Human Papillomavirus (HPV) and Men: Questions and Answers

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What is HPV?

There are over 100 types of human papillomavirus (HPV). HPV is a virus that can infect many parts of the body . Some types of HPV are sexually transmitted and can cause ano-genital warts in both men and women. The types of HPV that infect the ano-genital area are not the same as the ones that infect other areas such as the fingers, hands and face. Other types, not related to ano-genital warts, can very rarely cause cervical cancer in women and anal or penile cancer in men.

Some types of HPV are referred to as “low-risk” viruses because they rarely develop into cancer. HPV types that are more likely to lead to the development of cancer are referred to as “high-risk.”

What are the signs and symptoms of HPV in men?

Most men who have an ano-genital HPV infection do not have any symptoms. Since there is no treatment for asymptomatic HPV, most men are not treated. Most HPV infections go away without treatment, over the course of a few years. However, in some men HPV infections can persist for many years.

Does HPV cause ano-genital warts?

Some HPV infections, with low risk types, can cause ano-genital warts. Ano-genital warts are usually flesh-coloured, soft to the touch and may appear as tiny flat bumps, or bumps that look like cauliflowers. They are usually painless but may itch. They usually grow in more than one location and may cluster in large groups. Sometimes ano-genital warts can be present but may not be visible if they are internal (i.e. inside the vagina or rectum) or if they are on the skin but are too small to be seen. Ano-genital warts do not turn into cancer.

What is the link between HPV infection and cancer?

Persistent HPV infection, with high risk types, is the major cause of over 99% of cervical cancer. HPV may also play a role in cancers of the anus, penis, oropharynx (in the throat, at the back of the mouth). Similar to cervical cancer, HPV has been found to be a major cause of anal cancer. HPV is also strongly linked to penile cancer. Both reported anal and penile cancers are very rare in Canada. Researchers are working to more clearly define the link between HPV and cancers at sites other than the cervix.

If you are sexually active, you should have regular check-ups. If you think you have warts or have been exposed to HPV, you should speak with a health care professional.

How do men get ano-genital HPV?

HPV is estimated to be the most common sexually transmitted infection in Canada and around the world. Any person who is sexually active can get the virus. Studies show that approximately 75% of sexually active men and women will acquire ano-genital HPV

infection at some point in their lives. Most HPV infections occur without any symptoms and go away without treatment over the course of a few years.

The types of HPV that cause ano-genital warts are spread by skin-to-skin contact, usually during vaginal, anal, or possibly oral sex with someone who has the infection. It is possible, however, to become infected with the virus without having sex if you come into contact with an infected area in the ano-genital region. HPV is more likely to be transmitted when warts are present, but the virus can be transmitted even when there are no visible symptoms.

It is possible to have more than one type of HPV infection at a time.

Does an HPV infection mean that someone has cheated in a relationship?

Most people who are infected with ano-genital HPV never know it. A recent diagnosis of HPV, ano-genital warts or related cancer does not necessarily mean that a partner has been unfaithful. Infection with HPV may have occurred years ago and the virus can remain in the body for weeks, years, or even a lifetime, without any sign of an infection. This makes it hard to know exactly when or from whom someone got the virus. There is no way to find out how long a particular infection has been there, or to trace it back to a particular partner.

Is there a test for HPV, related cancers or ano-genital warts in men?

Currently in Canada there is no approved DNA (genetic information) test for HPV in men. However, it is possible to detect ano-genital warts, which are the most common sequelae associated with an HPV infection. Ano-genital warts are diagnosed by a visual inspection during a physical exam, by your health care professional. Just because you cannot see warts does not mean that you do not have any. They may be small, or in a place where you cannot see them, such as inside the rectum. It is important to have regular check-ups by your health provider.

There are currently no screening programs in place for penile or anal cancer. In some jurisdictions the Pap (Papicanolaou) test is used to screen for cell changes in the anus (precancerous and cancerous changes) in the same way it is used to detect cell changes in the cervix of woman. Researchers are still working to see if this is both an adequate and cost-effective way to screen for anal cancer in men. In the absence of screening programs or effective screening tests it is very important to have regular check-ups and to tell your health care professional about any signs or symptoms you are having.

Can HPV be treated?

Although there is no cure for HPV infection, the warts, lesions and precancerous or cancerous changes caused by the virus can be managed and/or treated.

No treatment guarantees a cure of HPV infection. Some treatments for ano-genital warts, such as cryotherapy (removing the warts by freezing them), are done in a clinic or doctor's office while other treatments, such as prescription creams, can be used at home.

Repeat treatments are often necessary. Just because you can no longer see the wart doesn't mean the HPV infection is gone - the virus may still be present which means you could develop warts again without being re-exposed to the virus. For most people, warts will clear on their own over time.

The lesions and precancerous changes caused by high risk types of HPV can be treated if necessary. Most of these infections will clear without any treatment. Only a very small number of high risk infections will progress to cancer. As with many other cancers early detection is one of the key factors to successful treatment.

Discuss treatment options with a health care professional to determine which treatment choice may be best for you. Immunocompromised people, especially those who are HIV-positive, may require special care.

What if my female sex partner has an abnormal Pap test, indicating an HPV infection?

Since abnormal Pap tests are most often an indication of a low-risk type of HPV, there is no clinical follow-up required for male partners without any HPV symptoms, such as ano-genital warts.

How can you protect yourself from getting HPV?

To reduce the risk of acquiring an HPV infection, always use a condom during sex. While condoms don't eliminate the risk of infection, u sing a condom, consistently and properly, during vaginal, anal and oral sex will decrease the chance that you will get HPV or pass it on to your partner. A condom will only protect the area it covers so it may be possible to become infected by any uncovered warts (for example, on the scrotum).

Using a condom will also help to protect you from other sexually transmitted infections and reduce the chances of unintended pregnancies.

Other ways to reduce your risk of infection are to delay sexual activity (waiting until you are older), limit your number of sex partners and to consider your partners sexual history if they have had multiple previous partners.

In order to prevent infection with four of the common types of HPV (6, 11, 16, and 18), females now have the option of being vaccinated. HPV vaccines are currently being studied for use in men. For more detail on the HPV vaccine see the HPV Vaccine specific fact sheet.

Is it normal to feel upset about being diagnosed with an HPV infection?

Yes, it is normal to feel ashamed or upset about having a sexually transmitted infection. People should not be judged negatively because they have an STI. It is important to realize that even with an HPV infection it is still possible to lead a healthy balanced life, including a fulfilling sex life. Also, considering the link between HPV and cancer it is important to remember that if you have an HPV infection, it is unlikely that you will develop cancer.