How to Determine if a Male Has HPV
There is no FDA-approved or clinically validated HPV test for men, and the CDC explicitly recommends against routine HPV screening in males. 1, 2
Why HPV Testing Is Not Performed in Men
The absence of male HPV screening is based on several key factors:
No validated diagnostic test exists: All FDA-cleared HPV tests are designed exclusively for cervical specimens and have not been validated for penile, anal, or oral samples in routine screening contexts. 1, 2
Most infections are transient and asymptomatic: The majority of HPV infections in men clear spontaneously without causing health problems, making screening of limited clinical benefit. 3, 1
Infection is often already shared: Within an ongoing sexual relationship, both partners are usually already infected by the time one person is diagnosed, even when signs are not apparent. 3, 2
Clinical Diagnosis Instead of Laboratory Testing
The primary method to identify HPV in men is visual examination for genital warts, which are the most common manifestation of HPV infection in males. 3, 1
- Genital warts should be diagnosed by direct clinical examination rather than laboratory testing. 1
- High-risk oncogenic HPV types (16,18) rarely produce visible warts, so absence of warts does not rule out infection. 1
- If genital warts are present, both partners should be screened for other sexually transmitted infections. 3, 1
Special Populations Where Screening May Be Considered
While routine screening is not recommended for most men, specific high-risk populations may benefit from anal cytology screening:
HIV-Positive Men
- Annual anal cytology (anal Pap test) is recommended for all HIV-infected men regardless of sexual practices, given their anal cancer incidence of 40-60 cases per 100,000 person-years. 1
- Screening should only be performed where high-resolution anoscopy (HRA) is available for follow-up of abnormal results. 1, 4
Men Who Have Sex with Men (MSM)
- HIV-positive MSM have dramatically elevated anal cancer risk at 80-131 cases per 100,000 person-years compared to 1-2 cases per 100,000 in the general male population. 1
- HIV-negative MSM with receptive anal intercourse have an incidence of approximately 14 cases per 100,000 person-years. 1
- Annual digital anorectal examination (DARE) is recommended for MSM with a history of receptive anal intercourse to detect palpable masses. 1
Immunocompromised Men
- Men receiving chronic immunosuppressive therapy (organ transplant recipients, long-term corticosteroid users) should be managed similarly to HIV-positive patients with consideration of anal cytology screening. 1
Prevention Strategies to Emphasize
Since testing is not available or recommended, prevention through vaccination is the primary strategy:
- 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 within the 9-26 year range. 1
- Either quadrivalent (4vHPV) or 9-valent (9vHPV) vaccine is recommended. 1
Critical Counseling Points
When discussing HPV with male patients, emphasize these key messages:
- Detection of HPV in a partner does not indicate infidelity, as HPV can persist for years before detection and most sexually active adults acquire HPV at some point. 3, 2
- Consistent condom use may reduce transmission risk, though HPV can infect areas not covered by condoms. 3, 2
- No antiviral treatment exists to eradicate HPV infection itself; only HPV-associated lesions like genital warts can be treated. 1
Common Pitfalls to Avoid
- Do not order HPV testing for asymptomatic men or partners of women with HPV—no validated test exists and it provides no clinical benefit. 3, 2
- Do not use HPV testing to decide whether to vaccinate—vaccination should not be withheld based on presumed prior exposure. 1
- Do not perform anal cytology without access to high-resolution anoscopy for appropriate follow-up of abnormal results. 1, 4