What should a male partner do if his female partner tests positive for Human Papillomavirus (HPV) and they are having unprotected sex, if he is asymptomatic?

Management of Male Partners When Female Partners Test Positive for HPV

Male partners of women who test positive for HPV do not require routine testing, but should consider consistent condom use and HPV vaccination if eligible. 1

Understanding HPV in Sexual Partnerships

• HPV is extremely common among sexually active individuals, with most people acquiring at least one HPV infection during their lifetime 1
• Sexual partners in long-term relationships tend to share HPV infections, meaning male partners of HPV-positive women are likely already infected, even without symptoms 1
• HPV infections are often asymptomatic in men, with the most common manifestation being genital warts (though high-risk HPV types rarely cause warts) 1
• Currently, there is no clinically validated test for HPV in asymptomatic men 1

Recommended Actions for Male Partners

Testing

• Routine HPV testing is not recommended for asymptomatic male partners of HPV-positive women 1, 2
• The CDC does not recommend routine screening for HPV in immunocompetent men 2
• Exception: Men who have sex with men and HIV-positive men may benefit from screening, including anal cytology, where appropriate follow-up is available 2

Prevention Measures

• Consistent condom use is recommended as it can:

  • Reduce the risk of cervical and vulvovaginal HPV infection 1
  • Decrease the time required to clear HPV in infected female partners 1
  • Note: Skin not covered by condoms remains vulnerable to HPV infection 1

• HPV vaccination should be considered for eligible male partners:

  • The quadrivalent vaccine (Gardasil) can prevent genital warts in men 1
  • Vaccination of men benefits both the men themselves and their female partners by reducing transmission 3

Important Considerations

• HPV infection can persist for many years before detection, and no method can accurately determine when the infection was acquired 1
• Detection of HPV in a woman does not indicate infidelity or sexual activity outside the relationship 1
• Studies show high concordance of HPV types between sexual partners, with one study finding 56.5% of couples sharing at least one viral type 4
• HPV-infected men serve as an important reservoir for transmission to women, potentially contributing to maintenance of infection and higher risk of cervical cancer 4

Common Misconceptions and Pitfalls

• Partner notification limitations: While communication between partners about HPV status can foster support and informed decision-making, partner notification has limited utility in preventing HPV transmission 5
• Unnecessary medical visits: Many providers incorrectly advise women to tell their partners to see a clinician (48-73% across specialties), despite lack of evidence supporting clinical evaluation of asymptomatic male partners 5
• Ping-pong effect concerns: Some worry about reinfection between partners, but since partners likely already share infections and most HPV infections clear naturally, this concern is often overstated 6

Clinical Approach Summary

1. Reassure that HPV is extremely common and usually clears on its own
2. Recommend consistent condom use to reduce transmission risk and potentially speed clearance
3. Consider HPV vaccination for eligible male partners
4. No routine HPV testing needed for asymptomatic male partners
5. Encourage open communication between partners about HPV status