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Meta-analysis Estimates 1 In 3 Men Worldwide Have Genital HPV Infection

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A new meta-analysis published in The Lancet Global Health finds that nearly one in three men around the world have one or more types of genital human papillomavirus (HPV) infection, and about one in five have at least one kind of high-risk HPV (HR-HPV).

Researchers from the Catalan Institute of Oncology in Barcelona, Spain, and the World Health Organization led the analysis of 65 studies involving 44,769 boys and men aged 15 years and older from 35 countries published from January 1, 1995, to June 1, 2022.

The study authors note that HPV is the most common sexually transmitted viral infection in the world, and research has shown that most sexually active men and women contract one or more genital HPV infections during their lives—most of them causing no symptoms.

Of the more than 200 types of sexually transmitted HPV, at least 12 can cause cancer, including cervical cancer. In men, HPV infection tends to cause anogenital warts and is linked to penile, anal, and throat cancers.

Prevalence peaked at ages 25 to 29

Worldwide, the pooled prevalence of genital HPV in men was 31% for any HPV type and 21% for HR-HPV. The most common genotype was HPV-16 (5%), followed by HPV-6 (4%). HPV prevalence peaked between ages 25 and 29, then leveled off or declined slightly.

Pooled HPV prevalence estimates were comparable in the UN Sustainable Development Goal regions in Europe and Northern America, Sub-Saharan Africa, Latin America and the Caribbean, and Australia and New Zealand. Estimates for East and Southeast Asia were half that of other regions.

These estimates emphasise the importance of incorporating men in comprehensive HPV prevention strategies.

The researchers said the results show that HPV prevalence in boys and men in young men is high and support that sexually active men of all ages are an important reservoir of the virus. "These estimates emphasise the importance of incorporating men in comprehensive HPV prevention strategies to reduce HPV-related morbidity and mortality in men and ultimately achieve elimination of cervical cancer and other HPV-related diseases."

Ob/Gyn: 1 In 5 New Cases Of Cervical Cancer Are In Women Over 65 — Here's What You Need To Know About HPV In Seniors

Those of us over a certain age likely don't spend much time thinking about the human papilloma virus (HPV). Despite the fact that the sexually transmitted virus is estimated to infect 4 out of every 5 women by the time we turn 50, we tend to think of HPV as a worry for the younger crowd — people in their 20s and 30s, not seniors. But do older adults, especially those in long-term, committed relationships need to be concerned? We asked two top MDs to weigh in on everything you need to know about the country's most common STI, including how often you should get screened and why an abnormal PAP smear shouldn't automatically be a cause for worry.

HPV can lie dormant, then reactivate in seniors

HPV is a sexually transmitted infection spread through intercourse with someone who has the virus. The infection can spread even though a person isn't showing signs or symptoms of an active infection. And for those who do contract HPV, you may not show signs for years.

Risk of contracting HPV may be highest when you're young, but unfortunately, that doesn't mean older women (and men) are out of the woods, says ob/gyn Barbara DePree, MD, a certified menopause practitioner and founder of MiddlesexMD.Com, an educational resource for women's sexual health in perimenopause and beyond.

"HPV can lie dormant in the body for years, only to become an active infection as the aging immune system grows too weak to suppress it," she says. In fact, she notes that HPV is the most common cause of "abnormal" Pap smears. What's more, a study in the Journal of Infectious Disease found that a latent HPV virus more likely to activate at onset of menopause. Dr. DePree likens this HPV reactivation to getting chicken pox as a child, then contracting shingles years down the road.

Indeed, in a study of 1,550 women between the ages of 57 and 85, 1 in 16 had a high-risk strain of HPV (i.E., one of two strains that can lead to cancer) — and this was not correlated with how sexually active they were.

HPV cells can lie dormant for yearsKATERYNA KON/SCIENCE PHOTO LIBRARY/Getty

Why so many seniors are unaware they have HPV

"We have a large population, that includes women over the age of 65, who have HPV," says Chicago ob/gyn Lauren Streicher, MD, Clinical Professor of Obstetrics and Gynecology at Northwestern University's medical school, The Feinberg School of Medicine, and host of Dr. Streicher's Inside Information: Menopause, Midlife and More Podcast. She adds many don't even know they have it. Why? Doctors only started using the HPV test (which was developed in 1999) as a screening tool in the last 20 years, she says. "Not only does the virus come and go, but Pap smears 20 years ago didn't test for HPV." At the time, she says, experts believed that cervical cancer was caused by the herpes virus, so HPV tests weren't a priority.

What's more, an HPV test only detects an active infection, Dr. Streicher says. That means a woman who's told she doesn't have HPV based on her most recent screening could still harbor a dormant virus. Likewise, a woman who's told for the first time that she has HPV (say at age 50 or 55) could have had it for decades. "If you have HPV that was just detected today, there is no way to tell when you acquired it, even you've had negative HPV tests in the past," Dr. Streicher notes. "It could have been three months ago or 30 years ago." This is why doctors still screen for HPV even among patients who've had no new exposure to the virus.

The most common signs and symptoms of HPV

Although Dr. DePree says most strains of HPV are harmless and cause no symptoms, some can trigger warts. Some appear as raised patches on the skin and others can look like cauliflower, with bumps and stem-like protrusions. Often they are genital warts that appear on the vulva, cervix, vagina or near the anus.

"Genital warts are unpleasant to deal with because they can be itchy and uncomfortable," Dr. Streicher says. "Sometimes they go away on their own. But we can also treat them and there are a number of ways to do it." Some of the more common treatments are medication and topical creams. Your doctor may also recommend dissolving the wart with an acid. "We can also remove them surgically, but they can recur." (Not sure if you have genital warts or vaginal boils? Click through to learn how to tell if you have a vaginal boil — and how to treat it.)

HPV wartRoman Budnyi/Getty

Complications of an HPV infection

While most types of HPV aren't problematic, some high-risk types — specifically types known as 16 and 18 — can lead to cancer. This includes cervical, vulvar, vaginal, penile and anal cancers, as well as cancers of the head and neck. (Click through to our sister publication to learn how to prevent cervical cancer.)

"A persistent HPV infection that doesn't clear can develop into pre-cancer or cancer," says Dr. Streicher. "But this happens very slowly. For people who do get cancer, it doesn't happen for years, which is why screening is so important." Once you (and your doctor) know that you have HPV, regular screenings will pick up any changes that can indicate cancer early enough to keep you safe, she says. "If someone is told they have HPV it doesn't mean they're going to get cancer. In fact, the overwhelming number of people don't. It just means they've been exposed and should be monitored to make sure it doesn't cause problems down the road."

How often seniors should get screened for HPV

For years, an annual exam and Pap smear were recommended. But because the HPV-driven changes to cervical cells that can lead to cancer happen very slowly over time, those guidelines were changed. The United States Preventative Services Task Force (USPSTF) currently advises a Pap test every three years for women ages 21 to 65, or a Pap test plus HPV test every five years for women ages 30 to 65. Additionally, the guidelines suggest that women who are older than 65 who have had "adequate screening" and are at low risk for cervical cancer no longer need to be screened.

"There is a lot of concern over this, because what we're starting to see now is that one in five new cases of cervical cancer are in women 65 and older. And 70% are being diagnosed at a late stage when it's less treatable," Dr. Streicher says. She says many women assume that if they don't need Pap or HPV tests, they can also forgo their annual check-ups. "The majority of women over age 65 are not seeing their gynecologists. Not only are they not getting a Pap test, but they're getting no visual inspection."

Dr. Streicher recommends that all women over the age of 50 get an annual gynecological exam. "The frequency of Pap tests depends on their personal and medical history," which can be discussed when you see your doctor, she adds.

Pap tests can help catch an active HPV infectionPeter Dazeley/Getty

Risk factors for HPV in seniors

Reactivation of the virus is a likely reason for seniors to be diagnosed with active HPV. But new infections can also occur. "Just because you're 65 doesn't mean you stop having sex," notes Dr. Streicher. "People get divorced, spouses die and people get remarried." But older folks with new sexual partners are less likely to use protection. "Pregnancy is no longer an issue. But an older woman is more vulnerable to HPV because her tissue is thin and more likely to tear." What's more, a study in the Journal of Infectious Disease found incidence of HPV is higher in men than in women. That's why Dr. Streicher advises all of her patients who begin new relationships use condoms.

But new sexual partners aren't the only risk factor for HPV. "People who smoke are less able to clear an HPV infection," Dr. Streicher says. Scientists suspect that DNA damage caused by smoking impairs the immune system's ability to fight off HPV. "Smoking affects cells throughout the body and is associated with so many diseases and different types of cancer."

Stress may also play a role, she says. In fact, researchers reporting in the journal BMC Cancer found that chronic stress and large changes in levels of the stress hormone cortisol from morning to night may play a role in HPV-induced cervical cancer. (If you're often anxious and exhausted, it might be mitochondrial dysfunction.)

More ways to ward off cancer caused by HPV

To help lower your risk of cervical cancer, eat a variety of fruits and vegetables every day, suggests Dr. DePree. These foods contain nutrients such as antioxidants, carotenoids, flavonoids and folate. These help the body fight off HPV and prevent an HPV infection from turning healthy cervical cells into cancerous ones.

And Dr. Streicher suggests getting the HPV vaccine. "The FDA has approved the HPV vaccine up until age 45," she says. "The immunological response to the vaccine is not going to be as robust after that. But it will still offer some protection and there are no safety issues. Plus, there is some data that shows the vaccine does help clear an HPV virus you already have. I think it's appropriate for women to discuss with their physicians."

Not in the mood as often lately? Read on to discover how to boost your libido naturally:

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

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Doctor Explains What You REALLY Need To Know About HPV

Shock, despair, confusion, surprise, anxiety, worry, guilt – the mixture of emotions some people experience after receiving the results of their cervical screening when it states that Human Papillomavirus (HPV) has been detected.

For some, it's the first they've ever heard of the virus and for others it is a cause of relationship breakdown and fidelity questions. The lack of awareness, myths, misconceptions, taboo and stigma surrounding HPV, cervical screening and cervical cancer, I believe, all play a role in this.

A recent survey by YouGov for the Eve Appeal, the UK's leading gynaecological cancer charity, found that only 15% of the people had a good understanding about cervical screening. This is a disappointing stat but also potentially explains why the numbers of people attending their screening appointments has continued to drop in recent years. In the UK, currently, only 1 in 3 attend. Why would you go for an assessment that is quite intimate and embarrassing (for many) if you do not understand its significance or the basis behind it?

What is cervical cancer and what is its connection with HPV?

Cervical cancer occurs in the cervix also known as the neck of the womb, the part that connects the vagina to the womb. It is the fourth most common cancer occurring in people with vaginas worldwide. It affects anyone with a cervix at any age but its incidence rates in the UK are highest amongst women aged between 30-34.

Cervical cancer is strongly associated with the virus, HPV. According to cancer research UK, HPV causes 99.8% of cervical cancer. It does this by causing changes to the cells of the cervix, which overtime can develop into cancer. There are over a hundred different strains of HPV including those that cause warts on the hands, face, feet, genitals etc. 13 of these strains are considered 'high-risk' as they are linked with cancer – of the anus, vagina, vulva, penis, mouth, throat and, as mentioned earlier, cervix. HPV is quite common and most people will have it at some point in their lifetime – around 80%! The good news is that our immune system is very good at getting rid of it – 90% of people will have cleared the virus within 2 years.

HPV is a sexually transmitted infection and this is likely where a lot of the taboo and stigma around it stems from – its link to sex. So many people assume that contracting it must mean that an individual has had multiple sexual partners or partook in high-risk sexual behaviours when in reality, it can be picked up from the very first sexual encounter, regardless of gender or sexual orientation and it does not have to involve penetrative sex. HPV can be transmitted through oral, vaginal or anal sex, sharing sex toys, fingering and so on. HPV does not often cause any symptoms so an infected person is usually completely unaware that they have it thereby facilitating its spread. Additionally, HPV can lay dormant/inactive in the body for a long time without being detected or causing any problems and then becoming active many years later. This is why it can be difficult to know at what point the virus was contracted and from whom.

Having said all of that, there are ways in which we can reduce our risks of being infected with HPV. This includes partaking in the HPV vaccination programme, which has been found to be 90% effective and its protection lasts at least 10 years. The vaccine is most effective when given before any sexually activity has begun. For this reason the vaccine is offered to both boys and girls aged 12-13 at schools in the UK. Not smoking, practicing safe sex, and building our immune systems can all help to reduce our risks too.

Awareness around HPV, its close link to cancer, how easily transmitted it is and the fact that it is preventable is paramount. A recent YouGov survey found that only 5% of people had a good understanding about HPV. This desperately needs to improve – knowledge is truly power and in this case lifesaving. Conversations surrounding HPV should be more open and free of judgement. They are crucial – especially as preventing HPV in turn helps to prevent cervical cancer.

How does cervical screening work and why is it important?

Cervical screening also known as smear test/pap smear is a test to check the health of the cervix. In the UK, women and people with a cervix between the ages of 25-64 are invited every 3-5 years depending on how old they are, where they live and their previous results. The test involves inserting a speculum which is a tool used to open up the vagina to clearly visualise the cervix and then using a brush to collect a sample of cervical cells which is then sent to a lab to be examined.

In England, Scotland and Wales, HPV primary screening is used where they test for high risk HPV first and if present cell changes are then assessed for. If these are found, the patient is referred for further assessments involving colposcopy -where the cervix is examined more extensively using a microscope and then treated accordingly. In this way, preventing cervical cancer from occurring at all.

Cervical screening literally saves thousands of lives a year. It prevents 70% of cervical cancer deaths and in the UK, it is free, as part of the national cancer screening programme. Anyone with a cervix is encouraged to attend their cervical screening appointment when eligible, whether they are lesbian, married, trans men or have only had one sexual partner their whole lives and regardless of how long it's been since their last sexual encounter. Even individuals who have not had sex before can also partake, if they wish. This is your friendly reminder; please book your appointment when you're due/invited. It could save your life!

If there is anything I would like you to remember after reading this, it is:

Get your HPV vaccine and encourage others to if eligible

Attend your cervical screening appointments when invited

Please don't smoke

Raise awareness about what you have learnt in this article by sharing the knowledge with family and friends. Knowledge is truly power.

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