HPV Testing in Males: Sample Collection Methods
HPV testing in males is primarily conducted using penile swab samples, as this is the most effective method for detecting HPV DNA. 1
Recommended Sample Collection Methods
- Penile swab samples are the method of choice for HPV detection in men, with emery paper abrasion followed by a saline-wetted Dacron swab showing the highest detection rates 1
- Multiple anatomical sites should be sampled to increase detection sensitivity, including penile shaft (24% positivity), glans (16%), foreskin (28% in uncircumcised men), and scrotum (17%) 1
- Urine samples alone are not comparable to penile swabs in HPV detection, showing only 41% sensitivity compared to penile swabs 2
Current Guidelines and Recommendations
- The CDC does not recommend routine HPV testing in immunocompetent men 3
- HPV tests are not useful for screening men, partners of women with HPV, or for conditions other than cervical cancer 4
- No clinically validated test exists for men to determine if they have HPV infection; the most common manifestation in men is genital warts 4
Special Populations and Considerations
- HPV screening, including anal cytology, may be beneficial for high-risk populations such as men who have sex with men and men who test positive for HIV 3
- Testing should be considered for these high-risk groups only in settings where appropriate follow-up, including high-resolution anoscopy, is available 3
- Sexual partners of women with sexually transmitted diseases may benefit from HPV testing even when asymptomatic 5
Testing Methods and Limitations
- FDA-cleared HPV tests detect viral DNA or messenger RNA but are only cleared for use with cervical specimens, not oral or anal specimens 4
- Testing for non-oncogenic HPV types (e.g., types 6 and 11) is not recommended 4
- HPV prevalence in men varies significantly due to sampling techniques and detection methods 6
- The most widely used detection techniques include reverse line blot (RLB) and hybrid capture (HC) 6
Improving Detection Rates
- Using emery paper (600A-grit) abrasion followed by a saline-wetted Dacron swab significantly improves sample quality, with 45% of samples positive for beta-globin compared to 23% with swab alone 1
- Combining urine samples with penile swabs may be useful in epidemiological or clearance studies, as 5% of urine samples detected high-risk HPV types not found in matching swabs 2
- Sampling multiple anatomical sites increases detection rates significantly 1
Common Pitfalls to Avoid
- Relying solely on urine samples for HPV detection in men will miss approximately 59% of infections compared to penile swabs 2
- Using inappropriate sampling techniques (like cytobrush alone) may result in inadequate sample collection 1
- Testing for low-risk HPV types (6 and 11) provides no clinical benefit and should be avoided 4
- HPV testing should not be used to decide whether to vaccinate against HPV 4