precancerous potential.

The lining of the anal canal, once infected with HPV, can reproduce uncontrollably if left untreated. In most cases, the immune system clears the infection naturally, but in a small number of cases, usually over many years, HPV can cause changes in the cells of the anus and rectum that can lead to cancer. The Pap smear is something that should be offered to all gay men. In March 2007, the New York State Department of Health AIDS Institute, in collaboration with the Johns Hopkins Division of Infectious Diseases, issued the following recommendation concerning anal Pap smear.

Clinicians should perform anal Pap tests at baseline and annually in the following populations:

1. Men who have sex with men

2. Any patient with a history of anal or genital warts

Clinicians should refer patients with abnormal anal Pap test findings for high- resolution anoscopy and/or examination with biopsy. Like cervical cancer, invasive squamous cell cancers of the anal canal are associated with certain types of HPV infection, most notably, HPV-16 and HPV- 18. Although this is a new practice that may not be routinely available, screening for cellular dysplasia is recommended, particularly in persons at high risk for infection with papilloma viruses.

There are various ways to treat genital and anal warts depending on the size and location. Topical medications, like podofilox & Imiquimod (Aldara) can sometimes be used.  Cryotherapy, electrodesiccation, application of trichloroacetic acid or bichloroacetic acid and interferon injections are just some of the many treatment options that should be discussed with your physician.

The anal Pap smear is a simple test that is performed by your doctor in his office. It involves swabbing the anus with a Dacron swab, which looks like a long Q-Tip. The swab is then smeared on slides and sent to the pathologist. This test is so important because there are many different types of HPV. The most common are types 6, 11, 16, and 18. Certain subtypes, specifically 16 and 18, are considered precancerous. As a patient, you should report any cauliflower-like lesions that develop on your skin because HPV can show up on your penis, anus, and even your tongue.

In 2006, Merck & Co delivered the first vaccine for HPV called Gardasil. It is a quadrivalent vaccine, which means it works on HPV subtypes 6, 11, 16, and 18, and it is given in three separate injections over six months. Currently, the vaccine is indicated only for women, but the majority of gay health- care providers are urging their gay male patients to consider this vaccine, especially those men who are HIV positive or have a history of HPV. At this time the vaccine is not covered by insurance and would have to be paid for out of pocket. Presently, Merck is studying this vaccine in 4,000 young men, including those who engage in sex with other men, and the National Institutes of Health (NIH) is evaluating the response to Merck’s vaccine in preteen HIV- positive boys and girls.

adapted from source: http://www.advocate.com/health/healthstory_ektid61607.asp?Category=Health+%26+Treatments

In a previous post, we discussed penile pearly papules.

Lichen planus can also cause bumps on the penis.  This condition is an inflammatory condition - NOT an STD.

Classical lichen planus is characterized by shiny, flat-topped, firm papules (bumps) varying from pin point size (‘guttate’) to larger than a centimetre. They are a purple colour and often are crossed by fine white lines (called ‘Wickham’s striae’). They may be close together or widespread, or grouped in lines (linear lichen planus) or rings (annular lichen planus). Linear lichen planus can be the result of scratching or injuring the skin. Although sometimes there are no symptoms, it is often very itchy.

Lichen planus may affect any area, but is most often seen on the front of the wrists, lower back, and ankles.  They are also commonly found on the penis.

Sometimes it may be necessary to take a skin biopsy to confirm the diagnosis.  One of the best treatments for lichen planus on the penis are injections with cortisone.

Penile warts are diagnosis that a trained doctor can make without a biopsy.  If patients have many warts or ones that look suspicious for other lesions like cancer I often biopsy a representative sample and freeze (with liquid nitrogen) or burn (electrocautery) or laser (C02 or YAG) the rest.  If a patient has warts on the foreskin and wants a circumcision I sent the tissue for biopsy. 

If your doctor didn’t send a biopsy and it didn’t come back that’s fine.  If it keeps coming back and there was never a biopsy ask your doctor to sent a piece to the lab or make sure they are convinced its not cancer.

I hope this post is helpful.  Go to our find a physician tab if you need an evaluation

Thanks,

Dr. A.

Jessica writes:

“I got married 8 months ago, and 2 months ago, for the first time ever i was diagnosed with HPV. According to the Dr, it didnt necessairly come from my hubsand, but i cant help feel like it did. Thankfully, i have no genital warts or currently any cancer causing lesions, but i Do have a brand new, first time ever skin wart on my knee. Ive just started liquid nitrogen treatment for the removal of that.
Im increadably disspaointed, and borderline terrified. This is a first for me, and while some people say “its no big deal”- to me it is a big deal. this is something ive never had to deal with before and to make it worse, i know next to nothing about the Virus. Ther are so many different websites on it that have s many different opinions, i hardly know which one to believe!!

I think the next best step for me is education myself on this virus, how to treat it, and how to NOt spread it!”

Thanks for writing!  First off… you have found a good place to discuss your concerns.  Please do not be terrified.  Warts are quite common.  Instead… lets get educated!

Your Doctor’s advice is correct.  The wart did not necessarily come from your husband.  You may be able to blame him for lots of things… but you can’t point a finger at him for this one.  Further, the type of wart that grows on the skin is typically a different strain of virus than that found in the genital areas.

There are many treatment options for common warts, and Liquid Nitrogen is often a good place to start.
Best of luck, and keep us updated!