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!

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

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!

by: Michelle Lipke

Liquid nitrogen is a popular destructive treatment for warts.  It is readily available in both dermatology and primary care offices.   Verucca-Freeze and many similar brands available over the counter are a liquid applied from a spray can, but only freeze to -70C.  Warts may not resolve with the over the counter freezing due to the fact that they do not freeze as fast as the liquid nitrogen available in the clinic setting; as well as the proper application technique may not always be used. The wart virus, known as human papilloma virus (HPV), is not destroyed by the freezing procedure.   Liquid nitrogen freezes at -196C and works by destroying the skin cells which in turn release the wart virus.  They body responds to this process by causing an immune response to resolve the wart.

The cryo-spray gun and cotton wool bud are the two main methods for treating common warts with liquid nitrogen.  Different providers often have a personal preference of which method they choose to perform this treatment.   There was no difference in cure rate between cryo-spray gun and cotton wool bud for warts treated every two weeks for three months.

Warts need to be frozen until 1-2 mm of surrounding skin turns white.  Repeat freezing after thawing may cause more effective tissue damage for some wart locations to help them resolve.  Paring the wart down with a scalpel or razor blade may reduce callous which can act as an insulator reducing the effect of the freeze.  Warts are usually treated on average of every two weeks, but sometimes the interval of treatment can depend on how a patient responds to the freezing in regard to side effects.

The common side effects from liquid nitrogen include redness, swelling, blistering and pain.  Plantar wart treatment may temporarily reduce the ability to walk due to pain and blistering.  Excessive blistering may create a ring recurrence around the treated wart which is thought to be caused by bordering dormant wart virus.  The freezing may cause lightening or darkening of the skin after the wart has resolved, especially in dark skinned individuals.  Deeper structures such as tendons, nerves and veins can be damaged with treatment that is too aggressive.

A new product called Veregen (sinecatechins) 15% ointment is now available for the treatment of warts. Sinecatechins are an extract from Green Tea, that cleared almost 90% of anogenital warts in clinical studies.

The medication is only approved for treatment of external genital and perianal warts, and is not without side effects.  One out of five patients experience erythema, pruritus, burning, pain/discomfort, erosion/ulceration, edema, induration or a vesicular rash.  The medication is also going to be expensive, and likely not covered by many insurance plans.

Anal warts are caused by the human papilloma virus, which is usually transmitted through sexual contact but not necessarily through anal intercourse. The same type of warts may occur on the penis, scrotum, vagina or labia. It is important to recognize and treat anal warts if you have them, as the risk of developing cancer is high.  The time from exposure to the virus and growth of the warts is commonly from one to six months, but it can be longer. During that time the virus remains in the tissues but is inactive. There are many types of human papilloma virus; some cause warts on the hands and feet and others cause genital and anal warts.

Peri-anal warts are a serious condition – with multiple treatment options.  There is a significant risk of developing anal cancer if these are not treated.  In fact, this risk may be greater than the risk of developing cervical cancer (which is what PAP smears check for.)  Though we typically do not test for the presence of HPV on the penis, it is very important to check for HPV in and around the anus in patients at risk (ie: those who have had anal sex).

Since it is difficult to examine yourself in this area, it is most important for you to get examined by a physician if you feel any growth, bump, roughness, or experience any bleeding from the area.

Getting treatment for genital warts or HPV is important.  Doctors can burn, freeze, cut or scrape away unsightly bumps.  The virus associated with HPV stays in the body like other viruses do.  Just like cold sores a new eruption can happen without a repeat exposure.  Someone who doesn’t have visible warts can still give someone else the virus during unprotected sexual contact.  While antibiotics can treat some sexual transmitted infections getting treated for genital warts does not constitute a cure.  Some cases of warts don’t progress at all.  Others grow to be big, painful and even disfiguring. 

Most patients are happy to have the growths treated and there partners or new prospective partners wont see the warts.  A responsible adult should use condoms to prevent sexually transmitted infections, HIV and warts. 

While we can make the warts disappear there is no guarantee the warts won’t have the last laugh.