STD Awareness: Is HPV Now a “Men’s Disease”?

Human papillomavirus, or HPV, is most notorious for causing cervical cancer — making it, in many people’s minds, a “women’s disease.” But this gender-blind sexually transmitted virus can cause cancer in any cell it infects, and is associated with cancers of the cervix, anus, vagina, vulva, penis, and mouth and throat — aka oropharyngeal cancer.

While oropharyngeal cancers used to be caused mostly by tobacco, as people quit smoking an increasing proportion is caused by HPV. In the 1980s, only 15 percent of oropharyngeal cancers were caused by HPV, but nowadays the virus is behind 70 percent of them. A 2011 study predicted that the number of HPV-positive oropharyngeal cancers will surpass cervical cancers by 2020.

HPV is rapidly gaining prominence among men.

It’s only 2017, but we’re ahead of schedule. Earlier this year, researchers reported that, in the United States, oropharyngeal cancer is more common among men than are cervical cancers among women — and oropharyngeal cancer rates are increasing in the male population, while they are relatively stagnant among women. These rates are projected to continue climbing, which will skew oropharyngeal cancer even more heavily toward the male population. But, in the public’s imagination, HPV is most well-known for its association with cervical cancer — while most people haven’t even heard of oropharyngeal cancer.

Oropharyngeal Cancer and HPV

Oropharyngeal cancer can strike the inside of your mouth and throat. Risk factors include tobacco (including cigarettes, snuff, and chewing tobacco), marijuana use, alcohol, and oral infection with HPV. HPV can be spread by most sexual activities — including vaginal, anal, and oral sex, as well as “French kissing” and rubbing genitals together. There are many strains of HPV, which come in two main categories: low-risk HPV, which can cause genital warts; and high-risk HPV, which can cause cancer.

Oral sex can lead to oral HPV infections, which themselves can lead to cancer. When HPV causes oropharyngeal cancer, it usually occurs at the base of the tongue, at the back of the throat, in the tonsils, or in the soft palate. Symptoms might include:

  • patches (white, red, or both) inside the mouth, on tongue, or on lips
  • swelling of the jaw
  • bleeding in the mouth
  • difficult or painful swallowing
  • trouble breathing or speaking

The fact that oral sex can transmit HPV from the genitals to the mouth lends credence to the idea that oral sex is indeed sex — not “third base,” not “almost sex.” Unfortunately, because so many of us have a lax attitude toward it, we may be less likely to use condoms or dental dams. There is also a vaccine that can protect you from infection with seven cancer-causing strains of HPV (plus two wart-causing strains), but vaccination rates aren’t as high as public health officials would like: The most recent data show that 65 percent of 17-year-old girls received at least two doses of the HPV vaccine, compared to only 46 percent of 17-year-old boys.

Men and HPV

This fall, scientists reported that 7 million U.S. men and 1.4 million U.S. women had oral HPV infections with cancer-causing strains of the virus. This finding, that five times as many men as women have potentially cancer-causing oral HPV infections, was not surprising — previous studies have also found that oral HPV is more common in males, as are HPV-associated oropharyngeal cancers.

We don’t know why men are disproportionately affected by oral HPV, but it’s possible that performing cunnilingus (sexual contact between the mouth and vulva) might be riskier than performing fellatio (sexual contact between the mouth and penis), possibly because HPV passes more easily through the vulva’s thin mucous membranes than through the thicker skin of the penis. It’s also possible that men are more likely to be infected with HPV, perhaps if they have more sexual partners, and certainly if they continue to be vaccinated at lower rates.

Recently, a large study found that 45 percent of American men carry genital HPV — for a total of nearly 35 million adult males. Furthermore, a quarter of men are infected with cancer-causing strains of HPV. And, while the female population sees a peak in HPV infections in their early 20s, male HPV prevalence increases with age. While 30 percent of men 18 to 22 years of age carried HPV, 60 percent of 58- and 59-year-olds were carriers.

For now, it’s a mystery why HPV prevalence increases as men age. It could be that they have a weaker immune response to the virus, helping infections to last longer and leaving them more vulnerable to reinfection. If men’s immunological memories are weaker, they might benefit from vaccination even after becoming sexually active, as it’s thought that the vaccine creates a stronger immune memory compared to a natural infection.

If cunnilingus is associated with an increased risk for oral HPV, it seems likely that lesbians would also be at higher risk for oral HPV infections, but data on oral HPV in lesbians is sparse. One recent study found that nearly 4 percent of women with female sexual partners have a current oral infection with a cancer-causing strain of HPV. We also know that lesbians can acquire genital HPV infections: 26 percent of lesbians have a current or past genital infection with HPV-16, a common cancer-causing strain of HPV, and 42 percent of lesbians have a current or past genital infection with HPV-6, a common wart-causing strain of HPV.

HPV can affect anyone, regardless of gender. Even though it’s gaining prominence among males, it would be no more accurate to categorize it as a “men’s disease” than it was to frame it as a women’s issue back when cervical cancer was more prominent.

Make an appointment at a Planned Parenthood health center to receive Gardasil 9, which protects against seven cancer-causing strains of HPV. If you are concerned you have symptoms of oropharyngeal cancer, Planned Parenthood Arizona can refer you to specialists who can evaluate your mouth and throat. You can also ask a dentist or doctor to perform a physical examination — although not all signs of cancer can be caught by a visual inspection.

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