Can Human Papillomavirus (HPV) cause health issues in men?

HPV Can Cause Significant Health Issues in Men

Yes, HPV can cause several serious health issues in men, including genital warts, anal cancer, penile cancer, and oropharyngeal cancers, with increasing incidence rates in recent years. 1

HPV-Related Diseases in Men

Genital Warts

• Most common clinical manifestation of HPV in men 2
• Caused primarily by HPV types 6 and 11 (90% of cases) 3, 4
• Highly infectious with approximately 65% transmission rate to sexual partners 4
• Develop approximately 2-3 months after infection with HPV types 6 or 11 3
• Estimated 1% of sexually active adolescents and adults have clinically apparent genital warts 3
• Can cause psychosocial distress and physical discomfort despite being benign 2

Anal Cancer

• HPV is associated with approximately 90% of anal squamous cell cancers 3
• Incidence has been increasing in the United States, especially among men 3
• Higher risk in men who have sex with men (MSM) and those with HIV infection 3
• Anal intraepithelial neoplasia (AIN) is a precursor to anal cancer 3

Penile Cancer

• Approximately 40% of invasive penile carcinomas are attributable to HPV 2
• HPV types 16,18, and 6/11 are most commonly detected in penile tumors 2
• Risk factors include lack of neonatal circumcision, phimosis, and history of anogenital warts 2
• Basaloid and warty histologic subtypes are most likely to test positive for HPV 2

Oropharyngeal Cancer

• HPV is associated with a subset of oral cancers 5
• Incidence is increasing in the general population and growing faster among immunocompromised individuals 5

Recurrent Respiratory Papillomatosis (RRP)

• Rare disease characterized by recurrent warts in the upper respiratory tract 3
• Primarily caused by HPV types 6 or 11 3
• Can cause extensive morbidity requiring multiple surgeries 3
• Adult-onset form exists but is less well characterized than juvenile-onset 3

Epidemiology and Natural History

• HPV infection is very common in men, with prevalence estimated at 65.2% in asymptomatic males aged 18-70 years 4
• Lifetime number of sexual partners is the most significant risk factor for HPV acquisition 4
• Median time to clearance of HPV infection in men is 5.9 months, with 75% of infections clearing within 12 months 4
• Circumcision has been associated with reduced detection of HPV infection in men 4
• Penile HPV infection remains high throughout a wide range of ages in heterosexual men 5

Prevention and Management

Vaccination

• Quadrivalent HPV vaccine protects against types that cause 90% of genital warts (6 and 11) and 70% of cervical cancers (16 and 18) 3, 6
• Recommended for males through age 21 years and for MSM, people living with HIV/AIDS, and immunocompromised persons through age 26 years 3
• Has been shown to be highly effective in reducing external genital lesions in young men 5, 2

Treatment Options for Genital Warts

• Cryotherapy with liquid nitrogen 3
• Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80-90% 3
• Surgical removal 3
• Podophyllin 10-25% for urethral meatus warts 3
• Imiquimod 3.75% cream (newer formulation) 3

Screening

• No FDA-approved HPV tests for men 6
• HPV testing for men is not clinically useful and is not recommended 6
• Annual digital anorectal examination may be useful for early detection of anal cancer in high-risk populations 3

Important Clinical Considerations

• HPV does not affect fertility or ability to carry a pregnancy to term 3, 6
• Correct and consistent condom use may lower transmission risk but is not fully protective 3, 6
• Treatments are available for conditions caused by HPV but not for the virus itself 3
• Low awareness of HPV in males may be a barrier to prevention efforts 4

HPV-related diseases in men represent a significant health burden that should not be overlooked. Early vaccination before sexual debut offers the best protection against HPV-related diseases in men.