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What is HPV?
Human papillomavirus (HPV) is a large family of viruses so widespread that most sexually active people will contract at least one strain at some point in their lives. There are approximately 200 known subtypes of HPV. More than 40 of these are sexually transmitted and can infect the genital areas of both men and women, such as the skin of the penis and the anal region. They can also affect the mouth and throat.
Sexually transmitted HPV strains are broadly divided into two categories based on their health impact:
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Low-risk types: Capable of causing genital warts (condylomata acuminata), but not cancer. The most common low-risk types are HPV 6 and HPV 11, which account for approximately 90% of all genital wart cases.
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High-risk (oncogenic) types: Associated with the potential development of cancer. In men, HPV-related cancers can affect:
- The anus
- The penis
- The oropharynx (back of the throat, including the base of the tongue and tonsils)
HPV infections are among the most common sexually transmitted infections (STIs) in most Western countries. Anyone who has ever been sexually active can be infected, although the risk increases with the number of lifetime sexual partners.
Following infection, some men develop genital warts while others remain entirely asymptomatic. For high-risk HPV strains, the immune system successfully clears the infection in the majority of cases within one to two years without any complications. However, in a minority of individuals, the infection persists for many years without an apparent cause. Over time, it can trigger cellular changes that, if left untreated, may become cancerous.
Correct and consistent use of latex condoms substantially reduces but does not completely eliminate the risk of acquiring or transmitting HPV. Available vaccines provide protection against several of the most dangerous HPV types, including the strains responsible for the majority of HPV-related cancers.
Symptoms
Most men with HPV have no symptoms at all and never know they are infected. When symptoms do occur, they depend on which HPV type is involved and which part of the body is affected.
Genital warts (condylomata):
- Appearance of one or more growths on the penis, testicles, groin, thighs, or inside or around the anus
- Warts can be single or multiple, raised or flat, smooth or cauliflower-shaped
- They typically cause no pain, though occasional mild discomfort or itching may occur
- Warts can appear within weeks to months after sexual contact with an infected person
Anal cancer:
- Sometimes no signs or symptoms are present in early stages
- Anal bleeding, pain, itching, or discharge
- Swollen lymph nodes in the anal or groin area
- Changes in bowel habits or in the shape of stools
Penile cancer:
Early signs:
- Changes in skin color on the penis
- Skin thickening
- Abnormal tissue buildup
Later signs:
- A growth or ulcer on the penis, usually painless initially but potentially becoming painful and bleeding over time
Oropharyngeal (throat and mouth) cancer:
- Persistent sore throat or ear pain not explained by infection
- Persistent cough
- Pain or difficulty swallowing or breathing
- Unintentional weight loss
- Hoarseness or voice changes persisting for more than two weeks
- A lump or mass in the neck
When to see a doctor: Consult a physician promptly if you notice warts, sores, ulcers, blisters, white patches, or any other unusual areas on the penis, scrotum, or around the anus. This is important even if they are painless. Similarly, seek evaluation for any of the throat or neck symptoms listed above if they persist beyond two to three weeks.
The Virus and How It Spreads
HPV is transmitted through direct skin-to-skin genital contact during sexual activity. The primary routes of transmission include:
- Vaginal intercourse: The most common route of genital HPV transmission
- Anal intercourse: High-risk transmission route, particularly relevant for HPV-related anal cancer risk
- Oral sex: Can transmit HPV to and from the mouth and throat
- Skin contact in the genital area without penetration: HPV can infect areas of skin not covered by a condom, meaning transmission can occur even without full penetrative sex
An important and often overlooked fact: anal HPV infection can occur even during vaginal intercourse, as the virus can spread from the genitals to the anal area through skin contact.
Because HPV typically causes no symptoms in either men or women, the vast majority of infected individuals are completely unaware of their infection and can unknowingly transmit the virus to their partners. This makes HPV extremely difficult to contain through awareness alone.
Symptoms may not appear until years or even decades after the initial infection. Men who have had only one sexual partner in their lifetime can still acquire HPV if that partner carries the virus.
Risks and Complications
Most men who contract HPV, regardless of the type, will never develop any health problems. In the majority of cases, the immune system clears the infection. However, a subset of HPV infections can lead to significant health consequences:
- Low-risk HPV types (particularly HPV 6 and 11) can cause genital warts (condylomata)
- High-risk HPV types (particularly HPV 16 and 18) can cause:
- Penile cancer
- Anal cancer
- Oropharyngeal cancer (tumors of the back of the throat, base of the tongue, and tonsils)
Critical distinction: The HPV types that cause genital warts are entirely different from those that cause cancer. Having genital warts does not increase a man’s risk of developing cancer, and vice versa.
It is also important to note that anal cancer is not the same as colorectal cancer, which is a far more common malignancy with completely different causes and risk factors. Anal cancer arises in the anal canal and is specifically associated with high-risk HPV infection.
Epidemiological data (United States, CDC):
- Approximately 1% of sexually active men in the US will develop genital warts at least once in their lifetime
- Annually in the US, HPV is associated with approximately:
- ~400 cases of penile cancer
- ~1,500 cases of anal cancer in men
- ~5,600 cases of oropharyngeal cancer in men (though many are also related to tobacco and alcohol use, not HPV alone)
According to CDC data, oropharyngeal cancer is now the most common HPV-related cancer in the United States. This shift surpasses even cervical cancer, likely due to two key factors: rising HPV-driven incidence in men and declining cervical cancer rates from vaccination and screening programs.
Groups at higher risk:
- Gay and bisexual men (men who have sex with men, MSM): Have approximately 17 times the risk of developing anal cancer compared to men who have sex exclusively with women, reflecting higher rates of receptive anal intercourse.
- Men living with HIV: Are significantly more likely to develop anal cancer, due to immunosuppression impairing viral clearance. They are also more likely to develop severe, treatment-resistant genital warts.
- Immunocompromised men (for any reason, including organ transplant recipients on immunosuppressive therapy): Face elevated risks similar to those with HIV.
Tests and Screening
The current state of HPV testing and screening in men is substantially less developed than in women. This is an important limitation that patients should understand:
No routine HPV test for men exists. The only approved HPV tests currently available are those used for cervical cancer screening in women (HPV DNA tests of cervical cells). There is currently no equivalent approved test to determine a man’s general HPV status.
Anal cancer screening: Routine anal cancer screening is not currently recommended for all men. While the evidence suggests screening may help prevent anal cancer deaths, most major guidelines still consider it insufficient to justify universal population screening. However, many expert clinicians in the United States and Europe do recommend annual anal Pap smear screening for:
- Gay and bisexual men (MSM)
- HIV-positive men
- Men with a history of receptive anal intercourse or anogenital warts
This is because anal cancer rates are substantially higher in these groups. Anal cytology, also known as anal Pap testing and similar to cervical cytology in women, can detect precancerous cellular changes (anal intraepithelial neoplasia, or AIN) before they progress to invasive cancer.
Genital wart diagnosis: There is no approved laboratory test for diagnosing genital warts in men or women. Instead, the diagnosis is clinical and relies on visual inspection by a trained healthcare provider. The warts are usually directly visible and recognizable. If you think you may have genital warts, consult a physician (typically a urologist, dermatologist, or infectious disease specialist) for evaluation and to discuss treatment options.
Penile cancer screening: There is currently no approved screening test for penile cancer. Men are advised to perform periodic self-examination of the penis, scrotum, and perianal area and to seek medical evaluation if they notice:
- Unusual growths, warts, or nodules
- Sores, blisters, or ulcers that do not heal
- White or discolored patches of skin
- Skin thickening or color changes on the penis
These findings should be evaluated promptly, even in the absence of pain.
Key message: Because there is no general HPV “status test” for men, clinical vigilance and self-examination are the most practical tools available. In most cases, the body clears HPV infection on its own, even without a test or treatment. An infection diagnosed today will most likely resolve spontaneously within one to two years.
Treatment
There is currently no antiviral treatment that eliminates HPV itself from the body. Medical management focuses on treating the health problems that HPV can cause:
Genital Warts
Several treatment options are available, and the choice depends on the size, number, and location of the warts, as well as patient preference and local clinical expertise:
Clinician-administered treatments:
- Cryotherapy (liquid nitrogen): The warts are frozen and destroyed. Multiple sessions are typically required.
- Trichloroacetic acid (TCA) application: A chemical solution applied directly to the warts to destroy them.
- Surgical excision: Warts are cut away under local anesthesia. This method is useful for larger or resistant warts.
- Electrocautery or laser ablation: Used for extensive or recalcitrant warts, typically performed by a specialist.
Patient-applied treatments (at home):
- Imiquimod cream: An immune response modifier that stimulates the local immune system to fight the virus. Applied by the patient at home several times per week.
- Podophyllotoxin (Warticon®, Condyline®): A cytotoxic agent that destroys wart tissue. Applied directly to the warts by the patient.
- Sinecatechins (green tea extract): A botanical treatment option available in some countries.
Important note: No treatment has been proven definitively superior to others. Genital warts frequently recur within weeks to months after treatment because the underlying HPV infection may persist in surrounding skin. Multiple treatment cycles are often necessary, and patients should be counseled to expect this possibility.
Treating genital warts does not necessarily eliminate the risk of transmitting HPV to sexual partners, as the virus may persist in apparently normal skin surrounding the visible warts.
If left untreated, genital warts can:
- Resolve spontaneously on their own (as the immune system clears the infection)
- Remain stable in size and number
- Grow larger or increase in number
They cannot transform into cancer. This distinction is critical for patient reassurance.
HPV-Related Cancers
Penile cancer, anal cancer, and oropharyngeal cancer associated with HPV are treated using the same modalities as other solid tumors at these sites. Treatment options, selected based on cancer stage and individual patient factors, include:
- Surgery: Excision of the tumor, ranging from organ-sparing procedures to more extensive resections depending on stage
- Radiation therapy: Often used as primary treatment for anal cancer (in combination with chemotherapy), and as adjuvant or definitive treatment for oropharyngeal cancers
- Chemotherapy: Used in combination with radiation (chemoradiation) for anal cancer and for locally advanced oropharyngeal cancer; also used for metastatic disease
- Immunotherapy: Increasingly used for recurrent or metastatic HPV-related cancers
The good news for oropharyngeal cancer: HPV-positive oropharyngeal cancers generally have a significantly better prognosis than HPV-negative tumors at the same site, with higher rates of response to treatment and higher overall survival. This is an important and encouraging distinction.
Vaccine and Prevention
Condoms
Condoms, when used correctly from the beginning to the end of every sexual encounter, can substantially reduce the risk of HPV transmission. However, they do not completely eliminate it. Because HPV infects skin surfaces not covered by condoms (such as the scrotum, perineum, and inner thighs), condoms do not provide 100% protection against HPV.
This means that even with correct and consistent condom use, HPV acquisition remains possible. The only completely certain way to avoid HPV is to abstain from all sexual activity. However, this standard is impractical for most people. Even individuals who have had only one sexual partner can acquire HPV if that partner is infected.
HPV Vaccine
The Gardasil® 9 vaccine is the gold standard for HPV prevention and is approved and recommended for both males and females. It protects against nine HPV types:
- High-risk types 16, 18, 31, 33, 45, 52, 58: The strains responsible for the vast majority of HPV-related cancers (cervical, anal, penile, vaginal, vulvar, and oropharyngeal)
- Low-risk types 6 and 11: The strains responsible for approximately 90% of genital wart cases
Proven benefits in men:
- Protection against genital warts caused by HPV 6 and 11
- Protection against anal cancer and anal precancerous lesions (AIN) caused by HPV 16 and 18
- Strong evidence suggests protection against penile cancer and oropharyngeal cancer associated with HPV, though direct clinical trial data specifically measuring these endpoints in men are more limited
Vaccine schedule and age recommendations:
- Most effective when administered before first sexual exposure, current recommendations favor vaccination ideally at ages 9 to 12.
- Recommended and beneficial for individuals up to age 26 without prior vaccination.
- For adults aged 27–45, vaccination decisions should be made through shared clinical decision-making with a physician, weighing individual risk factors and the likelihood of benefit given likely prior HPV exposure.
- The standard schedule is two doses for those vaccinated before age 15, or three doses over six months for those vaccinated at age 15 or older.
Safety and tolerability: The HPV vaccine has an excellent safety profile confirmed by extensive post-marketing surveillance involving tens of millions of doses administered worldwide. The most common side effect is temporary pain, redness, or swelling at the injection site. Rare instances of fainting (vasovagal syncope) after injection have been reported, as with many other vaccines, and patients are typically observed for 15 minutes post-vaccination. No serious long-term adverse effects have been confirmed in the scientific literature.
Critical limitations to understand:
- The vaccine prevents new infections with the HPV types it covers. However, it does not treat existing HPV infections or clear already-present HPV-related lesions.
- The vaccine is therefore most effective when given before first sexual exposure, though it still provides meaningful protection for sexually active individuals who have not yet encountered all vaccine-covered HPV types
Frequently Asked Questions
“I Just Found Out My Partner Has HPV”
First, take a deep breath. An HPV diagnosis in a partner is very common and does not necessarily indicate infidelity. A person can carry HPV for years or even decades without any symptoms or detectable signs, meaning there is often no way to determine when or from whom either partner acquired the infection. This is why an HPV diagnosis should never automatically be interpreted as evidence of cheating.
What you should know:
- Long-term partners tend to share HPV strains. If you have been in a relationship with an HPV-positive partner for some time, there is a reasonable probability that you have already been exposed to the same strain(s).
- Most sexually active adults acquire HPV at least once in their lifetime, and the vast majority experience no health consequences.
- Condoms reduce (but do not eliminate) the risk of HPV transmission and should be used consistently during all sexual activity.
- If you are under 26, consider discussing HPV vaccination with your doctor, as you may still benefit from immunization against strains you have not yet encountered.
- If your partner has active genital warts, avoid sexual contact until the warts have cleared or been successfully treated, as this period carries the highest risk of transmission.
- Consult your physician to discuss your individual risk and any screening or monitoring that may be appropriate for your situation.
“I Just Found Out I Have a Genital Wart”
Discovering that you have a genital wart can be emotionally difficult and feel embarrassing or distressing. However, it is important to put this in perspective: genital warts are a common, benign condition that poses no serious threat to your long-term health and does not prevent you from living a completely normal life.
Key points:
- Genital warts cannot transform into cancer. The HPV strains that cause warts are entirely different from those that cause cancer.
- You can and should inform any current or recent sexual partners, as they may have been exposed and could benefit from evaluation or reassurance.
- Avoid sexual contact while warts are present, or until they have been successfully treated and confirmed resolved, to minimize the risk of transmitting the virus.
- Condoms reduce but do not eliminate the transmission risk during treated or asymptomatic periods, as HPV can be present on skin surfaces beyond what a condom covers.
- Treatment should be discussed with a physician (dermatologist, urologist, or sexual health specialist). Multiple treatment cycles may be needed, and recurrence is common.
- How long a person remains contagious after warts disappear is not yet definitively known, as this is an area of ongoing research. It is likely that some risk of transmission persists even after visible warts resolve, though the degree of risk diminishes over time as the immune system clears the infection.
Sources and Bibliography
- CDC: HPV and Men (original resource no longer available at the original URL; information preserved from archived version)
- CDC: HPV and Oropharyngeal Cancer
- CDC: MMWR: HPV-Associated Cancer Statistics
- National Cancer Institute: HPV and Cancer
- World Health Organization (WHO) Human Papillomavirus (HPV)
- American Cancer Society: HPV and Cancer
- Giuliano AR, et al. Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males. N Engl J Med. 2011. DOI: 10.1056/NEJMoa0909537
- Palefsky JM, et al. HPV vaccine against anal HPV infection and anal intraepithelial neoplasia. N Engl J Med. 2011. DOI: 10.1056/NEJMoa0906482
- Chaturvedi AK, et al. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011. DOI: 10.1200/JCO.2011.36.4596
- Workowski KA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021. DOI: 10.15585/mmwr.rr7004a1
- European AIDS Clinical Society (EACS): HPV and Anal Cancer Screening Recommendations
