Treatment Approach for Men with Human Papillomavirus (HPV)
The primary treatment for men with HPV focuses on removing visible genital warts to alleviate symptoms, as there is no cure for the HPV infection itself. 1
Understanding HPV in Men
- HPV infection is extremely common, with an estimated prevalence of 65.2% in asymptomatic males aged 18-70 years 2
- More than 90% of genital warts are caused by non-oncogenic HPV types 6 and 11 2
- HPV infections may clear more quickly in men than women, with a median clearance time of 5.9 months and 75% of infections clearing within 12 months 2
- Without treatment, genital warts may resolve spontaneously (20-30% within 3 months), remain unchanged, or increase in size/number 1
Treatment Goals
- The primary goal is removal of visible warts and amelioration of symptoms, not eradication of HPV 1
- Treatment can induce wart-free periods but does not eliminate the virus 1
- No evidence indicates that treating genital warts reduces the risk of cervical cancer development 1
- It remains unclear whether treatment reduces future HPV transmission 1
Treatment Selection Factors
Treatment should be guided by:
- Patient preference 1
- Wart characteristics (size, number, location, morphology) 1
- Cost and convenience 1
- Potential adverse effects 1
- Provider experience 1
Treatment Options
Patient-Applied Therapies
Podofilox 0.5% solution:
- Apply twice daily for 3 days, followed by 4 days of no therapy
- May repeat for up to 4 cycles
- Total wart area treated should not exceed 10 cm²
- Contraindicated during pregnancy 1
Imiquimod 5% cream:
- Apply 3 times per week for up to 16 weeks
- Treatment should continue until warts clear or maximum treatment period reached
- Wash treatment area with mild soap 6-10 hours after application
- Acts by inducing interferon and other cytokines 3
Provider-Applied Therapies
Cryotherapy with liquid nitrogen:
- First-line treatment option for many wart types
- Relatively inexpensive and does not require anesthesia
- Minimal scarring when performed properly 1
Trichloroacetic acid (TCA) 80-90%:
- Apply only to warts
- Powder with talc or sodium bicarbonate to remove unreacted acid
- Repeat weekly if necessary 1
Surgical removal options:
- Electrodesiccation/electrocautery
- Surgical excision
- Carbon dioxide laser therapy
- Reserved for extensive or refractory warts 1
Treatment Considerations
- Most genital warts respond within 3 months of therapy 1
- Change treatment modality if no substantial improvement after a complete course or if side effects are severe 1
- Recurrence rates are high (at least 25% within 3 months) with all treatment modalities 1
- Warts on moist surfaces or in intertriginous areas respond best to topical treatments 1
Special Considerations
HIV-Infected Men
- HIV-infected individuals may have larger or more numerous warts
- May not respond as well to therapy and experience more frequent recurrences
- Higher risk for squamous cell carcinomas arising in warts 1
Uncircumcised Men
- When treating warts under the foreskin, should retract foreskin and clean area daily 3
- Circumcision has been associated with reduced detection of HPV infection 2
Prevention
- The quadrivalent HPV vaccine (Gardasil) can prevent infection with HPV types that cause 90% of genital warts (types 6 and 11) 1
- Recommended for males aged 9-26 years, even if already diagnosed with HPV 1
- Consistent condom use may reduce but not eliminate transmission risk, as HPV can infect areas not covered by condoms 1
Patient Counseling Points
- New warts may develop during therapy as treatment is not a cure 3
- Sexual contact should be avoided while treatment cream is on the skin 3
- Imiquimod may weaken condoms and vaginal diaphragms 3
- Most recurrences result from reactivation of subclinical infection rather than reinfection by a partner 1
- HPV diagnosis does not necessarily indicate sexual infidelity in a relationship 1