Gay men are at a high risk of developing sexually transmitted infections such as Hepatitis B, Hepatits C and HPV. This presentation discusses about the risk, preventive strategies and treatment.

1. WAYS
TO KEEP VIRUSES AWAY
Dr. Prasad Raj Dandekar

2. ◦ What are viruses
◦ Hep B & C
◦ Treatments and prevention
◦ HPV
◦ Cancers

3. What are Viruses

4. Cancer is a disease caused by an uncontrolled
division of abnormal cells in a part of the body.

5. Cancer
cell division
Fourth or
later mutation
Third
mutation
Second
mutation
First
mutation
Uncontrolled growth
Cell Suicide or Apoptosis
Cell damage—
no repair
Normal
cell division
Development of cancer

6. Causes of cancer
◦ Advanced age
◦ Genetic
◦ Environmental
◦ Life style changes
◦ Hormonal effects
◦ Viral infections
◦ Tobacco
◦ Alcohol
◦ Obesity

7. Which viruses can cause cancer
◦ Hepatitis B
◦ Hepatitis C
◦ Human Papilloma Virus

8. HEPATITIS B & C

9. What is the Liver?
◦ Makes chemicals that
your body needs to stay
healthy
◦ Removes waste products
and other harmful
substances from your
blood
◦ Guards against infection

10. What is Hepatitis?
◦ “Hepatitis” means inflammation of
the liver (Jaundice)
◦ Can be caused by:
◦ Alcohol
◦ Hepatitis viruses (A,B,C)
◦ Genetic diseases
◦ Medications (including over-the-
counter, e.g. crocin)

11. Why talk about Hepatitis B & C
◦ HBV and HCV together account for 500 million chronically infected
persons and one million deaths annually.
◦ India has over 40 million HBV carriers.
◦ Every year, one million Indians are at risk for HBV and about 100,000 die
from HBV infection.
◦ The population infected with HCV infection in India is 1%, 12 million.

12. HEPATITIS B

13. Hepatitis B Transmission
◦ STI, spread by contact with infected blood, semen, body fluids.
◦ Unprotected sexual intercourse
◦ Sharing syringe
◦ Tattoo
◦ Sharing toothbrush or razor
◦ Being bitten by infected person
◦ Mother to child
◦ Blood transfusion

14. Symptoms of Hepatitis B
◦ Jaundice(yellow color in the skin or the eyes).
◦ Fever
◦ Fatigue
◦ Loss of appetite
◦ Nausea, vomiting
◦ Abdominal pain
◦ Dark urine
◦ Clay-colored bowel movements
◦ Joint pain

15. Hepatitis B treatment
◦ Most often symptomatic
◦ Rest
◦ Low protein, low fat diet
◦ Abstinence from alcohol
◦ Rarely needs antivirals

16. Hepatitis B Prevention
◦ Vaccine
◦ 0 , 2 , 6 months
◦ Life long immunity in 95%
◦ To check after 1 month with HbsAg
antibody titers

17. 17
Hepatitis B Vaccine is less effective in case of
o Immunosuppressive illnesses (HIV, chronic liver disease, chronic renal failure,
diabetes)
o Obesity
o Smoking
o Older age

18. HEPATITIS C

19. Hepatitis C transmission
Transmitted by
◦ Unsterilized needles
◦ Tattooing
◦ From pregnant mother to child
◦ Sharing razors and/or toothbrushes
◦ Sexual transmission
◦ Occupational exposure

20. What Happens to People With Hepatitis C Virus?
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
Infected With Hepatitis C
100
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
15
No long term infection
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Long term infection
85
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Liver damagae - Cirrhosis
17
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2
Liver Cancer

21. What About Alcohol?
Drinker Without Hepatitis C
Drinker With Hepatitis C
Hepatitis C Non-Drinker
Chance of getting
Cirrhosis
Non-Drinker

22. HEPATITIS C
TREATMENT

23. Hepatitis C treatment until recently
◦ Interferon alone:
◦ 10 – 15% chance of clearing the virus from the blood
◦ Interferon & ribavirin:
◦ Up to 40% chance of clearing the virus
◦ Pegylated interferon alone:
◦ About the same as interferon & ribavirin 40%
◦ Pegylated interferon & ribavirin:
◦ Up to 50% chance of clearing the virus

24. Side Effects of Interferon & Ribavirin
◦ Headache
◦ Fatigue
◦ Muscle & joint aches
◦ Fever, chills
◦ Upset stomach, diarrhea
◦ Decreased blood counts
◦ Skin irritation from shots
◦ Depression
◦ Difficulty sleeping
◦ Difficulty concentrating
◦ Irritability
◦ Hair loss
◦ Weight loss
◦ Thyroid problems

25. Latest advances in Hep C treatment –
with cure rates > 90 %
◦ 12 week therapy
◦ Sofasbuvir
◦ Declatasvir
◦ Ledipasvir

26. Minimal side effects
◦ Tiredness
◦ Headaches
◦ Nausea
◦ Diarrhea
◦ Itchy skin

27. Hepatitis C, B & HIV Co-Infection
HIV
◦ Spread through blood and
sexual contact
◦ Over time makes it hard for
your body to fight off
dangerous infections
◦ Can be treated BUT there is
no cure
Hepatitis C
◦ Spread through blood only
◦ Over time can cause cirrhosis
and liver cancer
◦ There is a cure BUT it’s not
effective in all patients
These viruses are spread in similar ways but are very different diseases
All patients with hepatitis C & B should be tested for
HIV

28. INFECTION RATES by needle prick
RATE OF INFECTION AMOUNT OF BLOOD
Hep C Virus 0 – 7 % Not Known
Hep B Virus 22- 31% 0.0004 ml

29. ◦ Practice safe sex
◦ Do not share toothbrushes, razors, manicure instruments, or needles
◦ Have a hepatitis B vaccine
◦ Only allow well sterilized skin perforating equipment (E.g. tattoo, acupuncture)
◦ If you are infected, cover open wounds
◦ Go easy on the alcohol
How to prevent hepatitis B and C

30. H P V

31. Human Papillomavirus (HPV)
◦ ~100 types identified
◦ HPV 16 and HPV 18 types account for
the majority cancers caused by HPV
◦ HPV 6 and 11 are most often associated
with warts.
2

32. 80+%
~40%
~100%
60-90%
~100%
HPV infection can cause many cancers
Cervical
Cancer
Vulvar
Cancer
Vaginal
Cancer
Anal
Cancer
Genital
Warts
30%
Throat
Cancer
45%
Penile
Cancer
In male: Most commonly causes genital warts and anal cancers

33. Routes of HPV Transmission

34. Genital Warts
◦ Genital warts are lump-like
growths in the genital region
◦ HPV type 6 & 11

35. Treatment of warts
◦ Cryotherapy
◦ Electrosurgery and curettage
◦ Excision
◦ Laser treatment
◦ Chemical peels: salicylic acid, tretinoin, and glycolic
acid
◦ Bleomycin
◦ Immunotherapy

36. HPV risks in Gay Men
◦ Greater lifetime number of sex partners, and greater number of sex partners in
the last year increase a man’s risk for acquiring HPV infection.
◦ Young age (25-29 years) has been suggested to increase risk for HPV infection
in men.
◦ Uncircumcised males have an increased likelihood of acquiring HPV infection.
◦ Increases the probability of maintaining good penile hygiene.
◦ Glans of a circumcised penis has a thicker, cornified epithelium, which makes
it more resistant to small abrasions and less susceptible to HPV entry.

37. Condoms and HPV
◦ Latex condoms provide a barrier to particles, the size of HPV
◦ Consistent and correct use of condoms may not offer complete protection
as HPV may occur on other uncovered sites such as the scrotum, groin, base
of the penis, and anus.
◦ May afford some degree of protection in reducing the risk of HPV-
associated diseases, including warts in men and cervical neoplasia in women

38. Anal Cancer
◦ HPV is associated with
approximately 90% of anal
squamous cell cancers.
◦ Men who have sex with men and
persons who have HIV infection
also are at high risk for anal
cancer

39. HPV Vaccines
◦ Bivalent HPV vaccine (Cervarix®)
◦ Quadrivalent HPV vaccine (Gardasil®)
◦ Nonavalent HPV vaccine (Gardasil 9) (Not licensed in India)
◦ None of the vaccines are approved by DCGI in India to use in men

40. CANCER

41. Reducing risks of cancers
◦ Healthy balanced diet
◦ Healthy weight and regular exercise
◦ No tobacco
◦ Nil or moderate quantities of alcohol
◦ Regular health check ups and cancer screening
◦ Knowing your own risk of cancer
◦ Hepatitis B and HPV vaccination

42. Don’t Forget
◦Always, always and always safe sex
◦ Hepatitis B vaccine
◦ Consider HPV vaccination
◦ Nil or Minimal alcohol intake
◦ Consult a doctor as soon as possible in case of ill health.

43. THANK YOU
Dr. Prasad Raj Dandekar MD, DNB
Twitter - @drprasadraj
Facebook page - drprasadrajdandekar