Review article
Human Papillomavirus-Related Disease in Men: Not Just a Women's Issue

https://doi.org/10.1016/j.jadohealth.2010.01.010Get rights and content

Abstract

The most common cause of mortality related to human papillomavirus (HPV) infection is cervical cancer. However, male HPV infection is also an important concern, both for the disease burden in men and for the risk of transmission to women. HPV is associated with a variety of cancers in men, including anal cancer and a subset of penile and oral cancers. The incidence of anal and oral cancers related to HPV is increasing in the general population and is growing even faster among individuals who are immunocompromised because of human immunodeficiency virus (HIV) infection. Penile HPV infection is very common among heterosexual men and remains high throughout a wide range of ages. Likewise, anal HPV infection and anal intraepithelial neoplasia are very common throughout a wide range of ages in both HIV-negative and HIV-positive men who have sex with men. Other HPV-related diseases of clinical importance in men include condylomata acuminata (genital warts) and recurrent respiratory papillomatosis. The quadrivalent HPV vaccine has been shown to be highly efficacious in the prevention of genital warts in women and precancerous lesions of the cervix, vulva, and vagina. In addition, recent interim data have shown that the quadrivalent HPV vaccine is highly effective in reducing external genital lesions in young men. Although the protective efficacy of HPV vaccination in men has not yet been fully established—pending the outcome of public policy discussions and cost-efficacy studies—there may be a strong rationale for vaccinating boys, similar to girls, at an early age when they have had limited or no prior sexual activity.

Section snippets

Penile Disease

Penile cancer is a heterogeneous disease with respect to HPV infection, with the association with penile infection dependent on the histology [16], [17]. Squamous cell cancers of the penis have a low association with HPV, whereas warty/basaloid cancers are strongly associated with HPV. Depending on the proportion of samples that are squamous vs warty/basaloid in any one report, the proportion of penile cancers associated with HPV is variable.

The incidence of penile cancer is low relative to

Oral Disease

Penile cancer and oral cancer are similarly heterogeneous with respect to their association with HPV [41], [42]. Most oral cancers are associated with alcohol and tobacco use; however, a subset of oral cancers is associated with HPV and the sexual behaviors associated with HPV acquisition. HPV-associated cancers typically occur in the oropharynx, particularly in the tonsils. Their incidence is increasing in the general population in contrast to oral cancers associated with tobacco and alcohol

Anal Disease

Compared with cervical cancer, anal cancer is a rare disease in the general population. However, its incidence is increasing in the general population among both men and women at a rate of approximately 2% per year [48], [49]. Unlike cervical cancer, in which HPV 16 accounts for approximately 50% of cases, HPV 16 may lead to more than 70% of anal cancer cases [50], [51]. More common in women than in men within the general population, the annual incidence of anal cancer is approximately 1 per

Transmission of HPV to Women

In addition to the disease burden associated with HPV infection in men—anogenital cancer, oral cancer, RRP, and genital warts—another major clinical consequence of male HPV infection is the potential to infect women, where it may lead to substantial morbidity and mortality. Sexual transmission of HPV is a well-known fact, and there are now several studies showing the influence of male HPV infection on HPV infection and disease in women [20], [21], [77], [78]. Penile lesions are frequently found

The Case for Male HPV Vaccination

In 2006, the US Food and Drug Administration approved the quadrivalent HPV vaccine to prevent initial infection against HPV 6, 11, 16, and 18 in women [12], [13]. The quadrivalent vaccine has been approved in several other countries as well. The bivalent vaccine prevents initial infection with HPV 16 and 18 and has been approved in several countries, including the United States as of October 2009 [15]. Both vaccines have been shown to be highly efficacious in preventing HPV 16 and 18, which

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    Disclosure: This article appears in a supplement to the Journal of Adolescent Health sponsored by SciMed LLC and supported by an educational grant from Merck & Co., Inc. Dr. Palefsky receives grant/research support from Merck & Co., Inc. Dr. Palefsky received an honorarium from the accredited provider, SciMed, for his work on this article.

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