HPV is the most common sexually transmitted infection globally, transmitted through intimate skin-to-skin contact, including various forms of sexual activity. Nearly every sexually active person is likely to contract it at some point without vaccination. While many people associate HPV primarily with health issues in women, the virus equally affects men. The difference in routine testing between sexes stems from significant biological, logistical, and historical factors in disease screening.
The Current Landscape of HPV Testing
Routine HPV screening is a well-established public health protocol for women, centered on the prevention of cervical cancer. The standardized approach involves Papanicolaou (Pap) tests, which look for abnormal cell changes on the cervix, often used in conjunction with high-risk HPV DNA testing, a strategy known as co-testing. This dual-method screening has significantly lowered the incidence of cervical cancer in countries where it is regularly implemented.
However, no equivalent, widely recommended, or routine screening test exists for asymptomatic men. Current medical guidelines do not endorse mass screening for HPV in men, largely because most male infections clear on their own without causing health issues. Unlike the comprehensive cervical screening protocol, testing in men is generally reserved for targeted clinical situations.
Anatomical and Clinical Challenges
The primary reason for the lack of a routine male HPV test is the absence of a clear, standardized anatomical site for sampling that predicts cancer risk. For women, the cervix is a distinct and easily accessible transition zone where precancerous changes are highly concentrated and reliably sampled via a Pap test. This reliable sampling allows for the early detection of high-grade lesions that progress slowly to cancer.
In men, the virus can infect several different areas, including the penis, scrotum, and anus, making it difficult to obtain a consistent, representative cell sample from the thick, keratinized skin. Tests using samples from the skin of the penis may yield inconsistent results, complicating standardized collection method. Furthermore, a positive HPV test in a man is often not predictive of future disease because the infection is highly transient; the immune system clears approximately 90% of infections within two years.
The incidence of HPV-related cancers in men is considerably lower than the rate of cervical cancer was before widespread screening, which affects the feasibility of a population-wide male screening program. Without a reliable, non-invasive sampling method and a high rate of spontaneous viral clearance, a routine test would likely result in a high number of positive results that do not indicate a persistent, high-risk infection, leading to unnecessary anxiety and follow-up procedures.
HPV-Related Health Risks in Men
Despite the lack of routine screening, HPV infection in men carries several specific health risks. The most common manifestations of low-risk HPV strains are anogenital warts, which are non-cancerous but can cause physical discomfort and emotional distress. These warts are typically caused by HPV types 6 and 11.
The high-risk strains of HPV, particularly type 16, are linked to several cancers in men. Oropharyngeal cancer, which affects the back of the throat, base of the tongue, and tonsils, is the most common HPV-linked cancer in men in the United States, with HPV thought to cause about 70% of these cases. Additionally, HPV infection is responsible for the vast majority of anal cancers, with over 90% of cases tied to the virus.
Men who have sex with men (MSM) and individuals with weakened immune systems, such as those with HIV, face a significantly higher risk for HPV-related anal cancer. HPV is also the leading cause of penile cancer, though this form of cancer is rare overall.
Clinical Management and Prevention
The current clinical strategy for managing HPV in men focuses on prevention and targeted diagnosis rather than routine screening. The most effective tool for reducing HPV infection and disease in men is the HPV vaccine, which is recommended for both sexes and protects against the strains that cause most cancers and genital warts. Vaccination is most effective when administered before sexual debut, but it is recommended for all individuals up to age 26 who were not adequately vaccinated earlier.
For most asymptomatic men, the standard management is a “wait and see” approach, relying on the body’s immune system to clear the infection. Testing only occurs when visible symptoms appear, such as genital warts, which can then be treated with topical medications or surgical removal.
Targeted testing and surveillance are reserved for specific high-risk groups, such as an anal Pap test for men with HIV or those who engage in receptive anal sex, to screen for precancerous anal dysplasia. The goal of treatment for visible lesions is to reduce symptoms, as no direct treatment for the underlying HPV infection exists.