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Most sexually active people will get the human papillomavirus (HPV) at some point in their life, making it the most common sexually transmitted infection (STI). It is spread by oral, anal, or vaginal sex, but you can also get HPV through non-sexual skin-to-skin contact if you have a cut or small tear in your skin. HPV is usually harmless and resolves on its own; however, some strains have been linked to cancers, genital warts, and skin conditions like common warts and plantar warts.
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How do men get HPV?
Men can get HPV the same way as women — through any type of sexual contact or non-sexual skin-to-skin contact with someone infected with HPV. Even if there are no signs or symptoms of the virus, you or your partner can still be contagious.
What are the risk factors for HPV?
Several risk factors make it more likely for you to get an HPV infection:
- Age—common warts are seen more often in children, and genital warts appear in sexually active young adults in their teens and early 20s.
- Multiple sexual partners—the more sexual partners you have, the more likely you are to get HPV.
- Weak immune systems—conditions that weaken the immune system, like HIV/AIDS and certain medications, decrease your body’s ability to fight off an HPV infection.
- Damaged skin—healthy skin barriers are essential in protecting against HPV; skin that is punctured or injured increases the risk of developing warts.
- Personal contact—you can get infected if you come into contact with someone else’s warts.
The HPV vaccine: how it works and who it’s for
What are the symptoms of HPV in men?
Most of the time, men infected with HPV have no symptoms. Sometimes symptoms don’t develop until months or years after infection, or they don’t appear until serious health problems arise. The symptoms of HPV vary depending on the strain of the virus.
- Genital warts—bumps that grow in the genital area; they can be small or large, raised or flat, or shaped like a cauliflower. They may itch, bleed, or feel somewhat tender, but they are not usually painful. Genital warts appear on the penis, scrotum, around the anus in men. According to the CDC, about 1% of sexually active adults have genital warts at any given time (CDC, 2017). HPV types 6 and 11 cause approximately 90% of all genital warts (CDC-a, 2018).
- Common warts—raised bumps on hands and fingers; they feel rough and are not typically painful.
- Plantar warts—flesh-colored hard growths on the soles (bottoms) of your feet; they can be uncomfortable.
- Flat warts—flat, raised lesions that can form anywhere, usually in areas prone to skin injuries, like razor nicks and cuts. Flat warts are often seen in beard areas of men. Teens and children get these types of warts on the face.
There is no evidence that HPV is spread by touching hard surfaces, like toilet seats or by sharing clothing.
Treatment for HPV in men
For most men, HPV infections go away on their own within a few years. Unfortunately, there is no cure for the virus itself; the available treatments are aimed at the symptoms of HPV, such as warts, and include:
- Medications—trichloroacetic acid, podofilox, salicylic acid, imiquimod.
- Cryotherapy—liquid nitrogen is used to freeze warts.
- Laser therapy—uses a laser to remove warts or abnormal tissue.
- Electrocautery—warts are removed using the heat from an electrical current.
Since there is no treatment for HPV, prevention is key. Wearing a condom during sex decreases the risk of transmission; however, any infected skin not covered by the condom is still contagious. The best way to prevent HPV infections is to get the HPV vaccine; this is not just for women. It protects men against the nine strains most commonly implicated in HIV-related cancers and genital warts: 6, 11, 16, 18, 31, 33, 45, 52, and 58 (high-risk HPV). The FDA has approved routine HPV vaccine administration for boys as young as 9 up through age 26. Even if you are aged 27-45 years (Meites, 2019) and are not adequately vaccinated, you should talk to your healthcare provider; together, you will decide whether the vaccine is right for you.
HPV or human papillomavirus: everything you need to know
HPV-related cancers in men
If you are infected with one of the “high-risk” strains of HPV, you are at increased risk of certain types of cancer. Oropharyngeal, anal, and penile cancers are the most common HPV-associated cancers in men (CDC-a, 2019).
Oropharyngeal cancers come from having oral HPV and affect the back of the throat, including the base of the tongue and tonsils; about 10% of men and 3.6% of women have oral HPV (CDC-b, 2018). Oropharyngeal cancer is the most common HPV-related cancer in men with over 15,000 new cases each year (CDC-a, 2019). Data shows that 60-70% of oropharyngeal cancers (CDC-a, 2019) are linked to HPV infection; HPV type 16 causes most of the cases of oropharyngeal cancer. Fortunately, of the 26 million Americans (OCF, 2019) who have oral HPV at any one time, only a small percentage have HPV type 16.
Anal HPV can lead to anal cancer, especially if it is one of the “high-risk” types; over 90% of all cases (ACF, n.d.) of anal cancers are linked to HPV infection. Anal cancer affects the skin around and just inside the anus; it is not the same as rectal cancer. Approximately 2,000 men in the U.S. are affected by anal cancer each year (CDC-a, 2019).
Penile cancer is another HPV-related cancer; approximately 50% of penile cancers are caused by HPV (ACS, 2018). Fortunately, it is very rare with only around 1,300 cases in the U.S. each year (CDC-b, 2019).
Testing for HPV in men
There is no routine FDA-approved test for HPV in men. However, for men with HIV or men who receive anal sex, it may be appropriate to perform an anal Pap test as these groups are at increased risk for anal cancer. In a Pap test, your healthcare provider collects a sample of cells from your anus and sends them to be examined under a microscope. If any abnormal changes are seen, additional testing may be needed.
Is there an HPV test for men? Yes. But it’s not so useful
Will having HPV affect my partner?
If you or your partner are experiencing any new growths or sores on the scrotum, penis, anus or throat, talk to your healthcare provider and avoid having sex until they are gone. Sexual partners who have been together for a long time may share HPV, and it is nearly impossible to determine how or when the infection originated. Having HPV does not mean that your partner has been having sex outside of your relationship. It is vital to keep an open and honest dialog with your partner about any possible STIs either of you may experience.
- American Cancer Society (ACS). (2018). Risk Factors for Penile Cancer. Retrieved September 9, 2019 from https://www.cancer.org/cancer/penile-cancer/causes-risks-prevention/risk-factors.html
- Anal Cancer Foundation (ACF). (n.d.). What is HPV cancer? Symptoms, causes, & treatment. Retrieved Sep. 9, 2019 from https://www.analcancerfoundation.org/about-hpv/hpv-cancer/
- Centers for Disease Control and Prevention (CDC). (2017). Genital HPV Infection – CDC Fact Sheet. Retrieved Sep. 9, 2019 from https://www.cdc.gov/std/hpv/HPV-FS-July-2017.pdf
- Centers for Disease Control and Prevention (CDC-a). (2018). 2017 Sexually Transmitted Diseases Surveillance. Retrieved Sep. 9, 2019 from https://www.cdc.gov/nchhstp/newsroom/2018/2017-std-surveillance-report.html
- Centers for Disease Control and Prevention (CDC-b). (2018). HPV and Oropharyngeal Cancer. Retrieved Sep. 9, 2019 from https://www.cdc.gov/cancer/hpv/basic_info/hpv_oropharyngeal.htm
- Centers for Disease Control and Prevention (CDC-a). (2019). How Many Cancers Are Linked with HPV Each Year? Retrieved from https://www.cdc.gov/cancer/hpv/statistics/cases.htm
- Centers for Disease Control and Prevention (CDC-b). (2019). HPV – Associated Cancer Statistics. Retrieved Sep. 9, 2019 from https://www.cdc.gov/cancer/hpv/statistics/
- Meites, E., Szilagyi, P. G., Chesson, H. W., et al. (2019). Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR. Morbidity and Mortality Weekly Report, 68(32), 698–702. doi: 10.15585/mmwr.mm6832a3. Retrieved from https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm
- The Oral Cancer Foundation. (2019). HPV / Oral Cancer Facts. Retrieved Sep. 5, 2019 from https://oralcancerfoundation.org/understanding/hpv/hpv-oral-cancer-facts/
Dr. Tzvi Doron is Board Certified in Family Medicine by the American Board of Family Medicine and is Ro's Chief Clinical Officer.