What methods are used to test for Human Papillomavirus (HPV) in males?

HPV Testing in Males

Currently, the CDC does not recommend routine HPV testing in men as there is no standardized protocol or established screening pathway shown to reduce morbidity or mortality through early HPV detection. 1

Current Testing Recommendations

• No FDA-approved HPV test exists specifically for men 2
• HPV tests should not be used to screen:
  • Men
  • Partners of women with HPV
  • For health conditions other than cervical cancer 3

Why HPV Testing Is Not Recommended in Men

1. Lack of clinical utility:

   • No validated clinical management protocols exist for HPV-positive men 1
   • Most HPV infections in men clear spontaneously without causing health problems 1
   • A negative test result would not rule out HPV infection due to sampling limitations and the transient nature of detectable infection 1

2. Technical challenges:

   • Sampling is difficult due to the anatomical structure of male genitalia
   • HPV detection rates vary significantly based on sampling techniques and sites tested 4
   • No standardized sampling method has been established for clinical use

Special Populations Where Testing May Be Considered

While routine testing is not recommended, certain high-risk 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, 5
  • Should be considered in settings where appropriate follow-up including high-resolution anoscopy is available 5

• HIV-infected men:

  • At increased risk for anal dysplasia and cancer
  • Should have anal Pap tests if they have genital warts 1

Clinical Evaluation of HPV in Men

Instead of HPV testing, clinical evaluation focuses on:

• Visual inspection for genital warts or suspicious lesions
• For men with anal and/or intra-anal warts:
  • Digital examination
  • Standard anoscopy
  • High-resolution anoscopy may be beneficial 3

Research on HPV Detection Methods in Men

Though not recommended clinically, research has explored various sampling methods:

• Most effective sampling technique: Emery paper abrasion followed by saline-wetted Dacron swab (45% beta-globin detection rate vs. 23% for swab alone) 4
• Multiple site sampling increases detection rates:
  • Penile shaft (24% detection)
  • Glans (16%)
  • Foreskin (28%)
  • Scrotum (17%)
  • Urine (6%) 4

Prevention Strategies

Since testing is not recommended, prevention becomes paramount:

• HPV vaccination for males aged 9-21 years, and for those aged 22-26 years if not previously vaccinated 1
• Consistent condom use can lower transmission risk, though not fully protective 1
• Limiting sexual partners reduces exposure risk 1

Common Pitfalls to Avoid

• Do not use HPV testing as a screening tool for the male partners of women with HPV
• Do not assume that a negative HPV test in men rules out infection
• Do not use urethral smears for routine HPV screening despite some research suggesting their potential 6
• Remember that HPV prevalence is similar in circumcised and uncircumcised men, so circumcision status should not affect clinical decision-making 4