This week, Dr. Joe DeOrio, a urologist in Chicago, tackles questions about male sexuality. To ask Dr. Joe your own question, click here.
Dear Dr. Joe,
I am BEYOND confused because none of the information related to HPV seems to focus very much on HPV in men. Once a man has it, is it possible that the virus can go away completely? I don’t mean the symptoms (as I am aware that they often go away on their own), but the VIRUS that causes these symptoms? Will a man who once had the virus ever not be contagious? And would a man benefit from the HPV vaccine?
Great question! You are absolutely right — most people focus on human papilloma virus (HPV) in women, and understandably so, given its association with cervical cancer. But men can certainly become infected with HPV as well.
HPV is a virus, spread by skin-to-skin contact, and it is considered a sexually transmitted disease. There are over 100 subtypes of HPV, and over 30 of them can infect the genital area. At any given time, there are about 20 million people in the United States infected with HPV, with about 6.2 million new cases per year. In fact, 50% of sexually-active adults will have had HPV at some point during their lives, and by 50 years old, 80% of females have HPV. Risk factors for HPV infection include multiple sexual partners, initiating sexual intercourse at an early age, and having sex with an infected partner.
HPV infection is predominantly asymptomatic, meaning you don’t know you have it. Subtypes 6 and 11, however, are associated with genital warts, and subtypes 16 and 18 (as well as 31, 33, 35, 39, 45, and 51) are associated with malignancies, especially cervical and anal cancer, and, less frequently, penile cancer. In fact, 99% of cervical cancers and 84% of anal cancers are related to HPV infection.
Cancers aside, most HPV infections resolve on their own. The median duration of infection is about 8 months, with over 90% resolved by 2 years. So, yes, the virus can go away completely — and you would no longer be contagious. Unfortunately, there are no standard medical tests to check for HPV infection in men, so there is really no reliable way to know if you are infected, unless you have visible lesions.
Having said that, determining if you have been infected with HPV is not as important as ensuring that you don’t have any of the diseases that it can cause. So regularly check your junk. See something weird? Have it checked out. Warts are growths that are typically painless and can occur anywhere in the genital region. They can be raised, flat, or cauliflower-shaped, and are usually whitish or pink. Penile cancers, on the other hand, are much more varied. Appearances range from subtle color changes or bumps to large, ugly-appearing lesions. Sadly, anal cancer may not have any symptoms until late in its course, but some patients develop anal itching, bleeding, or changes in bowel habits.
If you develop genital warts, most will spontaneously regress. They are contagious, though, so avoid intercourse with your partner until they have regressed or you have had them removed. There are a number of treatments to remove genital warts, from creams to surgical excision. See a medical professional to determine which is best for you. Cancer, however, is a different story. It will not spontaneously resolve. If you are concerned that you may have cancer, see a doctor immediately.
Worried about infecting your partner? I understand, but in the absence of outward lesions, there is just no good way to know if you are infected with HPV. Have a female partner? Encourage her to have annual pelvic exams and Pap smears with her primary doctor. And, of course, use condoms correctly every time — they won’t protect your partner 100% but they can significantly reduce the risk of transmission by reducing the skin-to-skin contact.
If you are really concerned about HPV infection, consider the HPV vaccine. Currently, there are 2 vaccines on the market: Cervarix and Gardasil. Only Gardasil is approved for use in men, and it provides protection against HPV 6, 11, 16, and 18. That should protect you from about 90% of genital warts and 75% of cancers caused by HPV. A few things to note:
- The vaccine is most effective if received before you become sexually active. Nonetheless, the vaccine may still be beneficial in sexually active individuals.
- It will not cure you if you already are infected with HPV, and it certainly won’t treat cancer.
- The vaccine will not protect you from other STD’s, so safe sex practices still apply.
- The vaccine is only FDA-approved for individuals 9-26 years old. Why? Because that was the age of patients included in the initial studies of the drug. Can you receive the vaccine after 26? Probably, but there is no data on its safety in older patients, and your insurance likely won’t cover it.
Hope that helps clear things up for you!
— Dr. Joe
Dr. Joe earned his undergraduate degree in Molecular Biology from Princeton University. After attending the Loyola University Stritch School of Medicine, he completed his residency training in urological surgery at the Los Angeles County Medical Center. He lives and works in Chicago, IL. Keep an eye out for his upcoming blog at docjoe.net.