Whether it’s worries over Gardasil making girls go wild, or it’s somber discussion about cervical cancer, discourse about human papillomavirus (HPV) centers around its impact on females. But who are most of these females getting HPV from? For the most part, they’re getting it from male partners. And despite the fact that cervical cancer is the most common cancer associated with HPV, it is not the only one. A high-risk strain of HPV can lead to cancers of the penis, anus, mouth, and throat; additionally, there are strains of HPV that cause genital warts, which affect males and females equally. So why don’t males figure very prominently in discussions of HPV and the preventive vaccine, Gardasil?
Mouth, throat, penile, and anal cancers can all be caused by HPV.
Some people think that if they remain abstinent until marriage, they will be able to avoid sexually transmitted diseases (STDs) — but not very many people can say with certainty that their spouses have never had any other sexual partners. Eva Perón, the second wife of Argentine president Juan Perón and a leader in her own right, was made famous here by the musical Evita. According to physician and writer Shobha S. Krishnan, she died in 1952 of cervical cancer — the same fate that befell her husband’s first wife. Many believe that Juan Perón was the source of both women’s ultimately fatal HPV infections.
While one’s own sexual behavior can increase risk for acquiring an STD, it is not the only factor — the sexual history of one’s partner also plays an important role. HPV is especially tricky because there is currently no FDA-approved test for HPV in males — despite the fact that more than half of sexually active males are estimated to have been infected with HPV at some point in their lives. And, because it is so often asymptomatic, a male can carry this virus without knowing it, unwittingly infecting his partners.
Most females with HPV acquire it from a male partner. One study investigated young women in long-term monogamous relationships; their male significant others were the only sexual partners these subjects had ever had. Despite only having one sexual partner, nearly 50 percent of these females contracted HPV within three years. Risk was correlated with the male partners’ previous sexual experience.
Researchers have found that males are at increased risk for HPV infection if they:
- engage in unprotected sex
- have a higher number of sexual partners
- smoke or use other tobacco products
- are uncircumcised
Circumcision can be a touchy subject. However, it does seem that circumcision reduces the risk for acquiring many STDs, including HPV as well as HIV, gonorrhea, chlamydia, syphilis, and chancroid. A 2006 study found that circumcision reduced female-to-male HIV transmission rates by 48 to 60 percent — and now researchers are correlating circumcision with decreased HPV transmission rates as well. It is thought that the foreskin provides an ideal environment for many types of sexually transmitted viruses and microbes to thrive, as well as more surface area onto which pathogens can be transferred.
Another subgroup that is at increased risk for HPV infection is men who have sex with men (MSM). One study of HIV-negative men found that 31 percent of exclusively heterosexual males tested positive for one of the four types of HPV protected against by Gardasil; the prevalence of the same strains in MSM was 59 to 66 percent. HPV rates among HIV-positive MSM are much higher: Nearly 3 out of 4 are infected with potentially cancer-causing HPV strains. MSM is another group that is not well served by the dearth of education about HPV.
Sexually active people don’t just have to worry about their potential to transmit HPV to their partners — HPV can cause health problems in anyone, regardless of gender. Recurrent respiratory papillomatosis (RRP) is a rare infection that can be caused by genital warts in the airway. Although it can be transmitted to an infant during birth, among adults it is primarily transmitted by oral sex and afflicts males at a greater rate than it affects females. Those with RRP might be misdiagnosed as having asthma or bronchitis, as symptoms can include hoarseness and chronic coughing. In severe cases, warts can block the airways, interfering with breathing. These warts must be removed surgically, but it is common for them to grow back, requiring ongoing treatment.
HPV can also cause mouth, throat, penile, and anal cancers:
- While mouth and throat cancers used to be caused mostly by tobacco, an ever-increasing proportion of them are caused by HPV now that smoking is becoming less common. It was recently found that oral HPV is more common in males than in females — and so are HPV-caused mouth and throat cancers.
- Penile cancers are also rare, especially in populations where circumcision is widespread. In some societies in which circumcision is not customary, however, penile cancer rates can be quite high, accounting for 10 to 20 percent of cancers among males.
- Lastly, anal cancer affects both males and females and is strongly associated with engaging in receptive anal sex. Proportionately, men who have sex with men are at a higher risk of developing anal cancer, but in terms of sheer numbers, more females than males develop anal cancer. A University of Arizona study found that 1 out of 4 heterosexual men was infected with HPV in the anus; identifying as a heterosexual male might not mean you’re not at risk. Luckily, there are ways to screen for precancerous anal lesions in anyone at risk for anal cancer. If you are at risk for anal cancer and anal Pap tests are not a part of your routine health care, talk to a health-care provider about incorporating them into regular checkups.
You may have heard that, in the absence of symptoms such as warts or lesions, it is difficult or even impossible to test for HPV in males. This is because there is currently no FDA-approved screening method to detect HPV in males. However, HPV researchers have devised ways to test for the virus in males, and their methods have been invaluable in the study of HPV in the male population. One such technique involves applying fine-grain sandpaper or an emery board to the penis and scrotum, and using it to loosen skin cells, which are removed with a moistened swab. These cells can then be analyzed for the presence of HPV DNA. There are also ways to check blood for antibodies against HPV — but blood tests are currently only used for research purposes and seem to yield an unacceptable number of false negatives. Perhaps someday tests like those used in research will be improved and available to all males who wish to learn their HPV status.
More information about HPV in males can be found at the Centers for Disease Control and Prevention’s website. Planned Parenthood health centers, as well as other clinics and health-care providers, can diagnose and treat genital warts and penile skin lesions. Additionally, Planned Parenthood carries Gardasil, the vaccine that protects against four strains of HPV and is approved for use in both males and females.
Click here to check out other installments of our monthly STD Awareness series!