Do You Have an STD? You're Not the Only One
HPV Infection In Men
Much of the information about HPV virus (human papillomavirus) centers on women, since having the virus increases their risk of getting cervical cancer. But HPV virus in men can cause health problems, too. It's important for men to understand how to reduce the risks of HPV infection.
HPV infection can increase a man's risk of getting genital cancers, although these cancers are not common. HPV can also cause genital warts in men, just as in women.
More than half of men who are sexually active in the U.S. Will have HPV at some time in their life. Often, men will clear the virus on their own, with no health problems.
Some of the types of HPV associated with genital cancers can lead to cancer of the anus or penis in men. Both of these cancer types are rare, especially in men with a healthy immune system. The American Cancer Society (ACS) estimates that in 2022, about 2,070 men in the U.S. Will be diagnosed with cancer of the penis and 3,150 men will be diagnosed with anal cancer.
The risk of anal cancer is about 17 times higher in sexually active gay and bisexual men than in men who have sex only with women. Men who have HIV (human immunodeficiency virus) are also at higher risk of getting this cancer.
Most cancers that are found in the back of the throat, including at the base of the tongue and in the tonsils, are HPV related. In fact, these are the most common HPV-related cancers found in men. More than 13,000 new cases are diagnosed in men each year.
Other types of HPV virus rarely cause cancer in men, but they do cause genital warts. At any given point in time, about 1% of sexually active men in the U.S. Will have genital warts.
The types of high-risk HPV that can cause cancer rarely present any symptoms in men or in women. Genital warts are the first symptom you may see with low-risk HPV strains that cause warts but not cancer.
To diagnose genital warts in men, the doctor will visually check a man's genital area to see if warts are present. Some doctors will apply a vinegar solution to help identify warts that aren't raised and visible. But the test is not foolproof. Sometimes normal skin is mistakenly identified as a wart.
There is no routine test for men to check for high-risk HPV strains that can cause cancer. However, some doctors are urging anal Pap tests for gay and bisexual men, who are at higher risk of anal cancer caused by HPV. In an anal Pap test, the doctor collects cells from the anus, and then has them checked for abnormalities in a lab.
There is no treatment for HPV infection in men when no symptoms are present. Instead, doctors treat the health problems that are caused by the HPV virus.
When genital warts appear, a variety of treatments can be used. The patient can apply prescription creams at home. Or a doctor can surgically remove or freeze off the warts.
Early treatment of warts is discouraged by some doctors because genital warts can go away on their own. It can also take time for all warts to appear. So a person who treats warts as soon as they appear may need another treatment later on.
Anal cancer can be treated with radiation, chemotherapy, and surgery. The specific treatments depend on the stage of cancer -- how big the tumor is and how far the cancer has spread.
In the U.S. Gardasil 9 is available to prevent HPV infection, cervical, and anal cancer. It can be given to men and women as young as age 9 through age 45.
If a man's long-term sexual partner has HPV, chances are good HPV transmission has already occurred and they also have it. HPV in men may clear from the body more easily than in women. Women, in general, often clear the virus in two years or less.
The HPV types associated with cervical cancer usually do not cause health problems for a heterosexual man having sex with an HPV-infected woman.
If a partner has HPV, it does not necessarily mean they have had sex with someone else recently. The virus can lay dormant in the body for years without causing noticeable symptoms.
Abstinence is the only sure way to prevent HPV transmission. Risk of transmission can be lowered if a person has sex only with one person who is not infected and who is also monogamous.
To lower the risk of HPV transmission, men can also limit the number of sex partners and pick partners who have had few or no partners in the past.
Condoms can provide some protection against HPV transmission. Unfortunately, they aren't 100% effective, since HPV is transmitted primarily by skin-to-skin contact. The virus can still infect the skin uncovered by the condom.
In a recent study of young women who had just become sexually active, those whose partners used a condom each time they had sex were 70% less likely to get an HPV infection than were women whose partners used a condom less than 5% of the time.
8 Things You May Not Know About HPV
The human papillomavirus, or HPV, is the most common sexually transmitted infection in the United States. According to the Centers for Disease Control and Prevention (CDC), about 43 million Americans had a sexually transmitted form of HPV in 2018, the latest year for which statistics are available, and 13 million become newly infected that year.
For most people infected with HPV, the virus doesn't cause any health problems, but for some, it leads to genital warts or cancer. Of particular concern is the growing rate of oropharyngeal (mouth and throat) cancer caused by HPV, as reported in an investigation published December 16, 2021, in JAMA Otolaryngology Head and Neck Surgery. But HPV plays a significant role in multiple kinds of cancer, including cervical cancer and anal cancer.
In many cases, HPV infection is vaccine-preventable, but as of 2020, less than 60 percent of adolescents in the United States were fully vaccinated against HPV, according to an article published September 3, 2021, in the CDC's Morbidity and Mortality Weekly Report.
Experts worry that many people are still fuzzy on details about the virus — including how it's transmitted, who is most at risk, and how to protect yourself from infection.
"There's so much that people don't know or misunderstand about HPV," says William Robinson, MD, a gynecologic oncologist at the University of Mississippi Medical Center in Jackson. Here's what leading experts say about some aspects of HPV that may surprise you.
1. Odds Are You've Probably Had HPV"If you've been sexually active, you've got at least a 50 percent chance of having had the virus," says Dr. Robinson. But not all forms of HPV carry the same health risks.
HPV is actually an umbrella term for more than 150 strains of related viruses, most of which are relatively harmless. About 40 of them can infect the genital areas, and a smaller number can cause genital warts or cancer.
Most of the time, you'll never even know you've had HPV, because most strains (except those that cause warts) don't cause any symptoms. And in about 90 percent of cases, the immune system clears the virus naturally within two years, according to the CDC. But when HPV does not go away on its own, some HPV strains can cause a variety of types of cancer.
People who have HIV are more likely to have HPV infections that persist, raising their chances of developing an HPV-related cancer.
2. Condoms Can't Completely Protect You From HPVWhile using condoms can reduce your risk of HPV infection, it can't eliminate this risk entirely.
"The virus can live in the scrotum and the hair-bearing areas of the genitals," says Barbara Goff, MD, a gynecologic oncologist and surgeon-in-chief at the University of Washington Medical Center in Seattle. This means that any skin-to-skin genital contact can transmit the virus, as can oral, vaginal, and anal sex.
"That's why it's so important for young people to get vaccinated for HPV well before they become sexually active," says Dr. Goff.
3. If You Have HPV, Your Current Partner May Not Be to BlameIf you learn that you have HPV — which is most likely to occur after a cervical HPV test or Pap smear — don't jump to conclusions about how you got the infection.
"Some patients assume that their current sexual partner gave it to them," says Robinson. "But that's probably not the case. The women who develop cervical cancer at age 40 probably got infected shortly after [having sex] with their first sexual partner."
That's because HPV can stay dormant for years before it starts causing the cell damage that can lead to cancer. HPV-triggered cancers can take years, or even decades, to develop.
4. Cervical Cancer Isn't the Only Cancer Caused by HPVMost people who know about HPV associate it with cervical cancer, but the virus is increasingly implicated in other forms of cancer — including oropharyngeal cancers, as well as cancers of the vulva, vagina, anus, and penis. Evidence suggests that women who have had cervical cancer or precancerous changes (known as dysplasia) in the cervix are at greater risk for HPV-related cancers in other areas of the body, according to Goff.
The CDC estimates, based on data from 2014 to 2018, that each year in the United States:
Not all cases of cancer in these areas of the body are caused by HPV, but the majority are. The CDC estimates that 91 percent of cervical cancer cases are caused by HPV, as are 91 percent of anal cancer cases, as well as 69 percent of vulvar cancers and 63 percent of penile cancer cases.
There are currently no established screening guidelines for HPV-related cancers other than cervical cancer. But researchers are exploring how to identify people at high risk for other HPV-associated cancers, so that these cancer cases can be identified and treated early.
For people at risk for anal cancer, anal cytology testing (also called the anal Pap test) can be used to check for abnormal cells in the anal canal. Some medical societies recommend this test for sexually active adults with HIV starting around ages 25 to 30, but anyone with a suppressed immune system — such as organ transplant recipients — may be at higher risk for anal cancer. You don't need to have receptive anal sex to be at higher risk for anal cancer, since HPV can make its way into the anal canal from nearby areas.
5. Smoking Raises Your Risk for HPV-Related Cancer"Smoking weakens the immune system, which can allow HPV to grow more rampantly," says Sharyn Lewin, MD, the medical director of gynecologic oncology at Holy Name Medical Center in Teaneck, New Jersey. If you want to prevent a dormant HPV infection from turning into a precancerous or cancerous growth, kick your cigarette habit today.
6. The HPV Vaccine Isn't Just for GirlsThe HPV vaccine not only provides women with nearly 100 percent protection against cervical cancer caused by HPV types 16 and 18 — which cause 70 percent of cervical cancer cases — but it also provides direct health benefits for men, including prevention of genital warts. And although conclusive studies have yet to be done, many researchers believe that vaccination of boys will eventually reduce rates of oropharyngeal and other cancers as well.
Gardasil 9, the HPV vaccine currently available in the United States, is approved by the U.S. Food and Drug Administration (FDA) for use in all people ages 9 to 45.
The HPV vaccine doesn't protect against all potentially high-risk types of HPV, nor does it protect against any strains of the virus a person was exposed to before vaccination. So periodic cervical HPV tests or Pap tests are still recommended for women who have had the HPV vaccine.
Gardasil 9, the HPV vaccine, protects against HPV types 16, 18, 31, 33, 45, 52, and 58, all of which can cause cancer, as well as types 6 and 11, which can cause genital warts. Two earlier HPV vaccines, Cervarix and Gardasil, protect against fewer HPV strains.
8. The HPV Vaccine Doesn't Treat HPVThis may seem obvious, but it bears repeating: The HPV vaccine is only preventive. It doesn't fight the virus in people who already have it. That's partly why it's recommended primarily for children and young adults — chances are that if you're older, you've already been exposed to at least some of the HPV strains the vaccine protects against. But this isn't always the case, of course, which is why Gardasil 9 is approved for adults up to age 45.
There's no treatment for HPV infection, although it can go away on its own. Women who have abnormal HPV or Pap test results may be advised to have additional tests to further examine any abnormality, to undergo treatment to remove the abnormal cells, or to wait and get retested in three to six months, according to the American College of Obstetricians and Gynecologists.
Additional reporting by Quinn Phillips.
HPV In Men: Oral Cancer A Growing Concern
The most effective way for anyone to prevent getting genital warts and HPV-related cancers is to get the HPV vaccine at the recommended age.
Gardasil 9, the HPV vaccine currently available in the United States, protects against HPV types 16, 18, 31, 33, 45, 52, and 58, all of which can cause cancer, as well as types 6 and 11, which cause genital warts.
All young people should get the HPV vaccine at age 11 or 12. If you didn't get the complete series of vaccines at that age (or earlier), you can still get it through age 26.[8]
The HPV vaccine is also approved for adults up to age 45, based on a discussion with your healthcare provider about whether it makes sense for you.
For men of all ages, limiting your number of sex partners can lower your exposure to HPV, and using condoms or dental dams during sex is partially protective against HPV infection.
A new type of underwear made of stretchy latex and designed to prevent sexually transmitted infections during oral sex may provide another option. It was cleared by the U.S. Food and Drug Administration in May 2022. While men can wear these protective undergarments, they are sized primarily for women.
Additional reporting by Quinn Phillips.
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