How do you test a male for Human Papillomavirus (HPV)?

HPV Testing in Males

There is currently no FDA-approved or recommended HPV test for men, as no standardized protocol exists for using HPV test results to guide clinical management in males. 1

Current Guidelines on HPV Testing in Males

The Centers for Disease Control and Prevention (CDC) explicitly recommends against HPV testing in men for several reasons:

• No HPV test for men has been approved by the FDA 2
• There is no established screening pathway shown to reduce morbidity or mortality in men through early HPV detection 1
• Most HPV infections in men clear spontaneously without causing health problems 1
• HPV tests should not be used to screen male partners of women with HPV 3

Special Considerations

While routine HPV testing is not recommended for men, certain populations may benefit from targeted screening:

• 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
• HIV-infected men with HPV infection are at increased risk for anal dysplasia and cancer and should have anal Pap tests if they have genital warts 1

Alternative Approaches to HPV Management in Men

Since testing is not recommended, management focuses on:

1. Visual inspection: Healthcare providers can identify visible genital warts or lesions through physical examination
2. Symptom management: Treatment of visible warts or lesions when present
3. Prevention strategies:
   • HPV vaccination for males aged 9-21 years, and for those aged 22-26 years if not previously vaccinated 1
   • Consistent condom use (though not fully protective) 3
   • Limiting sexual partners 3

Patient Education Points

When discussing HPV with male patients:

• Explain that most sexually active adults will contract HPV at some point, though most never know it because infections are typically asymptomatic 3
• Clarify that a diagnosis of HPV in one partner is not indicative of sexual infidelity 3, 1
• Inform that within ongoing sexual relationships, both partners are usually infected by the time one person is diagnosed 3
• Emphasize that even if testing were available, a negative result would not rule out HPV infection due to sampling limitations and the transient nature of detectable infection 1

Common Pitfalls to Avoid

• Don't test men for HPV: Despite the high prevalence of HPV in men (86% in partners of HPV-positive women according to some studies 4), testing is not recommended due to lack of validated clinical management protocols
• Don't assume HPV testing technologies for women can be applied to men: The tests approved for cervical screening (like Abbott RealTime and Roche cobas 4800) are not validated for use in men 5, 6
• Don't overstate the value of condoms: While condom use can lower transmission risk, HPV can infect areas not covered by condoms 3

In summary, there is no recommended or approved test for HPV in men. Management focuses on prevention through vaccination, treatment of visible lesions when present, and targeted screening with anal cytology in high-risk populations.