HPV testing and men
Oct. 19th, 2003 09:15 pm![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
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vaginapaginaThis started as an answer to ![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-userinfo.gif)
privatized, but I put in so much research (stupid librarian genes) that I decided to post it with its own subject header, so it'd be searchable later. :-)
Okay: the jury is still officially out on HPV testing for men. In practice, it's discouraged unless he has a visible infection, and then it's for diagnosis and not general screening.
Background
Today it's estimated that 85% of the US population has, carries, or did have HPV. The vast majority of these are "silent" strains that never manifest (either as warts or cancer), or emerge as harmless (though upsetting) genital warts. Only a few strains of the virus's many strains cause cervical cancer. Condoms prevent some, but not all, transmission, because it's spread skin-to-skin, not just from the bits covered in rubber. (You can get more info from the American Social Health Association. It's a terrific all-around resource.)
The good news (From the Rutgers U Health Center): The large majority of people cure themselves of HPV, usually without ever knowing that they had been infected. Average length of time from infection to cure is about 8 months. Studies suggest (but don't confirm) that people who've recovered from an active HPV infection may be less likely to transmit it, as they've built an immunity in their system. And only a small number of the many HPV strains are linked to cervical cancer. (The strains that cause visible warts are not linked to cervical cancer.)
HPV Testing
There are (as I understand it) three ways to test for HPV. In a colposcopy, the doc sprays a mild acid wash over your cervix & gina, which makes warts or lesions appear as white spots. Some are nearly microscopic, so he examines you under magnification. Similarly, doctors can paint vinegar over a man's genitals and look for spots under magnification, but this only works if he has visible warts -- not if he's a silent carrier of another strain(s). In other words, it diagnoses an active infection with one of a few strains of HPV.
The second test is the Hybrid Capture II or HC2 HPV DNA test, which "can find very small amounts of HPV in fluid or tissue samples. If a Pap test is abnormal, this test can show the risk of cervical cancer." However, this test is FDA approved for women only, because it causes large numbers of false positives in men. Incidentally, the American Cancer Society (ACS) now recommends that women 30 years and older routinely have both a Pap test and the HC2 HPV DNA screening, instead of a Pap test alone. Again, the test is only for women.
The third method is DNA testing (by various means, lumped together as "DNA testing" ;). Here's a concrete example. A 2001 Canadian study tested sperm donors for viral HPV. Of the 85 men tested, 45 were documented as HPV+, and 40 were clinically HPV-negative. "Clinically negative" means that they never showed an infection, and had never slept with a women or man with warts, or a woman who had an abonormal Pap and HPV+ test.
Out of those 45 infected men, the DNA test caught only 25, plus 3 positives among the non-carriers.*** And of the positive tests, 75% caught the strain that causes visible warts. Only 25% of the tests caught silent strains -- it's not possible to know how many, if any, were missed. The study concluded that all sperm banks should test sperm for HPV, and reject the positive donors. As far as I know, no American medical authority has put this into policy; perhaps the cost of testing outweighs the benefit of catching only half of HPV+ men; especially when HPV is so prevalent in our population, is (ahem) "mostly harmless," and leads to (relatively) few deaths from cervical cancer thanks to yearly Pap smears and aggressive early treatment.
***I don't know if they were false positives, or if they found 3 silent HPV carriers among the clinically healthy.
There you have it: of the three tests, one is only for women, one only works for men if there's an active infection with a wart-causing strain (visible on the anus or penis), and one is only 50% effective (and more effective on wart-causing strains than silent strains). Right now, no policy-setting organization (FDA, CDC, American Council on Obstetrics and Gynecology, ACS, ASHA) recommends DNA testing to screen for HPV. Given such tests' high cost, they're performed *only* in such cases as sperm donation; I doubt most health plans would cover it.
If you have information that contradicts, or adds to, this report, please email it to me, and I'll gladly put it in!
EDIT: Not so much a problem forvaginapgaina, but gay/bi men can get warts and have warts on their rectum and perineal region.
privatized, but I put in so much research (stupid librarian genes) that I decided to post it with its own subject header, so it'd be searchable later. :-)Okay: the jury is still officially out on HPV testing for men. In practice, it's discouraged unless he has a visible infection, and then it's for diagnosis and not general screening.
Background
Today it's estimated that 85% of the US population has, carries, or did have HPV. The vast majority of these are "silent" strains that never manifest (either as warts or cancer), or emerge as harmless (though upsetting) genital warts. Only a few strains of the virus's many strains cause cervical cancer. Condoms prevent some, but not all, transmission, because it's spread skin-to-skin, not just from the bits covered in rubber. (You can get more info from the American Social Health Association. It's a terrific all-around resource.)
The good news (From the Rutgers U Health Center): The large majority of people cure themselves of HPV, usually without ever knowing that they had been infected. Average length of time from infection to cure is about 8 months. Studies suggest (but don't confirm) that people who've recovered from an active HPV infection may be less likely to transmit it, as they've built an immunity in their system. And only a small number of the many HPV strains are linked to cervical cancer. (The strains that cause visible warts are not linked to cervical cancer.)
HPV Testing
There are (as I understand it) three ways to test for HPV. In a colposcopy, the doc sprays a mild acid wash over your cervix & gina, which makes warts or lesions appear as white spots. Some are nearly microscopic, so he examines you under magnification. Similarly, doctors can paint vinegar over a man's genitals and look for spots under magnification, but this only works if he has visible warts -- not if he's a silent carrier of another strain(s). In other words, it diagnoses an active infection with one of a few strains of HPV.
The second test is the Hybrid Capture II or HC2 HPV DNA test, which "can find very small amounts of HPV in fluid or tissue samples. If a Pap test is abnormal, this test can show the risk of cervical cancer." However, this test is FDA approved for women only, because it causes large numbers of false positives in men. Incidentally, the American Cancer Society (ACS) now recommends that women 30 years and older routinely have both a Pap test and the HC2 HPV DNA screening, instead of a Pap test alone. Again, the test is only for women.
The third method is DNA testing (by various means, lumped together as "DNA testing" ;). Here's a concrete example. A 2001 Canadian study tested sperm donors for viral HPV. Of the 85 men tested, 45 were documented as HPV+, and 40 were clinically HPV-negative. "Clinically negative" means that they never showed an infection, and had never slept with a women or man with warts, or a woman who had an abonormal Pap and HPV+ test.
Out of those 45 infected men, the DNA test caught only 25, plus 3 positives among the non-carriers.*** And of the positive tests, 75% caught the strain that causes visible warts. Only 25% of the tests caught silent strains -- it's not possible to know how many, if any, were missed. The study concluded that all sperm banks should test sperm for HPV, and reject the positive donors. As far as I know, no American medical authority has put this into policy; perhaps the cost of testing outweighs the benefit of catching only half of HPV+ men; especially when HPV is so prevalent in our population, is (ahem) "mostly harmless," and leads to (relatively) few deaths from cervical cancer thanks to yearly Pap smears and aggressive early treatment.
***I don't know if they were false positives, or if they found 3 silent HPV carriers among the clinically healthy.
There you have it: of the three tests, one is only for women, one only works for men if there's an active infection with a wart-causing strain (visible on the anus or penis), and one is only 50% effective (and more effective on wart-causing strains than silent strains). Right now, no policy-setting organization (FDA, CDC, American Council on Obstetrics and Gynecology, ACS, ASHA) recommends DNA testing to screen for HPV. Given such tests' high cost, they're performed *only* in such cases as sperm donation; I doubt most health plans would cover it.
If you have information that contradicts, or adds to, this report, please email it to me, and I'll gladly put it in!
EDIT: Not so much a problem for
vaginapgaina, but gay/bi men can get warts and have warts on their rectum and perineal region.
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Date: 2003-10-19 07:04 pm (UTC)no subject
Date: 2003-10-19 07:08 pm (UTC)no subject
Date: 2003-10-19 07:18 pm (UTC)no subject
Date: 2003-10-19 09:39 pm (UTC)no subject
Date: 2003-10-20 12:27 am (UTC)no subject
Date: 2003-10-20 07:50 am (UTC)no subject
Date: 2003-10-20 09:56 am (UTC)Hopefully any health insurance will cover a HPV screen just as they would a Pap smear. The ACS recommends that annual Pap/HPV tests be standard for women over 30 or high-risk women.
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Date: 2003-10-20 10:09 am (UTC)no subject
Date: 2003-10-20 09:07 pm (UTC)