Human Papillomavirus (HPV) and Men: Questions and Answers

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Human Papillomavirus (HPV) and Men: Questions and Answers
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 warts or other consequences such as cancer (for example cervical, penile and anal) in the anogenital region of men and women. The types of HPV that infect the anogenital area are not the same as the ones that infect other areas of the body such as the fingers, hands and face. The types which cause anogenital warts do not usually cause cancer.

The various types of HPV are often classified into low and high risk according to their association with cancer. The “low-risk” types are rarely associated with cancer. The “high-risk” types are more likely to lead to the development of cancer.

What are the signs and symptoms of HPV in men?

Most men who have an anogenital HPV infection do not have any symptoms and most infections will go away without treatment over the course of a few years. However, in some people HPV infections can persist for many years. In those who do develop symptoms anogenital warts may develop (see below). The precancerous and cancerous changes that may result from HPV infection usually do not present with any noticeable symptoms, and therefore regular health check-ups are essential.

Does HPV cause anogenital warts?

Some HPV infections, with low risk types, can cause anogenital warts. Anogenital 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 anogenital 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. Anogenital 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 cancers. HPV may also play a role in cancers of the anus, penis and 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, although anal cancers are found at higher rates in men who have sex with men. 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 you should speak with a health care professional.

How do men get anogenital HPV?

HPV is estimated to be one of the most common sexually transmitted infections 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 an anogenital 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 anogenital 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 anogenital region. HPV is more likely to be transmitted when warts are present, but the virus can be transmitted even when there are no visible warts.

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 anogenital HPV never know it. A recent diagnosis of HPV, anogenital 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 anogenital warts in men?

Currently, in Canada there is an HPV DNA test approved for women but not for men. However, it is possible to detect anogenital warts, which are the most common consequence of an HPV infection. Anogenital warts are diagnosed by a visual inspection during a physical exam, by a 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 a health care professional.

There are currently no screening recommendations in place for penile or anal cancer. The Pap (Papicanolaou) test can be 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 the absence of screening recommendations 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 that HPV infection is no longer present in the body.
Some treatments for anogenital warts, such as cryotherapy (freezing the warts), 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 a health care provider feels that it is necessary. A large number of these infections will clear without any treatment. Only a 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 or has been diagnosed with cervical cancer, indicating an HPV infection? What if my female partner has tested positive for HPV? What if my partner currently has or has previously had anogenital warts?

If a woman has abnormalities detected on a Pap test or cervical cancer there is no need for her sex partner(s) to seek clinical assessment and treatment unless assessment is needed for HPV symptoms or other sexually transmitted infections.
Similarly, if your sexual partner  has a current or remote history of anogenital warts or HPV infection, there is no need to seek clinical assessment and treatment unless  assessment is needed for HPV symptoms or other sexually transmitted infections. 

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, using 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. You need to remember that a condom can 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 as this can create a risk to yourself. (eg. 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 okay to feel upset about being diagnosed with an HPV infection?

Yes, it is okay to feel ashamed or upset about having a sexually transmitted infection. People should not be judged negatively because they have an STI, it is not a reflection of personal character. It is important to realize that even with an HPV or other sexually transmitted 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.