DST - J bras Doenças Sex Transm 2013;25(1):41-45 - ISSN: 0103-4065 - ISSN on-line: 2177-8264 DOI: 10.5533/DST-2177-8264-201325109 REVIEW INTRODUCTION The infection by the human papillomavirus (HPV) results of one of the main sexually transmitted diseases (STDs) at present time. In recent years, the male infection has increasingly become a research object (1) after the awareness that sexual transmission is the main way of dissemination to women and that men also take the consequences of anogenital HPV infection in the form of anogeni- tal warts (AGW), penile intraepithelial neoplasia (PIN) and anal in- traepithelial neoplasia (AIN) and carcinoma invader, added to the development of prophylactic vaccination for both genders. Although benign, AGWs take on the psycho-social stigma cha- racter, often leading to depression and loss of quality of life, with a high social cost (2) . Penile carcinoma often occurs in men in their 60’s, with inci- dence ranging from 0.3 to 4.2/100,000, depending upon socioe- conomic differences and religious conditions, reason why this pathology studies have low priority (3) . However, anal carcinoma, which until recently were thought to arise as a result of chronic infammatory intestine disease, has today on HPV infection its primary etiologic agent, being the high-risk types associated with approximately 90 cases of anal squamous cell carcinoma, and most of these associated with HPV 16, followed by HPV 18 (4,5) . Its inci- dence has been increasing in the general population around 2% per year (2) , however, in some specifc groups, such as men who have sex with men (MSM), HIV-seropositive men for the human immu- nodefciency virus (HIV) and immunosuppressed, rates are more alarming – a recent study in San Diego shows the incidence of 224 per 100,000 individuals/year (6) . To better understand this fgure, we should mention that the incidence of UCC before the introduction of routine Pap smear examination was around 37/100.000 indivi- duals/year (7) . Sorting through cytology, similar to Pap smear, has been propo- sed for anal carcinoma, however there is still no consensus on the reliability of the method (6) . Physical examination with biopsy and histopathologic study is still considered a good option, although the visualization of sub-clinical lesions (annal intraepithelial ne- oplasias) most time is only possible with a set up view by a high resolution videocolposcope (8) , a kind of examination not yet well known by other experts than Gynecologists (2) . The tests for the detection of viral nucleic acid have high sen- sitivity and specifcity − like the polymerase chain reaction (PCR) and the capture of the hybrid (not available in all health services, mainly in public health) − and require knowledge about the viral behavior and the pathology in question, so that the interpretation of the results have a practical signifcance and not be just another inconvenience, with a waste of time and money. ANAL INFECTION BY HPV Transmission and epidemiology HPV transmission occurs by direct contact of two surfaces, i.e., through the skin or mucous membrane microtrauma, exposing the epithelial basal layer. The main route of transmission is the sexual contact without the exclusive need for penetration, followed by epi- sodes in which microtraumas may also occur. As the HPV are quite resistant to heat and drying, it is still possible a reduced transmis- sion via contaminated fomite (9) . HPV transmission does not occur through blood, since it doesn’t make viremia, or through ejaculate, except in the presence of urethral injury by HPV. Although it has already been detected in sperm, it has not been possible to prove its infectious potential in this circumstance (10) . The potential transmis- sion of HPV through seminal fuid raises the question of what might be possible for the transmission of HPV via sperm donation (11) . There is still no accurate HPV acquisition and elimination rates data, nor the incidence and duration of infection nor the production of antibodies in response to HPV infection in man. In Giuliano et al. study (12) , the prevalence among men and women in the same age group would be between 52.8% and 53.8%, respectively. Also Giu- liano et al. (13) in a recent prospective study, with heterosexual men aged between 18 and 44 years, points to the probability of 0.29% HPV infection per year. According to Burd (9) and Frisch et al. (13) , following are the main factors predispoing individuals to a greater risk of infection: pri- 1 Medical Doctor (MD) at the Hansen’s Disease Department of the Professor Rubem David Azulay Dermatology Institute, Santa Casa de Misericórdia do Rio de Janeiro, Rio de Janeiro State. 2 Associate Professor Head of the Virological Diagnostic Laboratory, UFF (Fluminense Federal University) Biomedical Institute, Niterói, Rio de Janeiro State. Virological and EpidEmiological aspEcts of anal carcinoma: currEnt and futurE challEngEs Elisabete Dobao 1 & Silvia Maria B Cavalcanti 2 ABSTRACT Human papillomavirus infection, a sexually transmitted disease studied mainly in women due to its link to uterine cervical carcinoma, has become a health problem in men also, mainly by the signifcant increase of the prevalence and incidence of anal intraepithelial neoplasia and anal carcinoma in specifc groups, such as men who have sex with men, HIV- seropositive and immunocompromised. The anal carcinoma, as cervical cancer, is associated with high- risk oncogenic HPV in 90% of cases, with HPV 16 as the predominant, followed by HPV 18. This fact occurs in a moment when there are no management protocols for HPV infection in the anal area, either preventive, diagnostic or therapeutic, and without an unique specialty that embraces the problem of HPV anogenital infection in men as does the gynecology for women, causing a dispersion of expertise. Added to this, there are still many doubts in the medical and general population about prophylactic vaccination for HPV in boys, and the absence of its distribution in a public health scale in most countries that still wait for statistical calculations to justify its use. Keywords: HPV, anal carcinoma, HIV, STD, intraepithelial neoplasia