What are the recommendations for Human Papillomavirus (HPV) testing in men?

HPV Testing in Men: Current Guidelines and Recommendations

Currently, routine HPV testing is not recommended for men as there is no FDA-approved test and no established screening pathway shown to reduce morbidity or mortality in men through early HPV detection. 1

Current Guidelines for HPV Testing in Men

• The Centers for Disease Control and Prevention (CDC) explicitly recommends against using HPV tests to screen men, partners of women with HPV, or for health conditions other than cervical cancer 1
• No HPV test for men has been approved by the FDA, nor has any test been approved for detection of the virus in areas other than the cervix 2
• Most HPV infections in men clear spontaneously without causing health problems, and there are no validated clinical management protocols for positive results 1

Special Populations Where Limited Testing May Be Beneficial

While routine testing is not recommended for the general male population, certain high-risk groups may benefit from targeted screening:

• Men who have sex with men (MSM), particularly those who are HIV-positive, may benefit from targeted screening with anal cytology (anal Pap tests) rather than direct HPV testing 1, 3
• 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 4
• For men with anal and/or intra-anal warts, digital examination, standard anoscopy, and high-resolution anoscopy may be beneficial 1

Prevention Strategies for Men

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

• HPV vaccination is recommended for:

  • All males aged 9-21 years 4, 1
  • Males aged 22-26 years if not previously vaccinated 4, 1

• Risk reduction measures:

  • Consistent condom use (though not fully protective) 1
  • Limiting sexual partners 1
  • Smoking cessation 5
  • Male circumcision may play a role in prevention 5

Clinical Implications and Patient Counseling

When discussing HPV with male patients:

• Explain that most sexually active adults will contract HPV at some point, though most infections are asymptomatic 1
• Within ongoing sexual relationships, both partners are usually infected by the time one person is diagnosed 1
• A diagnosis of HPV in one partner is not indicative of sexual infidelity 1
• 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

Why Testing Men Is Not Currently Recommended

• Lack of validated clinical management protocols for positive results 1
• No established screening pathway shown to reduce morbidity or mortality 1
• Most infections clear spontaneously without causing health problems 1
• The transient nature of HPV infection makes single-point testing of limited value 1

Future Considerations

Research suggests that prevention and treatment of HPV in men could benefit both men and women due to the high partner concordance for HPV 5, 6. Some studies indicate that male partners of women with HPV infection have infection rates ranging from 47-49%, with over 60% carrying high-risk virus types 6. However, until validated tests and management protocols are established, routine testing remains unsupported by current guidelines.