Males, especially those who have sex with many different partners, are at a very high risk for Human Papilloma Virus (HPV) infection, and the development of warts, pre-cancer and penile cancer. Many men who are exposed to the Papilloma virus will develop warts on their genitals, especially the crease between the shaft and the body and between the penis and lower abdomen.
Some other areas affected by HPV are: the scrotum, pharynx and mouth region, conjunctiva (lining of the eye), crotch, perineum, anus, urethra, and anal canal.
The rest of this page will discuss anal and pharyngeal cancer, and is aimed at heterosexual males, and both male and female homosexuals.
HPV among men
Genital warts and anal cancer
For women around the age of forty, about 40% carry the HPV virus around their anus, with half the strains being oncogenic. Also, half these women have had HPV infection in their genitals.
Until recently, anal cancer appeared only at old age for both men and women, with the mean age being 60. Today, due to the rising prevalence of Human Papilloma Virus (HPV) infections in young individuals, the average age of diagnosis has dropped to 45. The reason for this is that 80-90% of anal cancer cases are caused by HPV, especially strains 16 and 18. Strain 16 has been found in 70% of anal cancer and pre-cancer cases, while strain 18 in 6-8%.
The rising prevalence of HPV has caused, among other things, a doubling of anal cancer cases between the years 1975 and 2000. Every year, the prevalence of the cancer rises by 2%.
Those individuals who have anal sex (men or women) have a higher incidence rate of anal cancer than those who abstain from this activity.
With HIV carriers, and individuals whose immune system is impaired, the incidence rate of anal cancer is double that of non-carriers.
In the U.S, the incidence rate for homosexual men is 35 out of 100,000 men. As a comparison, the incidence for cervical cancer in women is 8-9 for every 100,000. In the past, before Pap smears became common, the rate of anal cancer was 5-6 times higher.
The success of Pap smears in reduction of cervical cancer rates in women has caused men to get Pap smears done on their anuses.
Regular Pap screening is recommended for the following populations:
- Men and women who are HIV carriers.
- Homosexual men.
- Women who have been diagnosed with cancer or pre-cancer in their genitals.
- Men and women with genital warts on their genitals.
Heterosexual males have an incidence rate of 13% for HPV infection in their rectum and 12% in or around the anus. Therefore, a quarter of males (25%) carry the Papilloma Virus in this area, even without having anal sexual relations. One possible explanation is self-infection.
In comparison to women, who have two peaks for HPV incidence rates (ages 20-30 and 40-50), for men the incidence rate is fixed for the first sixty years of their lives.
In conjunction with the rise of anal cancer in men and women, a rise in penile cancer has also been recently observed.
Genital warts and cancers of the upper respiratory tract, pharynx, and mouth
Similarly to the rise in anal cancers, the incidence of oral and pharyngeal cancers has risen, especially among those younger than previously reported.
Until recently, oral and pharyngeal cancers were common among smokers and alcohol drinkers, especially older men from a lower socioeconomic background and lower chances of recovery.
Today, due to the rise of HPV and its ability to cause these types of cancer, we find it in younger individuals, especially women (with a 3:1 ratio compared to men) from high socioeconomic backgrounds, no history of smoking or alcohol abuse, and high prevalence of oral sex. The good news, however, is that their prognosis is better than in the past.
With these cancers, as with anal cancers, the most common strain is 16.
It was found that between the years 1980 and 2004, the incidence rate for HPV in oral and pharyngeal cancers had risen 4.5 times (from 16% to 72%).
The reason for the rise in these types of upper-body cancers and decrease in cervical cancers is the failure to use condoms during oral sex, a rise in the prevalence of oral sex, and a rise in the number of sexual partners.
These reasons, respectively, also explain the increase in prevalence of anal cancer.
It is expected that by 2020 the incidence of cancer of the mouth and pharynx, for both men and women, will exceed that of cervical cancer, and here again the question of the methods of early detection comes into play. The question arises, will Pap oral swabs help reduce the incidence of upper-body cancers as it has benefited with cervical cancer.
Already today, the trend is for doctors to take Pap swabs of the mouth and pharynx, already a diagnostic test for oral cancers is already in use. This test, called VIZILITE, calls for the patient to use a mouth wash made of a diluted acetic acid solution, after which the area is examined by a doctor with a fluorescent light, and sometimes even with a colposcope.
HPV viruses are found in the outermost layer of the skin and mucous membranes – the oral cavity, genitals, the conjunctiva (lining of the eyelid), the anus, the urethra, and the anal canal. The fight with the viruses themselves is carried out by the immune system separately in each part of the body. Interestingly, every body part will react differently to the Human Papilloma Virus (HPV). It is possible for a man or a woman to rid themselves of the HPV virus in their genitals and not their anus for example.
It is also important to note that when a person is infected with the HPV virus in a certain body part, the risk of infection in other body parts grows, because the virus can move from one area to another even if there was no sexual contact in the area. This is the cause for cases where there is HPV infection in the anus even though there was no sexual contact in that area.
HPV-Genital warts in men