Signs of Male Genital HPV Infection

Most HPV infections in men are completely asymptomatic and have no visible signs or symptoms. 1, 2

Clinical Manifestations When Present

Visible genital warts are the most common clinical manifestation of HPV infection in men, caused by HPV types 6 and 11 in over 90% of cases 1, 3
Appear as small, cauliflower-like growths on the penis, scrotum, perineum, and perianal skin 1, 2
Can occur on the urethra, anus, and mouth, though less commonly 1
May be painful, friable (easily bleeding), or pruritic (itchy), though commonly asymptomatic 1
Highly infectious—approximately 65% of sexual partners of infected individuals will develop warts themselves 3

External genital areas: Penis, vulva, scrotum, perineum, and perianal skin are most commonly affected 1
Intra-anal warts: Seen predominantly in men who have had receptive anal intercourse, distinct from perianal warts which can occur without anal sex history 1
Urethral meatus: Warts can develop at the urethral opening 1
Oral cavity: Less common but possible with HPV types 6 and 11 1

HPV types 16,18,31,33, and 35 rarely cause visible warts but are associated with penile, anal, and oral cancers 1
May present as penile intraepithelial neoplasia: squamous cell carcinoma in situ, bowenoid papulosis, Erythroplasia of Queyrat, or Bowen's disease 1
Approximately 40% of invasive penile carcinomas are attributable to HPV 4
Lesions that are pigmented, indurated, fixed, and ulcerated warrant biopsy to rule out malignancy 1

No clinically validated test exists for men to determine if they have HPV infection 1
There is currently no FDA-approved test for HPV detection in men 5
Diagnosis of genital warts is typically clinical, based on visual inspection 1
Biopsy is only needed when: diagnosis is uncertain, lesions don't respond to standard therapy, disease worsens during therapy, patient is immunocompromised, or warts are pigmented/indurated/fixed/ulcerated 1

Genital HPV infection is very common in men, with prevalence estimated at 65.2% in asymptomatic males aged 18-70 years 3
Most sexually active adults will get HPV at some point in their lives, though most will never know it 1
Most HPV infections in men clear within one year—median time to clearance is 5.9 months, with 75% clearing within 12 months 5, 3
HPV infections may be less likely to persist in men than in women 3

The absence of visible signs does not mean absence of infection—most infections are subclinical 1, 5
HPV can be transmitted even when no visible signs or symptoms are present 2, 5
Different HPV types have different clinical significance: types causing genital warts (6,11) differ from those causing cancers (16,18,31,33,35) 1, 5
A diagnosis of HPV in one partner is not indicative of sexual infidelity, as infection could have been acquired years earlier 1, 5
HPV infection may persist in a dormant state and become infectious intermittently throughout a patient's lifetime 5

Lifetime number of sexual partners is the most significant risk factor for HPV acquisition 3
Lack of neonatal circumcision and phimosis are strongly associated with penile cancer risk 4
Immunosuppression increases risk of persistent infection and clinical manifestations 1