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PATIENT PARTICULARS
Human Papillomavirus and Men:
Questions and Answers
What should I know about HPV?
Jessica Hilst, OMS III, and
Tyler C. Cymet, DO
if his or her male partner has HPV. The following commonly asked questions, with
included answers, are designed to address
such aspects of HPV infection.
This fact sheet has been created for
your patients by the American Osteopathic Association. Use the information
that follows as a means of discussing
HPV with your patients.
The human papillomavirus (HPV), the
HPV quadrivalent vaccine and cervical
cancer have been much in the news since
2006, when the vaccine became available
for prevention of HPV-caused cervical
cancer. However, HPV does not affect only
women. More than half of men who are
sexually active will have HPV infection at
some time during their lives.1,2
Most men have healthy immune systems that will clear HPV infection on their
own. Many of these men will not even be
aware that they have a viral infection. In
some men, however, HPV infection progresses to much more serious conditions.
At any one time, approximately 1% of the
sexually active male population has genital
warts, most of which are caused by HPV
types 6 and 11.1,2 Other types of HPV,
most commonly types 16 and 18, may
cause cancers of the oral cavity, penis, and
rectum. In several US based studies of heterosexual men, approximately one-third of
those men were infected with cancerous
strains of HPV. 3
According to the February 2008 Journal
of Clinical Oncology,4 HPV infection will
surpass alcohol and tobacco as the leading
cause of oral cancer within the next
10 years. Anal cancer has increased threefold in the past 30 years, and most new cases
are attributable to HPV infection.3
Although such manifestations of HPV
infection remain relatively rare in men, it is
important for a man or woman to know
questions to ask his or her male partner in
regard to HPV and to know actions to take
Questions and answers
䡲 1) I think my partner has HPV infection. What should we do?
Most people who have had multiple sexual partners will become infected with HPV.
In many cases, HPV infection will resolve
on its own within one- to two-years without causing serious complications. One
study showed that 75% of men tested negative for HPV 12 months after initial detection.5 Most infected people do not even
know that they have HPV.
If your partner has any symptoms of
a sexually transmitted disease (STD), such
as genital warts, genital itching, penile
discharge, or pain with urination, he
should see his physician. Physicians can
prescribe various medications to manage
STDs. Valacyclovir hydrochloride is an
oral medication that can help decrease
outbreaks of HPV-associated genital warts
as well as reduce your chances of spreading
HPV.6 Once you or your partner has
an outbreak, there are several topical
medications that can be applied directly
to genital warts to speed recovery, such as
Imiquimod.7
䡲 2) What will lower my chances of
getting HPV from my partner?
The only sure way to prevent the spread
of HPV is to abstain from oral, anal and
vaginal sex. Wearing a condom reduces the
risk of HPV transmission, but a condom
does not cover all of the dermatologic areas
from which HPV can be transmitted between partners. The human papillomavirus
can be present on body areas other than
the shaft of the penis, such as the thighs,
testicles and base of the penis. In women,
HPV can infect all areas of the vagina and
thighs — that are also not protected with
condom use.
If your partner has HPV, your chances
of contracting the virus are lessened if
he does not have visible warts. However,
you should keep in mind that you can
still contract the virus during wart-free
periods too.
䡲 3) I was vaccinated with the HPV
vaccine. Does that mean I cannot get
HPV infection?
No. The quadrivalent vaccine approved by
the US Food and Drug Administration
(FDA) for protection against HPV, prevents infection of only HPV types 6, 11,
16, and 18. Although these four types
of HPV are the most common cases of
genital warts and cervical cancer, other less
common HPV types can also cause disease.
Thus, the HPV quadrivalent vaccine
protects against most strains of HPV that
cause genital warts and cancer, but you still
remain susceptible to other strains.
(continued on the next page)
15
䡲 4) What increases my risk of getting
HPV infection?
Studies have shown that having unprotected sex, frequent sex and multiple sex partners, as well as smoking and being an uncircumcised man, all enhance the chances
of getting HPV infection.8,9 Having sex
with a new partner puts you at greater risk
than having sex with a previous partner.2
Having sex at a young age and having a
partner who has had multiple sex partners
also increase the risk of HPV infection, as
well as of other STDs.
䡲 5) What test can my partner take to tell
if he has genital warts?
Genital warts are not always readily visible.
A physician can apply an acetic acid-based
solution (ie, vinegar) on a patient’s genital
area to help identify warts. When this solution is applied, any warts that are present
will turn white, making them easier to see.
However, these tests can yield false-positive
results. Thus, a skin biopsy may be called
for in many cases.
䡲 6) What test can my partner take to tell
if he has HPV-related cancer?
There is currently no regularly used test
that is available for determining if a man—
whether heterosexual or homosexual—has
HPV-related cancer. Some physicians recommend using anal Papanicolaou (Pap)
smear tests with gay and bisexual male patients to check for the presence of cancerous cells.2 This recommendation, however,
remains controversial, because removing
cancerous or precancerous cells detected
by Pap smear tests in men—unlike in
women—has not been shown to decrease
cancer rates.
䡲 7) If my partner has HPV-related
cancer, what is the treatment?
Patients with HPV-related penile, anal and
oral cancers can be treated with chemotherapy, radiation, and surgery like other kinds
of cancer. The treatment of cancer will be
decided between you and your doctor and
depends on the type of cancer and its level
of development.
16
䡲 8) What does having HPV infection
mean for my overall health and that of
my partner?
Most of the approximately 100 types of
HPV do not cause any symptoms at all and
resolve on their own. Some types of HPV
cause warts to develop on the anus, genitals
or thighs. These warts can be uncomfortable and itchy and bleed with contact.
A woman who has HPV infection is at
increased risk for cervical cancer. She
should be regularly screened for precancerous and cancerous cells with an annual
Pap smear test.
In men and women, approximately 40
of the approximately 100 types of HPV are
sexually transmitted and can lead to penile,
rectal, cervical or oral cancer.2 The chances
of getting cancer from HPV infection are
much lower in men than in women. Men
who are circumcised are at lowest risk for
the development of penile cancer.
In November 2008, the US Centers for
Disease Control and Prevention (CDC)
published a comprehensive assessment
of HPV-related cancer, based on registry
data from the CDC and National Cancer
Institute that were collected between 1998
and 2003.10 According to the study,10
about 800 men each year get penile cancer
associated with HPV, about 1,100 men
and 1,900 women each year get anal cancer associated with HPV, and about
10,800 women per year get cervical cancer
associated with HPV.
Although HPV-related cancer is relatively rare in men, any man who has HPV
infection should check for physical changes
that may be associated with cancer. If your
partner has any changes to the color, skin
texture or shape of his penis, or any open
sores or abnormal growths on his genitals,
these changes should be reported to his
physician. Rectal cancer commonly does
not result in physical signs or symptoms.
Rather, rectal cancer is associated with
changes in bowel habits, pain with defecation, rectal itching and abnormal discharge.
All of these changes should be reported to
the physician.
Among men, cancer associated with
HPV is most common in gay and bisexual
individuals and in men with compromised
immune systems, such as in cases of human
immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS).
䡲 9) If I get HPV from my partner, does
that mean he is cheating on me?
The human papillomavirus can lay dormant in an individual’s body for several
months or years after oral, vaginal or anal
sex with an infected partner. And, without
producing any physical signs or symptoms,
it might be passed to other sexual partners.
Thus, getting HPV infection from your
partner does not necessarily imply that he
had recent sexual relations with another individual.
When two sexually active partners become infected, it is difficult to determine
which partner had HPV first. It should be
kept in mind that most people with multiple sexual partners will have HPV at some
point during their lives, and most of those
people will be asymptomatic and unaware
that they have HPV infection.
䡲 10) If one of us has HPV, does that
mean that the other one will get infected?
Very commonly, if one person in a relationship has HPV, the other person in the relationship will also contract the infection.
The likelihood of viral transmission is increased because, as previously mentioned,
the infection can be present without producing visible symptoms. By the time genital warts develop in one partner—if they
ever do—the second partner may have already contracted the virus.
Transmission of HPV does not always
happen, however. Chances of transmission
can be reduced by wearing condoms and
by avoiding sexual contact when visible
warts are present. Most people who have
HPV infections have strains that do not
cause genital warts or cancer, and such infections resolve on their own over time.
䡲 11) Should my son, like my daughter,
get vaccinated against HPV infection?
In the United States, the quadrivalent HPV
vaccine is FDA-approved only for use in
girls and women between the ages of 9
and 26. In the United Kingdom, by contrast, HPV vaccines are on the market for
use in males between the ages of 9 and 15,
as well as for use in females.
A randomized, double-blinded, placebo-controlled trial of the vaccine involving
4,065 young men between the ages of
16 and 26—the Male Quadrivalent HPV
Vaccine Efficacy Trial Study Group—
was conducted.7,8 Results of phase III of
this trial were reported in November 2008
group and 31 cases in the placebo group.11,12
In December 2008, a request was made
to the FDA for permission to market a
quadrivalent vaccine for males between the
ages of 9 and 26.13
True or false?
䡲 If my partner has HPV infection, I will
be able to tell just by looking.
False. Many people are infected with types
of HPV that do not cause warts or any
other physical signs or symptoms. In such
cases, you would not be able to tell just by
looking if that person has HPV infection.
Your partner may not even know that he
has HPV if he has no signs or symptoms.
Physical signs of HPV infection, can include painless flat, raised, or cauliflowerlike growths on the penis, scrotum, rectum,
anus or oral cavity.
䡲 There are more than 100 types of HPV.
True. Of the more than 100 types of HPV,
many do not cause any signs, symptoms
or complications. Human papillmavirus
types 6 and 11 cause 90% of all genital
warts. Thirty other strains of HPV have
been associated with penile, anal and oral
cancers.1,2
䡲 The human papillomavirus cannot
be transmitted if genital warts are not
visible.
False. If your partner has genital warts but
is between outbreaks, you can still contract
HPV infection from him. Similarly, if he
has a type of HPV that does not cause
warts, you can contract that infection. The
only certain way to ensure that you do not
get HPV from your partner is to abstain
from oral, vaginal and anal sex.
at the International Multidisciplinary Conference of the European Research Organisation on Genital Infection and Neoplasia
(EUROGIN) in Nice, France.
The completed primary analysis
showed that the vaccine reduced external
genital lesions caused by HPV by 90.4%
(95% confidence interval, 69.2%-98.1%)
in study participants aged 16 to 26—with
three cases of genital warts in the vaccine
䡲 Gay and bisexual men are more likely
to get HPV infection than other men.
True. Men who have anal sex with other
men are most likely to contract HPV infection. Of those men, gay or bisexual individuals with impaired immune systems,
such as individuals with HIV/AIDS, are at
the greatest risk for HPV infection.
(continued on the next page)
17
10. CDC released first estimate of human
papillomavirus-associated cancer data [press release].
City: Centers for Disease Control and Prevention;
November 3, 2008. Available at: http://www.cdc.
gov/media/pressrel/2008/r081103.htm?s_cid=mediar
el_r081103_x. Accessed March 22, 2009.
11. Giuliano A, Palefsky J, on behalf of the Male
Quadrivalent HPV Vaccine Efficacy Trial Study Group.
The efficacy of the quadrivalent HPV (types
6/11/16/18) vaccine in reducing the incidence of HPV
infection and HPV-related genital disease in young
men. Paper presented at: International Multidisciplinary Conference of European Research Organisation
on Genital Infection and Neoplasia; November 2008;
Nice, France.
䡲 There is a cure for HPV infection.
False. There is no cure for HPV infection
in either men or women. If your partner
has genital warts, the lesions can be frozen
off or removed in a minor surgical procedure in the physician’s office. Most HPV
infections resolve on their own. Until then,
the infected individual should try to live a
healthy lifestyle and get any warts examined by a physician. The partner of the infected individual should avoid contact with
the warts.
䡲 Contact with warts on the fingers can
cause genital HPV warts and vice versa.
False. The human papillomavirus can cause
warts on the fingers and feet, but these
warts are caused by strains of HPV that are
different from the strains that cause genital
warts. Thus, if your partner has genital
warts, they should not spread to your fingers or feet. However, warts that occur in the
mouth, anus and genital areas may all be
caused by the same strains of HPV. Thus,
the best way to avoid spreading HPV is to
avoid contact with any visible warts. ❙ ww
3. Epidemiology of Human papillomavirus infections.
UptoDate Online version 17.1. Available at:
http://www.utdol.com/content/search. Accessed
March 25, 2009.
ed and -unrelated oral squamous cell carcinomas in
the United States. J Clin Oncol. 2008;26:612-619.
hp. Accessed March 22, 2009.
prevalence, incidence, and duration of human papillomavirus Infections in a Cohort of 290 US Men. J Infect
Dis. 2008; Sep 15;198(6):827-35.
6. Valtrex and Genital Warts. Available at:
http://www.valtrex.com/forherpes/increase_outbreak
free.html. Accessed April 20, 2009.
7. External genital warts. Available at:
http://aldara.com/aldara.jsp. Accessed April 20,
2009.
8. Lu B, Wu Y, Nielson CM, Flores R, Abrahamsen M,
Papenfuss M, et al. Factors associated with acquisition and clearance of human papillomavirus infection
9. Nyitray A, Nielson CM, Harris RB, Flores R, Abrahamsen M, Dunne EF, et al. Prevalence of and risk fac-
Cancer Biol. 1999;9:379-386.
sexual men. J Infect Dis. 2008;197:1676-1684.
18
boys, young men; January 7, 2009. Medical News
Today [serial online]. Available at:
MR; Lee JH; Abrahamsen M; Harris RB. Age-specific
tors for anal human papillomavirus infection in hetero-
stdfact-hpv-and-men.htm. Accessed March 22, 2009.
13. Merck seeks FDA approval for HPV vaccine use in
http://www.medicalnewstoday.com/articles/134590.p
life cycle: active and latent phases [review]. Semin
Web site. Available at: http://www.cdc.gov/std/hpv/
March 22, 2009.
5. Giuliano AR; Lu B; Nielson CM; Flores R; Papenfuss
References
fact sheet. Centers for Disease Control and Prevention
[serial online]. Available at: http://www.medical
ML. Incidence trends for human papillomavirus-relat-
in a cohort of US men: a prospective study. J Infect
2. Sexually transmitted diseases: HPV and men––CDC
in men; November 17, 2008. Medical News Today
newstoday.com/articles/129676.php. Accessed
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1. Stubenrauch F, Laimins LA. Human papillomavirus
12. Four-type HPV vaccine Gardasil¤ is also effective
Jessica Hilst is a third year medical student at
Nova Southeastern University College of Osteopathic Medicine. She is currently the president
of the Student Government Association at
NSUCOM as well as national 2nd vice chair
of the Council of Osteopathic Student Government Presidents. She was recently selected as an
Osteopathic Health Policy Intern for 20092010 by the American Association of Colleges
of Osteopathic Medicine.
Tyler C. Cymet, DO, is the associate vice president for medical education at the American
Association of Colleges of Osteopathic Medicine.
He is the president of the Maryland Association
of Osteopathic Physicians and is on the Board of
Trustees for DOCARE International. He can be
reached at [email protected].