Unfortunately many men do not appreciate the risks associated with human papillomavirus (HPV). This is mostly due to the fact that the appearance of visible genital warts is less common among men than it is in women. Also, the vaccine that has recently become available to immunize against various types of HPV is only approved for women. This also seems to suggest to men that HPV is a “woman problem.”
Finally, since the primary concern with human papillomavirus is cervical cancer and men are born without that anatomical structure, they feel an unwarranted sense of protection.
In truth, there are many reasons why men should be concerned with human papillomavirus (HPV). If for no other reason, human papillomavirus causes genital warts in women and men. While the rates of infection may be higher in women, HPV infection and genital warts are still the most common sexually transmitted disease.
Another reason for concern is that men may be infecting their sexual partners even though they have no apparent symptoms.
The lesions that occur on men may be nearly impossible to see with the naked eye. While many men may not recognize genital warts, once men have this HPV infection they become a “reservoir” for the virus. Human papillomavirus can live in the vas deferens (the tube that brings semen from the testes), the prostate gland, pubic hair follicles, and within the urethra (the tube through which urine exits the body).
While they are fairly rare, human papillomavirus infection has been associated with cancers of the penis and cancers of the urethra and anus in men. In fact, several of the over 80 identified types of HPV can cause cancer in men. For all of these reasons, it is important that men be aware of the problems that human papillomavirus (HPV) can cause, how to recognize the associated illnesses, and how to access the help that they need.
Genital warts can be skin-colored, whitish or gray. They are often raised above the level of the skin, but in men, maybe only slightly. In fact, it has been suggested that most men with genital warts only get a slightly raised, flat lesion that is barely noticeable. Also, symptoms may not ever occur with the eruption of genital warts in men.
Therefore men may not seek treatment. Another factor that makes genital warts in men difficult to detect is the fact that they may occur in areas obscured by pubic hair or behind the scrotum and are therefore rarely seen.
Genital warts may occur in any location on the body, even the mouth, throat, lungs, arms, or legs; however, genital warts in these locations are rare. In most cases, men will have genital warts:
- On the head or shaft of the penis
- Inside the urethra (the tube within the penis that passes urine)
- Within the foreskin of uncircumcised men (perhaps on the inside fold)
- Between the scrotum and the anus
- On the scrotum
- In the fold of the leg at the inner thigh
- On and around the anal sphincter
- Within the anus itself
Because genital warts on men can be so difficult to detect, a physician may need to perform a test for warts that are not immediately visible to the naked eye. By placing a small amount of acetic acid (vinegar) on a suspected wart, the area that made up of warty cells will turn white. Unfortunately the acetic acid test is not very sensitive or specific. In other words, it may miss a lot of genital warts that are really there and in other cases normal skin may show up like a wart. While there are more sophisticated tests available to detect the presence of HPV (by testing for human papillomavirus DNA) these are only used in a laboratory and clinical research settings and are not routinely commercially available.
It is reasonable to be as cautious as possible when it comes to human papillomavirus infection. Condoms do not fully prevent transmission of HPV, but using them properly and consistently can greatly reduce the risk. Since many genital warts on men are believed to be barely visible flat lesions on the shaft of the penis, covering that area with a latex condom separates the wart from the sexual partner. Since the highest concentration of HPV is in the genital wart itself, physical separation is an excellent way to reduce spread.
It is also important to know your sexual partner. Do not have sexual intercourse (vaginal, oral, or anal) with someone that has visible genital warts. It is difficult to know if the lesions are genital warts and if they are infectious at the time, but the transmission rate of HPV after a single sexual encounter with an infected person is 60%–that is extremely high. It is always best to encourage anyone with genital lesions or sores to seek medical advice and to avoid sexual intercourse until the condition is properly identified and treated.
The risk of genital warts and HPV-related cancers is higher in homosexual men, especially in men who participate in receptive intercourse with other men. While men and woman can get genital warts around the outside of the anus, it is exceeding rare to get genital warts inside of the anus without receptive anal intercourse with an infected person. Anal cancer occurs about 10 to 15 times as often in homosexual men than in heterosexual men (when both groups are actively having sex).
Also, men with HIV/AIDS are at greater risk for all HPV-related illnesses, including cancers. It is particularly important for men who have sex with men to routinely and consistently wear barrier protection (condoms) and to be completely open and forthcoming with the physicians that provide them with medical care.
Currently, the vaccine that is used to immunize against certain types of HPV is not available or approved by the FDA for use in men. Studies are currently being done to determine if the vaccine is effective in men at stopping the spread of HPV and if that translates into reduced rates of genital warts and certain cancers. If the research results are as expected, it could represent a huge breakthrough in the fight against human papillomavirus and genital warts in men.