HPV Testing in Men

Most men who get HPV (of any type) will never develop any symptoms or health problems. But some types of HPV can cause genital warts. Other types can cause cancers of the penis, anus, or oropharynx (back of the throat, including base of the tongue and tonsils). The types of HPV that can cause genital warts are not the same as the types that can cause cancer.

Several recent research studies have shown that men (especially high risk populations) may benefit from screening for HPV and that “findings from emerging research in high-risk populations of men who have sex with men (MSM) and men who test positive for human immunodeficiency virus (HIV) suggest that HPV infection is pervasive and persistent in these groups, warranting the adoption of additional screening measures”. (1) Other studies have proven that HPV DNA can be detected in men who are actively having sex with women with proven HPV infection. “The case by case matching of HPV positivity and negativity between urine and cervical/penile scrapes or biopsies obtained from women and their male partners demonstrated that the non-invasive urine sampling can be reliably used for screening genital HPV infection in both men and women.” (2)

Meta-analyses of the data showed that HPV is detectable in men, albeit with a seroprevelence that is lower in comparison to females. “…a total of 40 publications on HPV DNA detection and risk factors for HPV in men; 27 evaluated multiple anatomic sites or specimens, 10 evaluated a single site or specimen, and 3 evaluated risk factors or optimal anatomic sites/specimens for HPV detection. Twelve studies assessed site- or specimen specific HPV DNA detection. HPV prevalence in men was 1.3%–72.9% in studies in which multiple anatomic sites or specimens were evaluated… rates of seropositivity depended on the population, HPV type, and methods used. In 9 studies that evaluated both men and women, all but 1 demonstrated that HPV seroprevalence was lower in men than in women.” (3)

Another study out of Argentina in collaboration with the University of North Carolina examined detection rates of HPV from first void urine (FVU) and found “Seventy-three percent (135/185) of the FVU specimens were positive for HPV-DNA. The viral prevalence in patients with HPV-DNA positive partners was 68.8% (77/112), and 79.5% (58/73) of patients with penile lesions were found to be HPV positive. The most frequent viral type was HPV-11 (26.7%), followed by HPV-6 (23%), HPV-16 (21.5%), HPV-18 (6%), and HPV-31 (4.4%). In this study, 11.1% (15/135) of the HPV positive specimens were double infections”. They concluded that “These results indicate that high-risk HPVs can be found in clinical lesions in a high percentage (43.8%), as simple or double infections. In this sense, the male population represents an important reservoir for the virus and may play a role in the transmission and perpetuation of the infection in the general population.” (4)

Charles Sailey
MD, MS, FCAP, FASCP

References:

1. The Journal of the American Osteopathic Association, March 2011, Vol. 111, S26-S28.
2. The Journal of Clinical Virology. November 2006 Volume 37, Issue 3, Pages 190–194.
3. The Journal of Infectious Diseases, Volume 194, Issue 8, 15 October 2006, Pages 1044–1057.
4. Journal of Virological Methods. Volume 124, Issues 1–2, March 2005, Pages 217-220.