HPV and Men

In June, the FDA approved a vaccine for females that targets certain strains of the human papillomavirus, or HPV, the most common sexually transmitted disease. The recommendation that young women and girls should be vaccinated against genital HPV with the drug Gardasil was big news. For the first time, infection by the virus that leads to cervical cancer could actually be prevented.

But what about men and genital HPV? Are solutions in place to reduce infection and transmission?

The Uphill Climb

Scratch the surface of HPV research and you will find that there are far more questions than answers, especially when it comes to men. For example:

• There is no test to detect HPV. Screenings rely on the visibility of genital warts on one of the partners and/or abnormalities on a woman’s Pap test.
• There is no test to detect early signs of HPV-associated cancer in men, whereas women have annual Pap smears.
• There is no vaccine for men, whereas young women have Gardasil. Two major drug manufacturers have reported significant headway, but there is no preventive treatment yet. (Some doctors have apparently recommended Gardasil for men as an “off-label” use. By definition, off-label uses are not approved, and there is no evidence Gardasil will be an effective treatment for men.)

Eileen F. Dunne, MD, medical epidemiologist at the CDC, offers some explanation. “One reason there is not an HPV test for men is that it would not be very useful in determining who is at risk for disease or for cancer. HPV is very, very common, and finding the virus doesn’t mean disease will be present.”

Dunne acknowledges, however, that we know little about the long-term effects of genital HPV in males. “When they get HPV infection, what happens? What’s the result of that infection? There’s really limited data on the natural history of HPV infection in men.”

Infection and Symptoms

Genital HPV is frequently asymptomatic; that is, you or your partner could be infected and, in some cases, eventually clear the infection without ever developing any symptoms or disease. Because of this, many people never even know they have HPV.

That’s a lucky strike for the asymptomatic carrier, but the next partner he or she infects may not be as fortunate. The appearance of warts around the penis, scrotum or anus represents the first tier of a more problematic genital HPV infection. “It’s important to know there are treatments for genital warts,” says Dunne. “But what we don’t know is if treatment results in decreased transmission of HPV. … Prevention methods should be used.”

Safer Sex

The use and labeling of condoms for HPV prevention has been embroiled in political debate. Speaking purely in the interest of health, though, condom use is a good method against spreading the virus. Some studies say that proper use of a condom can reduce the likelihood of contracting HPV by 70 percent.

Abstinence has also been suggested, though proposing it as a measure against a sexually transmitted disease is like proposing people stay at home to prevent traffic accidents.

Who should use condoms? Well, everyone having sex, since an active sex life is the leading risk factor for contracting genital HPV. According to the American Social Health Association (ASHA), “Increasing numbers of partners increases the risk of getting HPV, but the virus is so common that having only a single lifetime partner does not assure protection. It is usually impossible to determine when or from whom HPV was caught.”

Anyone with a compromised immune system is at higher risk for developing symptoms and diseases associated with genital HPV. This is significant since so many conditions—from cardiovascular illnesses, respiratory illnesses and herpes to sunburn, pregnancy and old age—are associated with immunosuppression.

HPV and Cancer

Far more perilous than unsightly and uncomfortable warts is the fact that genital HPV can lead to cancer. In males, the HPV-associated cancers are penile cancer and anal cancer.

Relative to other malignancies, penile and anal cancers are uncommon. The CDC states that incidents of penile cancer account for about 0.2 percent of all cancers in American men and predicts 1,530 diagnoses of penile cancer and 1,910 of anal cancer in 2006. The risk for anal cancer is 17 times higher among gay and bisexual men, and studies by Joel Palefsky, MD, of the University of California at San Francisco have shown significantly higher risk of anal and penile cancers when HIV is a factor.

One of several reasons that HPV vaccines have focused on women rather than men is that cervical cancer accounts for 80 percent of HPV-related cancers. Male cancers are obviously in the minority, but 20 percent is still a significant number—especially considering the prevalence of HPV infection. “While women have about 80 percent of the total burden of disease and death,” says Tom Broker, president of the International Papillomavirus Society, “it’s certainly not inconsequential for men. Penile cancer is [infecting] 100,000 men a year worldwide, and the numbers are increasing. As a global issue, penile cancer is a terrible problem.”

No Definite Answers—Yet

If the virus is so widespread, why is the research on genital HPV in its infancy? When can we expect solutions for men?

The answers are thornier than the questions. It’s no secret that potential solutions get bogged down by stigma, political agendas and the expectation of low profit margins for drug companies. At the same time, hope arrives in the form of research, clinical training and awareness campaigns.

For the individual man, the risk level associated with HPV infection appears to be low. Responsible sexual habits can greatly reduce the possibility of infection. But without lifting the viral load off society at large, genital HPV will continue to be a serious problem. We need not only to reduce our own HPV infections, but to raise the prospect of eradicating HPV and related illnesses across the globe.

Further Reading:

• ASHA: Learn About HPV
• CDC: HPV and Men--CDC Fact Sheet
• National Network for Immunization Information: HPV Vaccines

Read More About Men's Sexual Health on MSN Health and Fitness:

• Sexual Dysfunction: Is Age the Culprit?
• Finding Blood Where It Shouldn't Be
• The Cancer That Hits Men Where It Hurts
• Join the Discussion About Men's Sexual Health