What are the health effects of Human Papillomavirus (HPV) in men?

What HPV Does to Men

HPV causes genital warts, penile cancer, anal cancer, oropharyngeal cancer, and recurrent respiratory papillomatosis in men, with infection rates remaining consistently high (approximately 40%) across all adult age groups.

Infection Prevalence and Natural History

• HPV infection is extremely common in sexually active men, with cumulative incidence of 29-40% over just 12 months 1
• Unlike women, infection rates in men remain constant across age groups at approximately 39-41% across ages 18-70 years 1
• Most HPV infections in men clear within 5.9 months (median), with 75% clearing within 12 months 2
• No clinically validated test exists for men to determine if they have HPV infection 1

Major Disease Manifestations

Genital Warts

• Approximately 90% of genital warts are caused by HPV types 6 and 11 1
• About 1% of sexually active men have clinically apparent genital warts at any given time 1
• Warts typically develop 6-10 months after infection (range up to 18 months) 1
• While 20-30% regress spontaneously, recurrence occurs in approximately 30% even after treatment 1
• Genital warts are highly infectious—approximately 65% of people who have sex with an infected partner will develop warts themselves 2

Penile Cancer

• HPV is responsible for approximately 50.8% of penile cancers globally and 79.8% of penile intraepithelial neoplasia (PeIN) 3
• HPV types 16,18, and 6/11 are most commonly detected in penile tumors 4
• Basaloid and warty histologic subtypes are most likely to test positive for HPV 4
• More than 80% of HPV-related cancers in men are caused by HPV16 and 18 1

Anal Cancer

• HPV is associated with approximately 90% of anal squamous cell cancers 1
• The incidence varies dramatically by risk group 1:
  • General male population: 1.3 per 100,000
  • HIV-positive men who have sex with men (MSM): 85 per 100,000 person-years
  • HIV-positive heterosexual men: 32 per 100,000 person-years
  • HIV-negative MSM: 19 per 100,000 person-years
• Anal HPV infection and anal intraepithelial neoplasia are very common throughout a wide age range in both HIV-negative and HIV-positive MSM 5

Oropharyngeal Cancer

• Oropharyngeal HPV infection prevalence is dramatically higher in men than women (10.1% vs 3.6%) 1
• HPV is responsible for 63-72% of oropharyngeal cancers, with higher rates in males (72%) than females (63%) 1
• HPV types 16 and 58 account for 70% and 12% of oropharyngeal cancers respectively 1
• The incidence of HPV-related head and neck cancer has increased 181% in recent decades 1
• Risk factors include higher number of lifetime oral-sexual partners, concurrent genital HPV infections, older age, and current smoking intensity 1

Recurrent Respiratory Papillomatosis (RRP)

• HPV types 6 or 11 rarely cause recurrent respiratory papillomatosis, characterized by recurrent warts in the upper respiratory tract, particularly the larynx 1
• Juvenile-onset RRP has an estimated incidence of 0.12 to 2.1 cases per 100,000 children aged <18 years 1
• The disease is believed to result from vertical transmission during delivery, though median age of diagnosis is 4 years 1
• Patients require a median of 13 lifetime surgeries to remove warts and maintain an open airway 1

Prevention Through Vaccination

• The quadrivalent HPV vaccine has demonstrated 90% efficacy in preventing HPV-related cancers and 77.5% efficacy in reducing anal intraepithelial neoplasia 3
• Vaccination is strongly recommended for specific high-risk groups aged 9-26 years, including HIV-infected patients, MSM, and patients with immunocompromising conditions 6
• HPV vaccination can prevent up to 90% of HPV-related cancers 1

Critical Clinical Pitfalls

• Unlike cervical cancer, there are no standardized screening recommendations for most HPV-related cancers in men, making prevention through vaccination particularly important 1
• Partners in long-term relationships tend to share HPV, and sexual partners of HPV-infected patients also likely have HPV, even without signs or symptoms 1
• Clinicians should be aware of the importance of intra-anal manifestations of HPV infection in MSM and HIV-infected men, given the association with anal dysplasia 6
• Low awareness of HPV in males remains a significant barrier to vaccine uptake and disease prevention 2