HPV Infection in Men

Much of the information about HPV virus (human papillomavirus) centers on women, since having the virus increases their risk of getting cervical cancer. But HPV virus in men can cause health problems, too. So it's important for men to understand how to reduce the risks of HPV infection.

It can increase a man's risk of getting genital cancers, although these cancers are not common. HPV can also cause genital warts in men, just as in women.

More than half of men who are sexually active in the United States will have HPV at some time in their life. Often, a man will clear the virus on his own, with no health problems.

Some of the 30 or so types of HPV associated with genital cancers can lead to cancer of the anus or penis in men. Both of these cancer types are rare. In those with a healthy immune system, they are even rarer. About 1,530 men in the U.S. were diagnosed with cancer of the penis in 2006, according to American Cancer Society estimates. About 1,910 men got a diagnosis of anal cancer.

The risk of anal cancer is about 17 times higher in sexually active gay and bisexual men than in men who have sex only with women. Men who have HIV (human immunodeficiency virus) are also at higher risk of getting this cancer.

Other types of HPV virus rarely cause cancer in men, but they do cause genital warts. At a given point in time, about 1% of sexually active men in the U.S. will have genital warts.

The types of high-risk HPV that can cause cancer rarely present any symptoms in men or in women. Genital warts are the first symptom you may see with low-risk HPV strains that cause warts but not cancer.

To diagnose genital warts in men, the doctor will visually check a man's genital area to see if warts are present. Some doctors will apply a vinegar solution to help identify warts that aren't raised and visible. But the test is not foolproof. Sometimes normal skin is mistakenly identified as a wart.

There is no routine test for men to check for high-risk HPV strains that can cause cancer. However, some doctors are urging anal Pap tests for gay and bisexual men, who are at higher risk of anal cancer caused by HPV. In an anal Pap test, the doctor collects cells from the anus, and then has them checked for abnormalities in a lab.

There is no treatment for asymptomatic HPV infection. Instead, doctors treat the health problems that are caused by the HPV virus.

When genital warts appear, a variety of treatments can be used. The patient can apply prescription creams at home. Or a doctor can surgically remove or freeze off the warts.

Early treatment of warts is discouraged by some doctors because genital warts can go away on their own. It can also take time for all warts to appear. So a person who treats warts as soon as they appear may need another treatment later on.

Anal cancer can be treated with radiation, chemotherapy, and surgery. The specific treatments depend on the stage of cancer - how big the tumor is and how far the cancer has spread.

The HPV vaccine Gardasil, approved for use in women in 2006, is not yet approved for men.

Studies are still being done to determine if the vaccine works in males. Eventually, public health experts say, boys and men may be vaccinated.

If a man's long-term sexual partner has HPV, chances are good HPV transmission has already occurred and he also has it. HPV in men may clear from the body more easily than in women. Women, in general, often clear the virus in two years or less.

The HPV types associated with cervical cancer usually do not cause health problems for a heterosexual man having sex with an HPV-infected woman.

If a partner has HPV, it does not necessarily mean they have had sex with someone else recently. The virus can lay dormant in the body for years without causing noticeable symptoms.

Abstinence is the only sure way to prevent HPV transmission. Risk of transmission can be lowered if a person has sex only with one person who is not infected and who is monogamous.

To lower the risk of HPV transmission, men can also limit the number of sex partners and pick partners who have had few or no partners in the past.

Condoms can provide some protection against HPV transmission. But they aren't 100% effective, since HPV is transmitted primarily by skin-to-skin contact. The virus can still infect the skin uncovered by the condom.

In a recent study of young women who had just become sexually active, those whose partners used a condom each time they had sex were 70% less likely to get an HPV infection than were women whose partners used a condom less than 5% of the time.

WebMD Medical Reference

SOURCES: Joel Palefsky, MD, professor of medicine, University of California, San Francisco. CDC: "HPV and Men," and "HPV Vaccine: Questions and Answers." American Social Health Association: "HPV: Genital Warts: Questions & Answers," and ""What Men Should Know." Diane Harper, MD, MPH, professor of community and family medicine and obstetrics and gynecology, Dartmouth Medical School, Hanover, N.H. Joan Walker, MD, gynecologic oncologist, University of Oklahoma Health Sciences Center, Oklahoma City. Winer R. New England Journal of Medicine, June 22, 2006: vol 354: pp 2645-2654.

Reviewed by Louise Chang, MD on April 24, 2007

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