HPV is one of the most common STD. The main reason is that men infected with Human Papilloma Virus have not any symptoms at all but can spread the infection through anal, oral, or vaginal sex. In those symptomatic people, the penile, anogenital, mouth and throat warts are the visible sign of infection. Cancer may be a late complication. There is currently no approved test for HPV in men. There is no specific treatment for HPV as well. We can destroy genital warts with cautery or cryotherapy. We can now prevent HPV infection with vaccines.
We know different types of HPV. Some of them increase cancer risk. The virus cannot survive alone for a long time outside the infected cells. Therefore, the infection is possible only during prolonged and intimate contact skin-to-skin or mucosa-to-mucosa. All kind of sex is at risk for disease.
Most new HPV infections occur in adolescents and young adults. Most sexually active adults have exposed to HPV. However, new infections can occur with a new sex partner or when the patient has multiple partners.
After the contact, HPV can live inside the infected cells for months. The infection starts silent, and, in most cases, the competent immune system can eliminate the disease without the patient noticing. Most HPV infections are transient and asymptomatic and cause no clinical problems. In other cases, the virus survives and replicates, causing a wart, which is the typical skin or mucosal abnormality, the only visible sign of the viral infection.
Men and women have different expressions of the disease. In men, they can become visible to the human eye only after several weeks or months. They may be small. The top of the growths may look like a cauliflower. They may occur as a cluster of warts, or just one wart. Rarely, however, genital warts can multiply into large groups, in someone with a suppressed immune system.
HPV infection can cause changes in the body that lead to penile cancer in men if left untreated. Cancer develops very slowly and may not appear until years, or even decades, after HPV infection.
There is currently no approved test for HPV in men. Therefore, routine testing (screening) to check for HPV or HPV-related disease before there are signs or symptom, is not possible. We cannot diagnose HPV infection before there are signs or symptoms (warts).
The physical examination of the penile, scrotal or pubic warts by a urologist, andrologist or dermatologist is enough to diagnose the HPV infection. Warts have the typical appearance described above. The optical magnification is useful to diagnose microscopic warts hardly visible to the naked eye after treating the skin with trichloroacetic acid (penoscopy)
No clinical antibody test can determine whether a person is already immune or still susceptible to any given HPV type.
The destruction of all visible warts is the only treatment that can eradicate the virus. Laser, cryo-ablation, or electro-cautery are effective treatments. The radical treatment (destroying all macroscopic and microscopic warts) is crucial to get rid of HPV infection. We can highlight small warts, or flat lesions not visible to the naked eye by using trichloroacetic acid solutions and magnifying tools (penoscopy). Often, we need more than one session to complete the eradication treatment.
Topical creams have only limited use in the treatment of penile warts. While we need multiple applications, the results are not always curative, and the side effects can cause ulcers that delay the healing.
Unfortunately, we do not know how long a person can spread HPV after the treatment of the detectable penile warts. Long surveillance of both partners is advisable.
Prevention is the only reliable way to lower the risk of getting HPV infection. Sexual abstinence is the best way to prevent HPV spread. The use of a condom may not give full protection against getting HPV. It can infect skin genital areas not covered by a condom. HPV vaccines are safe and effective. They can protect men against warts and certain cancers caused by HPV. We should do vaccination before ever having sex. After being infected or after developing warts, we do not recommend the administration of the vaccine because it does not give real benefits. Recommendations of the American advisory committee on immunization practices (2017).
If you or your partner have genital warts, you should avoid having sex until warts have gone or removed. However, we do not know how long a person can spread HPV after warts have gone.
HPV infections are usually temporary. A person may have had HPV for many years before it causes health problems. If you or your partner are diagnosed with an HPV-related disease, there is no way to know how long you have had HPV, whether your partner gave you HPV, or whether you gave HPV to your partner. HPV is not necessarily a sign that one of you is having sex outside of your relationship.