What are the guidelines for Human Papillomavirus (HPV) testing in males?

HPV Testing in Males

Routine HPV testing is not recommended for men, as there is no FDA-cleared or clinically validated HPV test for males, and the CDC explicitly advises against screening men for HPV. 1, 2

Why HPV Testing Is Not Performed in Men

• No validated test exists: FDA-cleared HPV tests are only approved for cervical specimens, not for penile, anal, or oral specimens in routine screening contexts 1
• No clinical utility for screening: The CDC states that HPV tests should not be used to screen men or partners of women with HPV 2
• Most infections are transient: The majority of HPV infections in men clear spontaneously without causing health problems 2
• Shared infection in partnerships: Within ongoing sexual relationships, both partners are typically already infected by the time one person is diagnosed, making partner testing clinically meaningless 1, 2

Clinical Manifestations to Monitor Instead

Rather than testing for HPV, focus on:

• Visual examination for genital warts: The most common manifestation of HPV in men is genital warts, which should be diagnosed clinically 1, 2
• Screen for other STDs: If genital warts or HPV-related conditions are present, screen both partners for other sexually transmitted infections 2

Special Populations Where Screening May Be Considered

High-Risk Groups (Limited Evidence)

While not part of standard guidelines, emerging research suggests potential benefit in:

• HIV-positive men: Anal cytology (anal Pap tests) should be considered for HIV-infected MSM, women with receptive anal intercourse history, or those with genital warts, but only in settings where high-resolution anoscopy follow-up is available 1
• Men who have sex with men (MSM): Anal cancer screening with anal cytology may be useful in HIV-positive MSM (80-131 cases per 100,000 person-years) and HIV-negative MSM (14 cases per 100,000 person-years), though data remain insufficient for routine screening recommendations 1

Important Caveats for Anal Screening

• Weak recommendation: Even for high-risk groups, anal Pap testing carries only a weak recommendation with moderate quality evidence 1
• Requires specialized follow-up: Anal cytology should only be performed where high-resolution anoscopy is available for abnormal results 1, 3
• Annual digital anorectal examination (DARE): May be useful to detect palpable masses in HIV-infected persons 1

What NOT to Do

Avoid these common pitfalls:

• Do not test for low-risk HPV types (types 6 and 11): This provides no clinical benefit 1, 2
• Do not use HPV testing to decide on vaccination: Testing should not guide vaccination decisions 1, 2
• Do not test oral specimens: HPV tests are not validated for oral use 1, 2
• Do not screen men under age 25: Even in high-risk populations, routine screening is not recommended for younger men 1

Prevention Strategies to Emphasize Instead

Since testing is not recommended, focus counseling on:

HPV Vaccination

• All males aged 9-21 years should receive HPV vaccination (strong recommendation) 1
• Males aged 22-26 years should be vaccinated if not previously vaccinated 1
• HIV-infected males should receive the three-dose series regardless of age (9-26 years) 1, 4

Risk Reduction Counseling

• Condom use: Consistent condom use may reduce transmission risk, though HPV can infect areas not covered by condoms 1, 2
• Reassurance about transmission: Detection of HPV does not indicate infidelity, as infection can be present for years before detection and most sexually active adults acquire HPV at some point 1, 2
• Partner notification: While not required, informed discussion with partners may be beneficial for some patients 1