What is the recommendation for men who want a Human Papillomavirus (HPV) oral swab for screening?

HPV Oral Swab Screening for Men: Current Recommendations

There is currently no recommendation to perform HPV oral swab screening in men as no screening test for oral HPV infection has been approved by the FDA. 1, 2

Current Guidelines and Evidence

The U.S. Preventive Services Task Force (USPSTF) and other medical organizations do not recommend routine screening for oral HPV infection in men for several reasons:

• No FDA-approved screening test exists specifically for oral HPV infection 1, 2
• Insufficient evidence that screening for oral cancer or HPV reduces morbidity or mortality 1
• Lack of evidence on the benefits of early treatment for screen-detected oral HPV 1
• Unclear natural history of screen-detected oral HPV infection 1

HPV-Related Oral and Oropharyngeal Cancer

While HPV-related oropharyngeal cancer is increasing in incidence, particularly among men, current evidence does not support routine screening:

• HPV-16 is associated with approximately 85-95% of HPV-positive oropharyngeal cancers 1
• The prevalence of oral HPV infection is estimated at 6.9% in adults aged 14-69 years in the United States 1
• Men who have more than 20 lifetime sexual partners or currently use tobacco may have HPV prevalence as high as 20% 1

Risk Factors for Oral HPV Infection

Several factors are associated with increased risk of oral HPV infection:

• HIV infection (19% HPV prevalence vs. 7% in HIV-negative men) 3
• Current smoking (adjusted odds ratio 2.2) 3
• Higher number of lifetime tongue-kissing partners 3
• Higher number of lifetime oral-penile sex partners 3
• Recent tooth-brushing (within the hour) 3

Special Populations

While general screening is not recommended, certain populations may warrant special consideration:

• Men who have sex with men (MSM): Despite higher risk, no specific oral HPV screening recommendation exists 4, 5
• HIV-positive individuals: Higher prevalence of oral HPV (19% vs. 7% in HIV-negative men) 3, but still no formal screening recommendation

Prevention Strategies

Instead of screening, prevention strategies are recommended:

• HPV vaccination, ideally administered at ages 11-12 years 2
• Tobacco cessation for current smokers 1
• Reduction in alcohol consumption 1
• Safe sexual practices 6

Clinical Examination

For men concerned about oral HPV:

• A systematic clinical examination of the oral cavity by a healthcare provider is the primary method for detecting potential abnormalities 1, 2
• This examination should include visual inspection of the face, neck, lips, labial mucosa, buccal mucosa, gingiva, floor of the mouth, tongue, and palate 1
• Palpation of regional lymph nodes, tongue, and floor of the mouth 1
• Any abnormality lasting more than 2 weeks should be reevaluated and considered for biopsy 1, 2

Patient Counseling

When discussing oral HPV with concerned patients:

• Explain that most oral HPV infections clear on their own (median duration approximately 7 months) 2
• Emphasize that no FDA-approved screening test exists for oral HPV 2
• Discuss the importance of HPV vaccination for prevention 2
• Encourage regular dental examinations 2
• Advise that partners do not need to be tested for HPV 1

Future Directions

Research is needed in several areas:

• Development of accurate screening tests for oral HPV infection
• Understanding the natural history of oral HPV infection
• Determining the efficacy of HPV vaccines in preventing oral HPV infection and oropharyngeal cancer 1
• Evaluating the potential role of HPV-16 E6 antibodies as markers of oncogenic infection 2

In conclusion, while oral HPV infection is a concern, particularly given the rising incidence of HPV-related oropharyngeal cancer, current evidence does not support routine oral HPV screening in men.