HPV infection in men

22.06.2020

Human Papilloma Virus (HPV) infection is the most common sexually transmitted disease (STD). We know different types of HPV. Some of them increase cancer risk. The virus cannot survive alone for a long time outside the infected cells. Therefore, the infection is possible only during prolonged and intimate contact skin to skin or mucosa to mucosa. All kinds of sex are at risk for infection and the virus can be found in the genital area, internally in the vagina in the uterine cervix, in the anal canal, and in the oral mucosa.

HPV is a common sexually transmitted infection. Most new HPV infections occur in adolescents and young adults. Although most sexually active adults have been exposed to HPV, new infections can occur with a new sex partner or when the patient has multiple partners.

After the contact, HPV can live inside the infected cells for months. The infection starts silent, and, in most cases, the competent immune system can eliminate the infection without the patient noticing. In fact, most HPV infections are transient and asymptomatic and cause no clinical problems. In other cases, the virus survives and replicates causing a wart which is the typical skin or mucosal abnormality, the only visible sign of the viral infection.

Men and women have different expressions of the disease. In men, they can become visible to the human eye only after several weeks or months. They may be small. The top of the growths may look like a cauliflower. They may occur as a cluster of warts, or just one wart. Rarely, however, genital warts can multiply into large clusters, in someone with a suppressed immune system.

HPV infection is not cancer but can cause changes in the body that lead to penile cancer in men if left untreated. Cancer develops very slowly and may not be diagnosed until years, or even decades, after HPV infection. Currently, there is not any test to identify who will develop cancer after getting HPV.

DIAGNOSIS OF HPV IN MEN

The HPV infection cannot be diagnosed before there are signs or symptoms (warts). In fact, there is currently no approved test for HPV in men. Therefore, routine testing (also called 'screening') to check for HPV or HPV-related disease before there are signs or symptom, is not recommended by the Centers for Disease Control and Prevention in the United States.

The physical examination of the penile, scrotal or pubic warts by urologist, andrologist or dermatologist is enough to diagnose the HPV infection. The warts have the typical appearance described above. The optical magnification after treating the skin with trichloroacetic acid (penoscopy), is useful to diagnose microscopic warts hardly visible to the naked eye.

No clinical antibody test can determine whether a person is already immune or still susceptible to any given HPV type.

TREATMENT OF PENILE WARTS

The eradication of the virus occurs with the destruction of all warts visible. Laser, cryo-ablation, or electro-cautery are effective treatments. The radical treatment (destroying all macroscopic and microscopic warts) is crucial to get rid of HPV infection. During treatment, small warts, or flat lesions not visible to the naked eye can be highlighted with the use of trichloroacetic acid solutions and magnifying tools (penoscopy). Often, we need more than one session to get rid of infection.

Topical creams have only limited use in the treatment of the penile warts. The medication has to be spread over the affected skin. While multiple applications are needed, the results are not always curative, and the side effects can cause ulcers that delay the healing.

Unfortunately, it is not known how long a person is able to spread HPV after the treatment of the detectable penile warts. Long surveillance of both partners is advisable.

PREVENTION OF HPV IN MEN

The prevention is the only reliable way to lower the risk of getting HPV infection. Sexual abstinence is the best way to prevent the HPV spread. The use of condom may not give full protection against getting HPV. In fact, HPV can infect skin genital areas that are not covered by a condom. HPV vaccines are safe and effective. They can protect men against warts and certain cancers caused by HPV. Ideally, you should get vaccinated before ever having sex. After getting infected or after the develop of warts, the administration of the vaccine does not give real benefits and it is not recommended.

RECOMMENDATIONS OF THE AMERICAN ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES (2017)

Children and adults aged 9 through 26 years. HPV vaccination is routinely recommended at age 11 or 12 years; vaccination can be given starting at age 9 years. Catch-up HPV vaccination is recommended for all persons through age 26 years who are not adequately vaccinated.

Adults aged >26 years. Catch-up HPV vaccination is not recommended for all adults aged >26 years. Instead, shared clinical decision-making regarding HPV vaccination is recommended for some adults aged 27 through 45 years who are not adequately vaccinated. HPV vaccines are not licensed for use in adults aged >45 years.

Special populations and medical conditions. These recommendations for children and adults aged 9 through 26 years and for adults aged >26 years apply to all persons, regardless of behavioural or medical risk factors for HPV infection or disease. For persons who are pregnant, HPV vaccination should be delayed until after pregnancy; however, pregnancy testing is not needed before vaccination. Persons who are breastfeeding or lactating can receive HPV vaccine.

HPV IN A STABLE RELATIONSHIP

If you or your partner have genital warts, you should avoid having sex until the warts are gone or removed. However, it is not known how long a person is able to spread HPV after warts are gone.

HPV infections are usually temporary. A person may have had HPV for many years before it causes health problems. If you or your partner are diagnosed with an HPV-related disease, there is no way to know how long you have had HPV, whether your partner gave you HPV, or whether you gave HPV to your partner. HPV is not necessarily a sign that one of you is having sex outside of your relationship. It is important that sex partners discuss their sexual health, and risk for all STIs, with each other.

Reference

Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep 2019;68:698-702. DOI: https://dx.doi.org/10.15585/mmwr.mm6832a3