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HPV and Men

HPV in Men – Causes, Diagnosis and its Treatment

Introduction

The human papilloma virus (HPV) is spread through sexual contact and can spread via vaginal, anal or oral sex. It can also spread through intimate skin contact during sexual activity, if the skin had cuts or breaks in it. All sexually active men and women can get HPV and it is thought that the majority of sexually active people will get infected with HPV at some point during their lifetime. In most people the viral infection remains asymptomatic, with the virus eventually leaving the body within three years. In others, it can go on to cause genital warts and cancers. In fact HPV infection in men increases their risk of getting genital cancers.

Cause

There are more than 100 types of human papilloma viruses. A person may also be infected with more than one type of HPV at a time. HPV types 6 and 11 cause genital warts in both men and women. Other types (30 or so) may cause cancer, for instance cervical cancer in women and anal or penile cancers in men with persistent HPV infections.

HPV infection is spread through vaginal, anal and oral sex. Since in the majority of cases, the infection shows no signs or symptoms, HPV spread happens easily.

Risk Factors:

Some men are found to be at a greater risk for the development of HPV related cancers. These men include those with compromised immune systems such as those infected with human immunodeficiency virus (HIV) and men who engage in anal sex. The latter are more likely to have anal cancers. Cigarette smoking and a history of genital cancers are also associated with an increased risk.

Clinical Presentation

HPV infections in men usually go away without producing any symptoms; however in cases in which the virus stays in the body, it can cause genital warts or certain kinds of cancers.

Genital warts are caused by HPV types of relatively low risk (6 and 11). Genital warts are flesh colored bumps or growths seen in the genital region. In men, they most often appear near the anus. Infected men may experience symptoms such as burning, itching, pain and/or soreness in the genital area.

In men, HPV related cancers are not as common as women and mostly affect men with a weakened immune system. The cancers are caused by HPV types that are considered high risk (ex. HPV 16 and 18). The cancers caused by HPV in men include penile and anal cancer. The virus can also cause oropharyngeal cancer, which affects the tongue, tonsils, soft palate and pharynx.

Diagnosis

Unlike women, men do not normally get routinely screened for HPV. However in high-risk individuals such as gay or bisexual men, it is recommended that anal pap tests be done. An anal pap test involves collecting cells from the anus and checking them under a microscope for abnormalities.

HPV related genital warts and cancers are more easily diagnosed. A doctor will usually examine the genital area of a man to check for warts. Some doctors may choose to use a mild acetic acid (vinegar) solution, to help make the warts more visible.

Anal cancer can be asymptomatic but in some cases it is accompanied by bleeding, pain and itching in the genital area, strain during bowel movement, anal discharge, swollen lymph nodes in the genital area and abnormal bowel habits. Diagnosis of anal cancer is done by recording a person’s medical history and doing a physical exam of the rectal area including endoscopy (anoscopy and/or protoscopy). If anal cancer is suspected, a biopsy or imaging tests (ultrasound, CT scan, MRI etc.) may be performed.

Treatment for HPV

There is currently no treatment for HPV infection. Treatment involves treating the associated health conditions caused by the virus.

Treatment for genital warts includes cryotherapy (freezing them), surgical removal and/or prescription topical creams. Repeat treatments may be necessary and in some cases, doctors discourage wart removal as they are likely to go away on their own.

Treatment for anal cancer is determined by the stage at which the cancer is detected, the size and spread of the cancerous tumor and the health status of the individual. Radiation, chemotherapy and surgery may then be recommended.

Prevention

  1. Safe sex practices can lower the risk of HPV infection considerably. Use of condoms, limiting sexual partners, monogamy and abstinence lowers a person’s chances of getting not just HPV but other sexually transmitted infections (STIs) too.
  2. HPV vaccines Gardasil and Gardasil 9 can protect men against the types of HPV that cause genital warts and cancers. For vaccines to be effective, individuals need to get them before becoming sexually active. It is therefore recommended that boys at the age of 11-12 years be vaccinated. In cases, where men have not been vaccinated at a young age, they may get the vaccine through the age of 26 especially in men belonging to high-risk groups (gay and bisexual and immuno-compromised men).