From the Guidelines
There is no routine screening test for HPV in men, and diagnosis typically occurs when visible symptoms appear, such as genital warts, which can be identified through a visual examination of the genital area or a biopsy 1. Unlike women who can be tested through Pap smears, men do not have a standard screening method for HPV. Healthcare providers may perform a visual examination of the genital area to check for warts or abnormal tissue. In some cases, a doctor might apply a vinegar solution (acetic acid) to help identify flat warts that aren't easily visible. For men who have sex with men or those who are immunocompromised, some doctors recommend anal Pap tests, though these aren't standard practice. If warts are present, a biopsy might be taken to confirm HPV infection. Blood tests don't detect HPV, and there's no FDA-approved test to detect the virus in men without symptoms. This lack of testing options exists because HPV infections in men often clear on their own without causing health problems, though they can still transmit the virus to partners. Some key points to consider when checking for HPV in men include:
- The importance of visual examination and biopsy in diagnosing HPV-related genital warts 1
- The lack of standard screening methods for HPV in men, unlike women who can undergo Pap smears 1
- The potential benefits of anal Pap tests for men who have sex with men or are immunocompromised, although this is not a standard practice 1
- The fact that HPV infections in men often clear on their own without causing health problems, but can still be transmitted to partners 1. The best prevention remains vaccination before sexual activity begins, as the HPV vaccine protects against the most high-risk strains of the virus 1.
From the Research
Checking for HPV in Men
To check for HPV in men, several methods can be used, including:
- Sampling from the penile shaft, glans, prepuce, coronal sulcus, urine, and semen 2
- Reverse line blot (RLB) and hybrid capture (HC) techniques for detection 2
- Anal Pap test screening, which involves the blind insertion of a swab into the anal canal and fixing cells for cytological examination 3
- High-resolution anoscopy (HRA)-guided biopsy, which is considered the diagnostic standard 3
- HPV DNA testing, which can be used to detect and differentiate HPV viral strains 3
Risk Factors and Screening
Certain groups of men are at higher risk for anal cancer and HPV infection, including:
- HIV-positive men, particularly those who have sex with men 3, 4
- Men with immune dysfunctions 3
- Men with a history of genital warts or other sexually transmitted infections 4, 5 Screening for anal cancer and HPV infection is important for these high-risk groups, and can include:
- Annual anal Pap testing 3
- HPV DNA testing 3, 6
- HRA-guided biopsy 3, 6
Diagnostic Performance
The diagnostic performance of different screening methods varies, with:
- Anal cytology having low sensitivity (59%) but high specificity (73%) 6
- HR-HPV testing having higher sensitivity (85%) but lower specificity (43%) when used alone 6
- Cotesting (combining anal cytology and HR-HPV testing) having the highest sensitivity (85%) but lowest specificity (43%) 6
- HR-HPV testing being useful for triaging patients with normal and atypical squamous cells of undetermined significance cytology for HRA 6