While typically considered an issue affecting women, human papillomavirus (HPV) infection is common in men and can cause health problems requiring treatment. A recent large study of men worldwide found that 31 percent of men have HPV, and 21 percent have a high-risk HPV type that predisposes them to cancer. Each year, HPV causes cancer in about 12,100 men.
Most commonly, HPV is found in men between the ages of 25 and 29 years, and most men who acquire HPV will clear the infection within 1 year without developing complications. However, some men do not clear HPV, placing them at risk for developing subsequent diseases. Men who are most susceptible to HPV-related conditions include those who are immunocompromised such as from the human immunodeficiency virus (HIV) or organ transplantation or who possess other risk factors such as smoking or sexual activity with multiple partners.
Some men with HPV who have risk factors for progression of the infection may develop the following:
- Small, flesh-colored bumps. These affect multiple areas of the body. Most commonly they are found in the anal and genital area (anogenital warts), but they can also occur on the soles of the feet (plantar warts). Sometimes, they are too small to be seen and other times they have a large, cauliflower-like appearance on the penis, although many different appearances are possible. Warts can cause psychological problems such as shame or embarrassment. Sometimes they are not symptomatic, but they can also become irritated, causing pain, itching, or bleeding. Warts are highly contagious via sexual activity. Unlike cancers, warts are normally caused by low-risk HPV types such as HPV 6 and 11. Depending on the type of wart, treatment involves topical therapies, cryotherapy, electrosurgery, or other surgical methods.
- Recurrent respiratory papillomatosis. In this condition, noncancerous tumors grow in the respiratory tract. They occur most commonly in the larynx (voice box) and can cause hoarseness. In some cases, they can cause difficulty breathing from blocking the airway. These are diagnosed by viewing the tumors using a device called a laryngoscope and obtaining a biopsy. This condition is also caused by low-risk HPV types although high-risk types are frequently found at the same time. Treatment involves removing the tumors using different surgical options.
- Head and neck cancer. Since HPV can be transmitted by oral sex, it can cause cancers of the mouth, throat, and larynx. Head and neck cancers are the most common type of HPV-associated cancer in men. Symptoms can include a sore throat that does not improve, ear pain, hoarseness, pain with swallowing, and weight loss. Depending on the type and location of cancer, treatment involves radiation therapy, chemotherapy, or surgery.
- Anal cancer. Worldwide, 85 percent of anal cancers are caused by HPV. Men who have sex with men are much more likely to have anal cancer. Symptoms can include bleeding, pain, pressure, itching, or changes in bowel habits. As with other HPV-related cancers, treatment involves a combination of radiation therapy, chemotherapy, or surgery.
- Penile cancer. One of the rarest types of HPV-related cancer in men, penile cancer affects fewer than 1 per 100,000 men in the U.S. Compared to anal cancer, penile cancer is less likely to be caused by HPV, and less than 50 percent of penile cancers test positive for HPV. Penile cancer may be suggested by skin changes or a lump or sore on the penis that can bleed, swell, or become irritated. There are many other appearances that can occur with penile cancer.
Why is HPV Testing Not Usually Performed in Men?
Despite the various diseases that HPV can cause in men, testing for the virus is uncommonly performed in men compared to women and is mostly restricted to research purposes in the United States. The Center for Disease Control and Prevention does not recommend routine HPV testing in men, and there is no standardized method for how to obtain an adequate sample for testing (unlike in women). Moreover, there is currently no test officially approved by the Food and Drug Administration for detecting HPV in men compared to women. Therefore, men who are tested for HPV do not always have reliable results, especially if they are tested in different locations of the anal or genital area.
More importantly, however, HPV testing may not be as useful in men compared to women. In women, a positive HPV test is often used in conjunction with a Pap smear to determine whether they have HPV-related changes to the cells of their cervix. If so, they can be treated to prevent the development of cervical cancer. In men, however, there is currently no way to prevent the development of cancer associated with HPV besides waiting for the infection to resolve. In men who have warts, the warts are the target of treatment, not the HPV itself; in other words, testing men who have warts for HPV would not change treatment. In men who have lesions on the penis, anus, mouth, or throat concerning for cancer, the HPV test is also not very useful because diagnosis is made based on a biopsy.
In summary, clinical HPV testing has limited usefulness in men for several reasons: there is no treatment for HPV (unlike for other sexually transmitted infections such as HIV), warts can be successfully treated without knowing the man’s HPV status, there is no standard way to prevent progression of HPV to cancer in men, and cancers are diagnosed by a biopsy without regard for HPV status. There is ongoing research into whether HPV testing can help predict the severity of HPV-related diseases and help guide treatment decisions in rare cases.
Sources:
Bruni, L., Albero, G., Rowley, J., Alemany, L., Arbyn, M., Giuliano, A.R., Markowitz, L.E., Broutet, N., & Taylor, M. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis. Lancet, 11(9): e1345-62.
Giuliano, A.R., Anic, G., & Nyitray, A.G. (2010). Epidemiology and pathology of HPV disease in males. Gynecol Oncol, 117(2 Suppl): S15-19.
Martin, M. Is there an HPV test for men? Yes. But it’s not so useful. Ro. https://ro.co/health-guide/hpv-test-for-men/
Palefsky, J.M. (2007). HPV infection in men. Dis Markers, 23(4): 261-72.
