Skip to main content

Advertisement

Log in

Human Papilloma Virus Infections in Men: Focus on Vaccination and Treatment Options

  • HIV Medicine (CJ Yoon, Section editor)
  • Published:
Current Treatment Options in Infectious Diseases Aims and scope Submit manuscript

Opinion statement

Human papilloma virus (HPV) infection is the most prevalent among sexually transmitted diseases (STDs). There are more than 100 types of HPV, with the possibility of infection for both male and female, affecting sexual organs, mouth, and throat. The majority of people affected are unaware of the infection. HPV is associated with a large spectrum of clinical features, such as unapparent infections, unspecific epithelial lesions, genital warts, and cancers. Although a consistent and coherent picture about the epidemiology and pathogenesis of genital HPV infections in women has been developed over the past 30 years, fewer studies have been conducted on this infection in men. The same has happened with regards to the vaccine, which were concentrated on females with the primary objective being the prevention of cervical cancer. In recent years, with a better understanding of HPV infection and its clinical manifestations in males, the quadrivalent vaccine has been approved signifying a more forward-thinking approach in this population. More targeted interventions are needed for the control of HPV infection in men, particularly those who are unaware and probably account for most transmissions. The purpose of this review is to give an insight on the most recent evidence available in the literature on HPV treatment and prevention among men.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Siegel JF, Mellinger BC. Human papillomavirus in the male patient. Urol Clin North Am. 1992;19:83–91.

    CAS  PubMed  Google Scholar 

  2. Koutsky LA, Holmes KK, Critchlow CW, et al. A cohort study of the risk of cervical intraepithelial neoplasia grade 2 or 3 in relation to papillomavirus infection. N Engl J Med. 1992;327:1272–8.

    Article  CAS  PubMed  Google Scholar 

  3. Strand A, Rylander E, Wilander E, Zehbe I, Kraaz W. Histopathologic examination of penile epithelial lesions is of limited diagnostic value in human papillomavirus infection. Sex Transm Dis. 1996;23:293–8.

    Article  CAS  PubMed  Google Scholar 

  4. Krebs HB, Schneider V. Human papillomavirus-associated lesions of the penis: colposcopy, cytology, and histology. Obstet Gynecol. 1987;70:299–304.

    CAS  PubMed  Google Scholar 

  5. Siegel JF, Mellinger BC. Human papillomavirus in the male patient. Urol Clin North Am. 1992;19:83–91.

    CAS  PubMed  Google Scholar 

  6. Dillner J. The serological response to papillomaviruses. Semin Cancer Biol. 1999;9:423–30.

    Article  CAS  PubMed  Google Scholar 

  7. Carter JJ, Koutsky LA, Hughes JP, et al. Comparison of human papillomavirus types 16, 18, and 6 capsid antibody responses following incident infection. J Infect Dis. 2000;181:1911–9.

    Article  CAS  PubMed  Google Scholar 

  8. Bouvard V, Baan R, Straif K, et al. WHO International Agency for Research on Cancer monograph working group. A review of human carcinogens-part B: biological agents. Lancet Oncol. 2009;10:321–2.

  9. World Health Organization. Sexually transmitted infections (STIs): the importance of a renewed commitment to STI prevention and control in achieving global sexual and reproductive health, Geneva. 2013. http://www.who.int/iris/handle/10665/82207.

  10. De Martel C, Ferlay J, Franceschi S, et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012;13:607–15.

    Article  PubMed  Google Scholar 

  11. Giuliano AR, Lazcano-Ponce E, Villa LL, et al. The human papillomavirus infection in men study: human papillomavirus prevalence and type distribution among men residing in Brazil, Mexico, and the United States. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2008;17(8):2036–43.

    Article  CAS  Google Scholar 

  12. Saslow D, Andrews KS, Manassaram-Baptiste D, Loomer L, Lam KE, Fisher-Borne M, Smith RA, Fontham ET. Human papillomavirus vaccination guideline update: American Cancer Society guideline endorsement. CA Cancer J Clin. 2016;66(5):375–85.

    Article  PubMed  Google Scholar 

  13. Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet. 2007;370(9590):890–907.

    Article  CAS  PubMed  Google Scholar 

  14. Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER. Quadrivalent human papillomavirus vaccine: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2007;56:1–24.

    PubMed  Google Scholar 

  15. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, Curtis CR, Gee J, Bocchini Jr JA, Unger ER, Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination: recommendations of the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2014;63(RR-05):1–30.

    PubMed  Google Scholar 

  16. Centers for Disease Control and Prevention (CDC). FDA licensure of bivalent human papillomavirus vaccine (HPV2, Cervarix) for use in females and updated HPV vaccination recommendations from the advisory committee on immunization practices (ACIP). MMWR Recomm Rep. 2010;59(20):626–9.

    Google Scholar 

  17. Nielson CM, Harris RB, Dunne EF, Abrahamsen M, Papenfuss MR, Flores R, Markowitz LE, Giuliano AR. Risk factors for anogenital human papillomavirus infection in men. J Infect Dis. 2007;196(8):1137–45.

    Article  PubMed  Google Scholar 

  18. Giuliano AR, Nielson CM, Flores R, Dunne EF, Abrahamsen M, Papenfuss MR, Markowitz LE, Smith D, Harris RB. The optimal anatomic sites for sampling heterosexual men for human papillomavirus (HPV) detection: the HPV detection in men study. J Infect Dis. 2007;196(8):1146–52.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Palefsky JM. HPV infection in men. Dis Markers. 2007;23(4):261–72.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kim JJ, Andres-Beck B, Goldie SJ. The value of including boys in an HPV vaccination programme: a cost-effectiveness analysis in a low-resource setting. Br J Cancer. 2007;97(9):1322–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Paavonen J, Naud P, Salmeron J, et al. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA): final analysis of a double-blind, randomised study in young women. Lancet. 2009;374:301–14.

    Article  CAS  PubMed  Google Scholar 

  22. Centers for Disease Control and Prevention (CDC). FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the advisory committee on immunization practices (ACIP). MMWR Morb Mortal Wkly Rep. 2010;59:630–2.

    Google Scholar 

  23. Centers for Disease Control and Prevention (CDC). Recommendations on the use of quadrivalent human papillomavirus vaccine in males—advisory committee on immunization practices (ACIP) 2011. MMWR Morb Mortal Wkly Rep. 2011;60(50):1705.

    Google Scholar 

  24. Food and Drug Administration. Highlights of prescribing information. Gardasil (human papillomavirus quadrivalent [types 6, 11, 16 and 18]). Silver Spring, MD: Food and Drug Administration. 2011. Available at http://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm111263.pdf. Accessed 13 Dec 2011.

  25. Luxembourg A. Program summary and new 9-valent HPV vaccine trial data. Presentation before the Advisory Committee on Immunization Practices (ACIP), October 30, 2014. Atlanta, GA: US Department of Health and Human Services, CDC. 2014. Available at http://www.cdc.gov/vaccines/acip/meetings/downloads/min-archive/min-2014-10.pdf.

  26. Petrosky E, Bocchini Jr JA, Hariri S, Chesson H, Curtis CR, Saraiya M, Unger ER, Markowitz LE, Centers for Disease Control and Prevention (CDC). Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV vaccination recommendations of the advisory committee on immunization practices. MMWR Morb Mortal Wkly Rep. 2015;64(11):300–4.

    PubMed  Google Scholar 

  27. Vesikari T, Brodszki N, van Damme P, et al. A randomized, double-blind, phase III study of the immunogenicity and safety of a 9-valent human papillomavirus L1 viruslike particle vaccine (V503) versus Gardasil in 9–15-year-old girls. Pediatr Infect Dis J. 2015;34:992–8.

    Article  PubMed  Google Scholar 

  28. Joura EA, Giuliano AR, Iversen OE, et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med. 2015;372:711–23.

    Article  CAS  PubMed  Google Scholar 

  29. Van Damme P, Meijer CJ, Kieninger D, Schuyleman A, Thomas S, Luxembourg A, Baudin M. A phase III clinical study to compare the immunogenicity and safety of the 9-valent and quadrivalent HPV vaccines in men. Vaccine. 2016;34(35):4205–12.

    Article  CAS  PubMed  Google Scholar 

  30. • Hartwig S, Baldauf JJ, Dominiak-Felden G, Simondon F, Alemany L, de Sanjosé S, et al. Estimation of the epidemiological burden of HPV-related anogenital cancers, precancerous lesions, and genital warts in women and men in Europe: potential additional benefit of a nine-valent second generation HPV vaccine compared to first generation HPV vaccines. Papillomavirus Res. 2015;1:90–100. Offers an accurate overview of the public health impact of HPV infection and disease in Europe. Underlines the contribution of a nine valent vaccine for cancer prevention.

    Article  Google Scholar 

  31. Centers for Disease Control and Prevention. Incidence, prevalence, and cost of sexual transmitted infections in the United States. 2013. Retrieved from http://www.cdc.gov/std/stats/STIEstimates-Fact-Sheet-Feb-2013.pdf.

  32. Markowitz LE, Liu G, Hariri S, Steinau M, Dunne EF, Unger ER. Prevalence of HPV after introduction of the vaccination program in the United States. Pediatrics. 2016;137:1–9.

    Article  Google Scholar 

  33. Voss DS, Wofford LG. Human papillomavirus vaccine uptake in adolescent boys: an evidence review. Worldviews Evid-Based Nurs. 2016;13(5):390–5.

    Article  PubMed  Google Scholar 

  34. Prue G, Shapiro G, Maybin R, Santin O, Lawler M. Knowledge and acceptance of human papillomavirus (HPV) and HPV vaccination in adolescent boys worldwide: a systematic review. J Cancer Policy. 2016;10:1–15.

    Article  Google Scholar 

  35. Walling EB, Benzoni N, Dornfeld J, Bhandari R, Sisk BA, Garbutt J, Colditz G. Interventions to improve HPV vaccine uptake: a systematic review. Pediatrics. 2016;138

  36. •• Schmeler KM1, Sturgis EM2. Expanding the benefits of HPV vaccination to boys and men. Lancet. 2016 Apr 30;387(10030):1798–9. Emphasizes the importance of recommend routinely vaccination in prepubescent boys considering the growing numbers of patients who are susceptible to serious HPV-related morbidity because of chronic pathology and use of immunosuppressive therapy

  37. Beutner KR, Wiley DJ, Douglas JM, Tyring SK, Fife K, Trofatter K, et al. Genital warts and their treatment. Clin Infect Dis. 1999;28(Suppl 1):S37–56.

    Article  PubMed  Google Scholar 

  38. Beutner KR, Ferenczy A. Therapeutic approaches to genital warts. Am J Med. 1997;102(5A):28–37.

    Article  CAS  PubMed  Google Scholar 

  39. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64:1.

    Article  PubMed  Google Scholar 

  40. Jablonska S. Traditional therapies for the treatment of condylomata acuminata (genital warts). Australas J Dermatol. 1998;39(Suppl 1):S2.

    PubMed  Google Scholar 

  41. Mohanty KC. The cost effectiveness of treatment of genital warts with podophyllotoxin. Int J STD AIDS. 1994;5(4):253–6.

    Article  CAS  PubMed  Google Scholar 

  42. Maw RD. Treatment of anogenital warts. Dermatol Clin. 1998;16:829.

    Article  CAS  PubMed  Google Scholar 

  43. von Krogh G, et al. European guideline for the management of anogenital warts. Int J STD AIDS. 2001;12(Suppl 3):40–7.

    Google Scholar 

  44. Meltzer SM, Monk BJ, Tewari KS. Green tea catechins for treatment of external genital warts. Am J Obstet Gynecol. 2009;200(3):233.

    Article  PubMed  Google Scholar 

  45. Sutherland BA, Rahman RM, Appleton I. Mechanisms of action of green tea catechins, with a focus on ischemia-induced neurodegeneration. J Nutr Biochem. 2006;17(5):291–306.

    Article  CAS  PubMed  Google Scholar 

  46. Wagstaff AJ, Perry CM. Topical imiquimod: a review of its use in the management of anogenital warts, actinic keratoses, basal cell carcinoma and other skin lesions. Drugs. 2007;67:2187.

    Article  CAS  PubMed  Google Scholar 

  47. Gunter J. Genital and perianal warts: new treatment opportunities for human papillomavirus infection. Am J Obstet Gynecol. 2003;189:S3.

    Article  PubMed  Google Scholar 

  48. Klutke JJ, Bergman A. Interferon as an adjuvant treatment for genital condyloma acuminatum. Int J Gynaecol Obstet. 1995;49:171.

    Article  CAS  PubMed  Google Scholar 

  49. Fleshner PR, Freilich MI. Adjuvant interferon for anal condyloma. A prospective, randomized trial. Dis Colon rectum. 1994;37:1255.

  50. Petersen CS, et al. Systemic interferon alpha-2b increases the cure rate in laser treated patients with multiple persistent genital warts: a placebo-controlled study. Genitourin Med. 1991;67(2):99–102.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Douglas Jr JM, et al. A randomized trial of combination therapy with intralesional interferon alpha 2b and podophyllin versus podophyllin alone for the therapy of anogenital warts. J Infect Dis. 1990;162(1):52–9.

    Article  PubMed  Google Scholar 

  52. de Sanjosé S, Bruni L, Alemany L. HPV in genital cancers (at the exception of cervical cancer) and anal cancers. Presse Medicale 2014;43(12P2)

  53. Schraut WH, Wang CH, Dawson PJ. Block GE depth of invasion, location, and size of cancer of the anus dictate operative treatment. Cancer. 1983;51(7):1291–6.

    Article  CAS  PubMed  Google Scholar 

  54. Matalon SA, Mamon HJ, Fuchs CS, Doyle LA, Tirumani SH, Ramaiya NH, et al. Anorectal cancer: critical anatomic and staging distinctions that affect use of radiation therapy. Radiographics. 2015;35(7):2090–107.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Glynne-Jones R, Nilsson PJ, Aschele C, Goh V, Peiffert D, Cervantes A. Arnold D; European Society for Medical Oncology (ESMO).; European Society of Surgical Oncology (ESSO).; European Society of Radiotherapy and Oncology (ESTRO). Eur J Surg Oncol. 2014;40(10):1165–76.

    Article  CAS  PubMed  Google Scholar 

  56. •• Rosenberg SA, Restifo NP. Adoptive cell transfer as personalized immunotherapy for human cancer. Science. 2015;348:62–8. doi:10.1126/science.aaa4967. Offers the possibility to become aware of current strategies in the development of immunotherapies showing how these unconventional treatment are no more a rescue therapy but a “living treatment”

    Article  CAS  PubMed  Google Scholar 

  57. Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, Plummer M. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol. 2012;13(6):607–15.

    Article  PubMed  Google Scholar 

  58. Hakenberg OW, Compérat EM, Minhas S, Necchi A, Protzel C, Watkin N. EAU guidelines on penile cancer: 2014 update. Eur Urol. 2015;67(1):142–50.

    Article  PubMed  Google Scholar 

  59. Micali G, Nasca MR, Innocenzi D, Schwartz RA. Invasive penile carcinoma: a review. Dermatol Surg. 2004;30(2 Pt 2):311–20.

    PubMed  Google Scholar 

  60. Micali G, Nasca MR, Innocenzi D, Schwartz RA. Penile cancer systemic chemotherapy with a wide range of treatment like monochemotherapy with bleomycin, methotrexate, or cisplatin alone or combined with other drugs for a synergistic. J Am Acad Dermatol. 2006;54(3):369–91.

    Article  PubMed  Google Scholar 

  61. Di Lorenzo G, Pagliaro LC, Buonerba C, Dorff TB, Lee RJ, Di Lorenzo G. Penile cancer: current therapy and future directions. Ann Oncol. 2013;24(5):1179–89.

    Article  PubMed  PubMed Central  Google Scholar 

  62. D'Souza G, Kreimer AR, Viscidi R, Pawlita M, Fakhry C, Koch WM, Westra WH, Gillison ML. Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007;356(19):1944–56.

    Article  PubMed  Google Scholar 

  63. Kreimer AR, Clifford GM, Boyle P, Franceschi S. Human papillomavirus types in head and neck squamous cell carcinomas worldwide: a systematic review. Cancer Epidemiol Biomark Prev. 2005;14(2):467–75.

    Article  CAS  Google Scholar 

  64. Gillison ML, Koch WM, Capone RB, et al. Evidence for a causal association between human papillomavirus and a subset of head and neck cancers. J Natl Cancer Inst. 2000;92:709–20.

    Article  CAS  PubMed  Google Scholar 

  65. O'Rorke MA, Ellison MV, Murray LJ, et al. Human papillomavirus related head and neck cancer survival: a systematic review and meta-analysis. Oral Oncol. 2012;48:1191–201.

    Article  PubMed  Google Scholar 

  66. Guihard S, Ramolu L, Macabre C, et al. The NEDD8 conjugation pathway regulates p53 transcriptional activity and head and neck cancer cell sensitivity to ionizing radiation. Int J Oncol 2012.

  67. Forastiere AA. Chemotherapy in the treatment of locally advanced head and neck cancer. J Surg Oncol. 2008;97:701–7.

    Article  CAS  PubMed  Google Scholar 

  68. Mannarini L, Kratochvil V, Calabrese L, et al. Human papilloma virus (HPV) in head and neck region: review of literature. Acta Otorhinolaryngol Ital. 2009;29:119–26.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Giordano Madeddu MD.

Ethics declarations

Conflict of Interest

Paola Bagella, Vito Fiore, Giorgia Caruana, Silvia Ortu, Sergio Babudieri, and Giordano Madeddu declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on HIV Medicine

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bagella, P., Fiore, V., Caruana, G. et al. Human Papilloma Virus Infections in Men: Focus on Vaccination and Treatment Options. Curr Treat Options Infect Dis 9, 34–43 (2017). https://doi.org/10.1007/s40506-017-0112-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40506-017-0112-1

Keywords

Navigation