Some straight talk about anal human papillomavirus infection.

for Merck on the Gardasil in Men trial. He is a member of the Merck advisory board for this product (human papillomavirus vaccine), chairman of the Merck Gardasil scientific advisory board, and a speaker in the Merck speakers' bureau. For decades, anogenital human papillo-mavirus (HPV) research largely focused on viral infection in women, with men only discussed in regard to diagnosis and treatment of penile condyloma. It was not until the past decade that investigators began to look in earnest at the natural history of HPV infection in men. Again, most research focused on genital infections, but increasing rates of anal cancer in men who have sex with men and in immunocom-promised individuals shed some light on anal HPV infection in these at-risk populations. Still, studies of anal infection in men who have sex with women (MSW) languished, with many researchers dismissing it as a clinically irrelevant or even potentially dangerous area of investigation , fearing iatrogenically induced viral inoculation during sampling from surrounding perianal skin. As a clinician and scientist who has spent a large part of his career investigating HPV-related diseases, I have heard these arguments countless times at conferences and in peer discussions. I have listened as too many young men with anal condyloma who were referred for treatment recounted stories of clinicians refusing to accept that " true " heterosexual men could develop anal warts. Thankfully, things might finally be changing. In this issue of the Journal, Nyitray et al [1] present results from the largest (to my knowledge) prospective, multicenter, international trial to look at the prevalence of and risk factors for anal HPV infection in MSW. More than 1300 men from Bra-zil, Mexico, and the United States were enrolled in the HPV in Men (HIM) study cohort. For this analysis, men who acknowledged recent sexual behavior with another man, those with 12 prior male sexual partners, those who refused intra-anal sampling for HPV with a swab, and those with inadequate samples were excluded , leaving 1900 evaluable participants. Samples were tested for 37 HPV types and were considered positive for on-cogenic HPV if any of 13 known onco-and 66) were present. What the authors of this very important article have shown is that anal canal HPV infection in MSW is not rare; HPV was detected in samples from 12% of participants , with 7% carrying an oncogenic type and 7% carrying a nononcogenic type …