Can males be tested for Human Papillomavirus (HPV)?

HPV Testing in Males

HPV tests should not be used to screen men, as recommended by the Centers for Disease Control and Prevention (CDC) guidelines. 1

Current Recommendations on HPV Testing in Males

The CDC's sexually transmitted diseases treatment guidelines explicitly state that HPV tests should not be used to screen men, partners of women with HPV, adolescent females, or for health conditions other than cervical cancer 1. This recommendation is clear and unambiguous, prioritizing evidence-based approaches to HPV management.

Why HPV Testing is Not Recommended for Males:

• No FDA-approved test: Currently, no HPV test for men has been approved by the FDA 2
• Limited clinical utility: Unlike in women, where HPV testing guides cervical cancer screening, there is no standardized protocol for using HPV test results to guide clinical management in men
• Natural history: Most HPV infections in men clear spontaneously without causing health problems 1
• No validated screening algorithm: There is no established screening pathway that has been shown to reduce morbidity or mortality in men through early detection of HPV

Special Populations Where Testing May Be Considered

While routine HPV testing is not recommended for men in general, certain high-risk populations might benefit from targeted screening approaches:

• Men who have sex with men (MSM): Particularly those who are HIV-positive may benefit from anal cytology (anal Pap tests) rather than direct HPV testing 1, 3
• HIV-positive individuals: HIV-infected men with HPV infection are at increased risk for anal dysplasia and cancer 1
• Men with genital warts: Should have anal Pap tests if they are HIV-infected 1

Prevention Strategies for Males

Since testing is not recommended, prevention becomes the primary strategy:

1. HPV vaccination: Recommended for all males aged 9-21 years, and for those aged 22-26 years if not previously vaccinated 1, 4
2. Consistent condom use: While not fully protective (as HPV can infect areas not covered by condoms), correct and consistent condom use can lower transmission risk 1, 4
3. Limiting sexual partners: Reduces exposure risk, though HPV is so common that even individuals with only one lifetime partner can be infected 1, 4

Clinical Approach to Men Concerned About HPV

When men request HPV testing:

• Educate about limitations: Explain that there is no clinically validated test for HPV in men 1, 2
• Visual examination: Clinicians can perform visual inspection for genital warts or suspicious lesions
• Partner considerations: If a female partner has HPV, testing the male partner is not recommended 1
• Vaccination status: Verify and recommend HPV vaccination if eligible and not previously vaccinated 4

Common Pitfalls to Avoid

• Unnecessary testing: Ordering non-validated HPV tests for men can lead to anxiety without clinical benefit
• Misinterpreting research: Some research studies use HPV testing in men, but these methods are not validated for clinical use
• Partner blame: A diagnosis of HPV in one partner is not indicative of sexual infidelity, as HPV can remain dormant for years 4
• False reassurance: Even if a test were available, a negative result would not rule out HPV infection due to sampling limitations and transient nature of detectable infection

In conclusion, while HPV infection affects both men and women, current evidence does not support routine HPV testing in males. Prevention through vaccination and safer sexual practices remains the cornerstone of HPV control in men.