HPV Testing for Men

Routine HPV testing is not recommended for asymptomatic men, and no FDA-cleared HPV test exists for use in males. 1, 2

Current Testing Guidelines

HPV testing should not be performed in immunocompetent asymptomatic men, as the CDC explicitly states that no clinically validated test exists for men to determine if they have HPV infection. 1, 2
All FDA-cleared HPV tests are only approved for cervical specimens, not for oral, anal, penile, or urethral specimens. 1
Testing for low-risk (nononcogenic) HPV types (e.g., types 6 and 11) is not recommended and provides no clinical benefit. 1, 2
HPV testing should not be used to screen male partners of women with HPV, as both partners in ongoing relationships are typically already infected by the time one is diagnosed. 1, 3, 2

The approach differs significantly for men at elevated risk for anal cancer, though routine anal HPV testing is still not recommended:

Annual digital anorectal examination (DARE) should be performed to detect palpable masses in MSM (with or without HIV) who have a history of receptive anal intercourse, and in all persons with HIV infection. 1
Anal cytology screening is not routinely recommended even in high-risk groups, as data are insufficient to demonstrate that screening reduces anal cancer incidence or mortality. 1
If anal cytology screening is performed at specialized centers, it should only be done when high-resolution anoscopy (HRA) and biopsy services are available for follow-up of abnormal results. 1
HPV testing using high-risk HPV types is not clinically useful for anal cancer screening because of the extremely high prevalence of anal HPV infection in these populations (particularly MSM), which would result in excessive false positives. 1
The incidence of anal cancer is highest in MSM with HIV (131 cases per 100,000 person-years), followed by MSM without HIV (14 cases per 100,000 person-years). 1

For immunosuppressed men (e.g., inflammatory bowel disease on immunomodulators, transplant recipients), routine HPV screening is not recommended. 1
Focus should be on HPV vaccination according to national guidelines and clinical surveillance for visible lesions. 1

Visual inspection and clinical diagnosis are the appropriate approaches for men presenting with genital warts or suspicious lesions—not HPV testing. 1, 2
HPV testing should not be used in the management of persons with genital warts or their partners. 1
Both partners should be screened for other sexually transmitted infections when one has genital warts, but not for HPV itself. 3, 2

Do not order HPV testing to determine vaccination eligibility—HPV testing should never be used to decide whether to vaccinate against HPV. 1, 2
Do not test male partners of HPV-positive women—this provides no clinical utility, as partners are typically already infected and most infections clear spontaneously. 1, 2
Do not use urine HPV testing—while some research has explored this, it is not validated or recommended for clinical use in asymptomatic men. 4
Do not assume anal cytology equals cervical cytology—anal cytology has limited sensitivity (55-89%) and specificity (40-67%) for detecting high-grade squamous intraepithelial lesions (HSIL), and its use should be restricted to specialized centers with HRA capability. 1

When discussing HPV with male patients:

Most sexually active persons acquire HPV at some point in their lives, even those with only one lifetime partner. 1
No test can determine when HPV infection was acquired, so a diagnosis does not indicate recent sexual activity or infidelity. 1, 3
The most common manifestation of HPV in men is genital warts, caused primarily by HPV types 6 and 11. 1, 5
Condoms reduce but do not eliminate HPV transmission, as the virus can infect skin areas not covered by condoms. 1, 3, 2
HPV vaccination is recommended for males aged 9-26 years (routine through age 21, permissive through age 26), with routine vaccination for MSM and HIV-positive men through age 26. 5