Quality of life of homosexual males with genital warts: a qualitative study

Lee Mortensen and Larsen BMC Research Notes 2010, 3:280 http://www.biomedcentral.com/1756-0500/3/280 SHORT REPORT Open Access Quality of life of homosexual males with genital warts: a qualitative study Gitte Lee Mortensen1*, Helle K Larsen2 Abstract Background: A recent qualitative study in Denmark showed that genital warts (GWs) can considerably lower the quality of life of heterosexual patients. In this follow-up study, we interviewed men having sex with men (MSM) suffering from GWs to obtain an in-depth understanding of their perception of GWs and determine the extent to which minority (homosexual) cultural issues affect these patients’ experiences. Qualitative interviews with six MSM were performed using a semi-structured interview guide. Questions were formulated on the basis of the earlier qualitative study in heterosexual patients with GWs along with a literature review. Data were analysed using a medical anthropological approach. Findings: Many MSM worried about being stigmatised and excluded from the small homosexual ’scene’, their key social group, thereby lowering their chances of finding sex and love. Most participants had suffered from GWs for several years which added to the negative psycho-sexual and social effects of the disease. Participants’ fears of developing anal cancer were similar to those expressed about cervical cancer by females with GWs. Conclusions: Ano-genital human papillomavirus (HPV) infection is common and has a serious psychological and sexual impact among MSM. However, they do not benefit to the same extent as heterosexual men from the herd immunity effect of HPV vaccination of girls. The pathological profile and concerns specific to MSM should be addressed when communicating with these patients, and should be taken into account when considering HPV vaccination of boys. Background Genital warts (GWs), one of the most common sexually transmitted diseases (STD), can significantly lower patients’ quality of life (QoL). A qualitative study carried out among young heterosexual Danes [1] showed that patients with GWs worried about the uncertain timeline and perspectives of recovery, and that they were often depressed and had low self esteem. The patients’ selfimage as well as their social lives were affected by the stigmatisation caused by the disease. Patients found it difficult to detach themselves from their GWs because of the repeated treatments, the social manoeuvres required to conceal the disease and the negative effects on their love and sex lives, in particular [1]. These results are in line with published data pointing to a substantial need for more knowledge about GWs and improved doctor-patient communication [2-16]. * Correspondence: 1 AnthroConsult, Aarhus, Denmark Full list of author information is available at the end of the article Fifteen articles (in English) on the effects of GWs on the QoL of patients of both sexes were identified from a literature search using PubMed, Embase, Cinahl and Psycinfo [2-16]. Four of the studies focused on the effects of human papillomavirus (HPV) infection in men [4-7]. A review of the articles showed that the effects of having GWs on QoL were similar for men and women. However, women tended to worry more about their fertility, infecting a baby during childbirth and the development of cervical cancer for those who knew about HPV [8,9]. One study revealed that men more frequently reacted with denial, delayed seeking treatment and worried about pain [6]. Only one study focused on men having sex with men (MSM) and their knowledge of HPV [4]. Approximately 90% of GWs are caused by infection with HPV types 6 and 11 [17]. The quadrivalent HPV vaccine that was introduced in the Danish childhood immunisation programme in October 2008 contains HPV 6 and 11 virus-like particles as well HPV type 16 and 18 virus-like particles (high-risk HPV types). In Denmark, this vaccine © 2010 Mortensen et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lee Mortensen and Larsen BMC Research Notes 2010, 3:280 http://www.biomedcentral.com/1756-0500/3/280 is recommended for the prevention of cervical cancer in 12-year-old girls with a catch-up programme for 13-15 year-old girls. A herd immunity effect on heterosexual men is expected, but such effects for MSM would be expected to be more limited [18]. GWs in MSM are often located in the intra- or perianal region, and it has been reported that anal warts are twice as frequent as GWs in this population [19]. Like the cervical tract, the anal canal has a transformation zone between the columnar epithelium of the rectum and the squamous epithelium of the anus, which is more receptive to HPV infection than the mucosa and skin of the rest of the ano-genital region [20]. The treatment of intra-anal warts is often protracted and painful, and recurrence rates are high. The impact of treatment on the risk of HPV transmission is uncertain [21,22]. HPV infection is highly prevalent in men and even more so in the case of MSM [23-28]. In one study, HPV DNA was found in the anal canal in 57% of HIV-negative MSM, with 26% having high-risk HPV types and 26% having low-risk HPV types; co-infection is frequent [29]. Anal infection with multiple HPV types is associated with receptive anal intercourse and the number of sex partners [29,30]. High-risk HPV types are found in almost all anal cancers in homosexual men, suggesting that HPV infection is prerequisite for the development of these cancers [31,32]. Although anal HPV infections are frequent, anal cancers are still relatively rare in Denmark (0.5 per 100 000 person-years) suggesting that unidentified factors influence the progression from HPV infection to cancer. Nonetheless, incidence rates of anal cancer have increased over the last half century, and incidence rates among MSM are high compared with that of the general population. It is estimated that the prevalence of anal cancer among MSM is currently at least as high as the prevalence of cervical cancer before the introduction of cervical screening programmes [29]. Incidence rates are particularly high among HIV-positive MSM, in spite of treatment with HAART (highly active antiretroviral therapy) [32,33]. Despite the fact that MSM have a higher risk than heterosexual men of contracting GWs, are less likely to benefit from the herd immunity effect of the vaccination programme, and are more likely to develop anal cancer, very little data are available on GWs in MSM. The objective of the present study, the first of its kind in MSM, was to examine in depth the way GWs may affect the QoL in this population and if particular minority cultural issues were relevant to their experiences with this disease. Methods The previou (...truncated)