What is a Human Papillomavirus (HPV)?
Genital human papillomavirus (HPV) is a common virus. Most sexually active people in the will have HPV at some time in their lives. There are more than 40 types of HPV that are passed on through sexual contact. These types can infect the genital areas of men, including the skin on and around the penis or anus. They can also infect the mouth and throat.
- Genital warts usually appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. Warts will not turn into cancer.
- Anal warts (also called "condyloma acuminata") are a condition that affects the area around and inside the anus. They may also affect the skin of the genital area. They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow larger than the size of a pea. Usually, they do not cause pain or discomfort to afflicted individuals. As a result, patients may be unaware that the warts are present. Some patients will experience symptoms such as itching, bleeding, mucus discharge and/or a feeling of a lump or mass in the anal area.
How do Men get HPV?
HPV is passed on through genital contact—most often during vaginal and anal sex. HPV may also be passed on during oral sex. Since HPV usually causes no symptoms, most men and women can get HPV—and pass it on—without realizing it. People can have HPV even if years have passed since they had sex. Even men with only one lifetime sex partner can get HPV.
What are the health problems caused by HPV in men?
Most men who get HPV (of any type) never develop any symptoms or health problems. But some types of HPV can cause genital warts. Other types can cause cancers of the penis, anus, or oropharynx (back of the throat, including base of the tongue and tonsils.) The types of HPV that can cause genital warts are not the same as the types that can cause cancer.
Note: Anal cancer is not the same as colorectal cancer. Colorectal cancer is more common than anal cancer, and is not caused by HPV.
How common are HPV-related health problems in men?
About 1% of sexually active men in the U.S. have genital warts at any one time.
Cancers of the penis, anus and oropharynx are uncommon, and only a subset of these cancers are actually related to HPV. Each year in the U.S. there are about:
400 men who get HPV-related cancer of the penis
1,500 men who get HPV-related cancer of the anus
5,600 men who get cancers of the oropharynx (back of throat), but many of these cancers are related to tobacco and alcohol use, not HPV.
Some men are more likely to develop HPV-related diseases than others:
Gay and bisexual men (who have sex with other men) are about 17 times more likely to develop anal cancer than men who only have sex with women.
Men with weakened immune systems, including those who have HIV, are more likely than other men to develop anal cancer. Men with HIV are also more likely to get severe cases of genital warts that are harder to treat.
What are the signs and symptoms?
Most men who get HPV never develop any symptoms or health problems. But for those who do develop health problems, these are some of the signs and symptoms:
One or more growths on the penis, testicles, groin, thighs, or in/around the anus.
Warts may be single, grouped, raised, flat, or cauliflower-shaped. They usually do not hurt.
Warts may appear within weeks or months after sexual contact with an infected person.
Is there a test for HPV in men?
Currently, there is no HPV test recommended for men. The only approved HPV tests on the market are for screening women for cervical cancer. They are not useful for screening for HPV-related cancers or genital warts in men.
There is no approved test to find genital warts for men or women. However, most of the time, you can see genital warts. If you think you may have genital warts, you should see a health care provider.
There is no test for men to check one’s overall “HPV status.” But HPV usually goes away on its own, without causing health problems. So an HPV infection that is found today will most likely not be there a year or two from now.
You can check for any abnormalities on your penis, scrotum, or around the anus. See your doctor if you find warts, blisters, sores, ulcers, white patches, or other abnormal areas on your penis—even if they do not hurt.
Is there a treatment or cure for HPV?
There is no treatment or cure for HPV. But there are ways to treat the health problems caused by HPV in men.
Genital warts can be treated with medicine, removed (surgery), or frozen off. Some of these treatments involve a visit to the doctor. Others can be done at home by the patient himself. No one treatment is better than another. But warts often come back within a few months after treatment—so several treatments may be needed.
Treating genital warts may not necessarily lower a man’s chances of passing HPV on to his sex partner. If warts are not treated, they may go away on their own, stay the same, or grow (in size or number)
Podofilox is an antimitotic drug that destroys warts, is relatively inexpensive, easy to use, safe, and self-applied. Podofilox solution should be applied with a cotton swab, or podofilox gel with a finger, to visible genital warts twice a day for 3 days, followed by 4 days of no therapy. This cycle can be repeated, as necessary, for up to four cycles. The total wart area treated should not exceed 10 cm2, and the total volume of podofilox should be limited to 0.5 mL per day. If possible, the health-care provider should apply the initial treatment to demonstrate the proper application technique and identify which warts should be treated. Mild to moderate pain or local irritation might develop after treatment. The safety of podofilox during pregnancy has not been established.
Imiquimod is a topically active immune enhancer that stimulates production of interferon and other cytokines. Imiquimod cream should be applied once daily at bedtime, three times a week for up to 16 weeks. The treatment area should be washed with soap and water 6–10 hours after the application. Local inflammatory reactions, including redness, irritation, induration, ulceration/erosions, and vesicles, are common with the use of imiquimod, and hypopigmentation has also been described. Imiquimod might weaken condoms and vaginal diaphragms. The safety of imiquimod during pregnancy has not been established.
Sinecatechin ointment, a green-tea extract with an active product (catechins), should be applied three times daily (0.5-cm strand of ointment to each wart) using a finger to ensure coverage with a thin layer of ointment until complete clearance of warts. This product should not be continued for longer than 16 weeks. The medication should not be washed off after use. Sexual (i.e., genital, anal, or oral) contact should be avoided while the ointment is on the skin. The most common side effects of sinecatechins 15% are erythema, pruritis/burning, pain, ulceration, edema, induration, and vesicular rash. This medication may weaken condoms and diaphragms. No clinical data are available regarding the efficacy or safety of sinecatechins compared with other available anogenital wart treatment modalities. The medication is not recommended for HIV-infected persons, immunocompromised persons, or persons with clinical genital herpes because the safety and efficacy of therapy in these settings has not been established. The safety of sinecatechins during pregnancy also is unknown.
Cryotherapy destroys warts by thermal-induced cytolysis. Health-care providers must be trained on the proper use of this therapy because over- and undertreatment can result in complications or low efficacy. Pain after application of the liquid nitrogen, followed by necrosis and sometimes blistering, is common. Local anesthesia (topical or injected) might facilitate therapy if warts are present in many areas or if the area of warts is large.
Pedophyllin resin 10%–25% should be applied to each wart and allowed to air-dry before the treated area comes into contact with clothing; overapplication or failure to air dry can result in local irritation caused by spread of the compound to adjacent areas. The treatment can be repeated weekly, if necessary. To avoid the possibility of complications associated with systemic absorption and toxicity, two guidelines should be followed: 1) application should be limited to <0.5 mL of podophyllin or an area of <10 cm2 of warts per session and 2) the area to which treatment is administered should not contain any open lesions or wounds. The preparation should be thoroughly washed off 1–4 hours after application to reduce local irritation. The safety of podophyllin during pregnancy has not been established. Podophyllin resin preparations differ in the concentration of active components and contaminants. The shelf life and stability of podophyllin preparations are unknown.
Trichloroacetic acid (TCA) or Bichloroacetic acid (BCA) are caustic agents that destroy warts by chemical coagulation of proteins. Although these preparations are widely used, they have not been investigated thoroughly. TCA solutions have a low viscosity comparable with that of water and can spread rapidly if applied excessively; therefore, they can damage adjacent tissues. A small amount should be applied only to the warts and allowed to dry before the patient sits or stands, at which time a white frosting develops. If pain is intense, the acid can be neutralized with soap or sodium bicarbonate. If an excess amount of acid is applied, the treated area should be powdered with talc, sodium bicarbonate (i.e., baking soda), or liquid soap preparations to remove unreacted acid. This treatment can be repeated weekly, if necessary.
Surgical therapy has the advantage of usually eliminating warts at a single visit. However, such therapy requires substantial clinical training, additional equipment, and a longer office visit. After local anesthesia is applied, the visible genital warts can be physically destroyed by electrocautery, in which case no additional hemostasis is required. Care must be taken to control the depth of electrocautery to prevent scarring. Alternatively, the warts can be removed either by tangential excision with a pair of fine scissors or a scalpel, by laser, or by curettage. Because most warts are exophytic, this procedure can be accomplished with a resulting wound that only extends into the upper dermis. Hemostasis can be achieved with an electrocautery unit or a chemical styptic (e.g., an aluminum chloride solution). Suturing is neither required nor indicated in most cases if surgical removal is performed properly. Surgical therapy is most beneficial for patients who have a large number or area of genital warts. Both carbon dioxide laser and surgery might be useful in the management of extensive warts or intraurethral warts, particularly for those persons who have not responded to other treatments.
Because all available treatments have shortcomings, some clinics employ combination therapy (simultaneous use of two or more modalities on the same wart at the same time). Data are limited regarding the efficacy or risk of complications associated with use of such combinations.
BEFORE PURCHASING THOSE CREAMS/OINTMENTS PLEASE SEEK YOUR DOCTORS ADVISE FIRST.
Are there ways to lower my chances of getting HPV?
A safe and effective HPV vaccine (Gardasil) can protect boys and men against the HPV types that cause most genital warts and anal cancers. It is given in three shots over six months.
Condoms (if used with every sex act, from start to finish) may lower your chances of passing HPV to a partner or developing HPV-related diseases. But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.
Because HPV is so common and usually invisible, the only sure way to prevent it is not to have sexual contact. Even people with only one lifetime sex partner can get HPV, if their partner was infected with HPV.
I heard about a new HPV vaccine – can it help me?
If you are 26 or younger, there is an HPV vaccine that can help protect you against the types of HPV that most commonly cause problems in men. The HPV vaccine (Gardasil) works by preventing four common HPV types, two that cause most genital warts and two that cause cancers, including anal cancer. It protects against new HPV infections; it does not cure existing HPV infections or disease (like genital warts). It is most effective when given before a person’s first sexual contact (i.e., when s/he may be exposed to HPV).
CDC recommends the HPV vaccine for all boys ages 11 or 12, and for males through age 21, who have not already received all three doses. The vaccine is also recommended for gay and bisexual men (or any man who has sex with men), and men with compromised immune systems (including HIV) through age 26, if they did not get fully vaccinated when they were younger. The vaccine is safe for all men through age 26, but it is most effective when given at younger ages.
The HPV vaccine is very safe and effective, with no serious side effects. The most common side effect is soreness in the arm. Studies show that the vaccine can protect men against genital warts and anal cancers. It is likely that this vaccine also protects men from other HPV-related cancers, like cancers of the penis and oropharynx (back of throat, including base of tongue and tonsils), but there are no vaccine studies that have evaluated these outcomes.
I just found out that my partner has HPV …
What does it mean for my health?
Partners usually share HPV. If you have been with your partner for a long time, you probably have HPV already. Most sexually active adults will have HPV at some time in their lives. Although HPV is common, the health problems caused by HPV are much less common.
Condoms may lower your chances of getting HPV or developing HPV-related diseases, if used with every sex act, from start to finish. You may want to consider talking to your doctor about being vaccinated against HPV if you are 26 years or younger. But not having sex is the only sure way to avoid HPV.
If your partner has genital warts, you should avoid having sex until the warts are gone or removed. You can check for any abnormalities on your penis, such as genital warts. Also, you may want to get checked by a health care provider for genital warts and other sexually transmitted disease (STDs).
What does it mean for our relationship?
A person can have HPV for many years before it is found or causes health problems. So there is no way to know if your partner gave you HPV, or if you gave HPV to your partner. HPV should not be seen as a sign that you or your partner is having sex outside of your relationship.
I just found out I have genital warts …
What does it mean for me and my partner?
Having genital warts may be hard to cope with, but they are not a threat to your health. People with genital warts can still lead normal, healthy lives.
Because genital warts may be easily passed on to sex partners, you should inform them about having genital warts and avoid sexual activity until the warts are gone or removed. There are ways to protect your partner
You and your partner may benefit from getting screened for other STDs.
If used with every sex act, male latex condoms may lower your chances of passing genital warts. But HPV can infect areas that are not covered by a condom—so condoms may not fully protect against HPV.
It is important that sex partners discuss their health and risk for STIs. However, it is not clear if there is any health benefit to informing future sex partners about a past diagnosis of genital warts because it is not known how long a person remains contagious after warts are gone.
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