Most sexually active women in the modern era know about human papillomavirus. Some were offered the HPV vaccine in their early teenage years and saw the ads all over television about reducing the risk of cervical cancer.
But women aren’t the only ones who contract HPV. According to the U.S. Centers for Disease Control and Prevention, 79 million American women and men are currently infected with HPV. And while awareness about how men can contract and spread the virus is increasing, there’s still a gap between women and men when it comes to prevention and treatment.
Simply put: Men aren’t routinely tested like women are. In fact, there’s currently no approved test for HPV in men.
“Men can be tested during an anal pap smear if they request that the tests include one for HPV,” said Sunny Rodgers, a sex educator and ambassador for the American Sexual Health Association. “However, an anal pap smear is not usually included in male exams unless the individual has tested positive for HIV.”
Most people with HPV have no symptoms, so they wouldn’t necessarily know to request testing for the virus. If they do develop symptoms, the most common is genital warts in both men and women.
“These warts usually appear near the sex organs ... and can be a single bump or a group of bumps close together,” Rodgers said. “They can have different shapes ― some are raised, others flat, and in groups, they can look like the head of a cauliflower. They can be flesh-tone, white, pink and red in color.”
Bumps may also itch ― and they can be treated, said Carlos Malvestutto, an infectious disease expert with The Ohio State University Wexner Medical Center. “There are topical antiviral medications to treat genital warts,” he explained. “Larger or more numerous genital warts can be treated with cryoablation, laser ablation, electrocautery or surgery.”
That said, most people have few or no symptoms of HPV, and the immune system will clear the virus on its own in the vast majority of cases. High-risk HPV strains that are never cleared from body are usually the ones docs are most concerned about because they’re linked to an increased risk of cancer; specifically, HPV16 and HPV18 may lead to cervical, anal, oropharyngeal, penile, vaginal and vulvar cancers.
Why Men Aren’t Tested, Even Though HPV Affects Them
So, if men and women both get HPV that can cause disease, why aren’t men also regularly tested at a doctor’s appointment? It has to do with whether discovering HPV can lead to any form of prevention.
Women are tested for HPV as part of their pap smears, which they typically get once every three years from ages 21 to 65, unless their doctors decide more frequent testing should occur. This is specifically to look for abnormal cervical cells.
“The American Cancer Society has found that cervical cancer can be prevented. Therefore, HPV is tested for during female pap smears because HPV can lead to cervical cancer,” Rodgers said. “There is a direct correlation between testing and prevention. But thus far, there is very little research showing male anal HPV testing as a certain preventive measure for cancer.”
The Food and Drug Administration approved HPV testing as a primary screening for cervical cancer in 2014. There is ongoing research being conducted on an HPV test for men, but so far the FDA hasn’t approved one. According to a study published in The Journal of the American Osteopathic Association, testing a man’s mouth or throat was not an effective way to discover HPV.
Discovering a test for men is vital for the culture that surrounds HPV as well, Rogers said. Since only women can currently be tested, it reinforces the notion that HPV is a woman’s sexually transmitted infection. However, the CDC reports that approximately 25% of men in the U.S. have high-risk HPV, compared to only 20% of women.
“The stigma associated with women having to be the primary individuals tested for HPV is so evident that there has been research documenting it,” Rodgers said. “According to the BMJ, raising public awareness of the sexually transmitted nature of HPV can potentially increase women’s feelings of stigma, shame and anxiety ― but their research also found that when women learned HPV was common, it helped reduce these feelings by ‘normalizing’ the infection.”
How To Prevent HPV
In the absence of a test that can screen for HPV, prevention mechanisms are still powerful.
The majority of people contract HPV when they become sexually active, according to the CDC. Experts stress that the vaccine is something everyone should ask their doctor about.
Gardasil prevents nine different strains of HPV, including two low-risk strains that cause genital warts and seven high-risk strains that are linked to cancer. While it’s typically given to boys and girls when they’re 11 or 12, it’s often recommended for ages up to 26 ― and perhaps even later than that.
“Prior to October 2018, Gardasil was used to vaccinate males and females from ages nine to 26 only,” Rodgers said. “But on that date, the FDA approved its use for people aged 27 to 45.”
The approval was based on a long-term study of 3,200 women in this older age group, in which the vaccine was 88% effective in preventing infection and cancer. Men in the older age category should see improved prevention as well, according to the FDA.
“Even for someone who has a history of genital warts or has been found to have HPV-associated lesions, there is still benefit to taking the vaccine because it will protect them from acquiring any of the other high-risk genotypes that they could become exposed to,” Malvestutto said.
The importance of the vaccine can’t be understated, Malvestutto added. “Widespread adoption of this vaccine is leading to a reduction in incidence of cervical cancer in several countries around the world,” he said. “In Australia, it is estimated that cervical cancer may be eliminated by 2028 due to the widespread adoption of the HPV vaccine.”
Aside from the vaccine, you should also reduce your risk of contracting HPV by practicing safe sex, though complete prevention isn’t always possible.
“At some point in their lives, most people will have the HPV virus,” Rodgers said. “There is only one way to not contract the HPV virus, and that’s totally avoiding any sexual contact.”
Condoms can offer some protection from HPV infection, though, and shouldn’t be discounted as a way to prevent the virus. “The HPV virus may be on skin that isn’t covered by the condom, but polyurethane condoms are made from a special type of plastic that helps prevent pregnancy and STI infection,” Rodgers said. “They are also good alternatives for anyone allergic to latex.”
So, like any STI, having an awareness of HPV and how to prevent it, test for it and treat it is important ― for both women and men.