Academic articles, July

HPV Knows No Gender: Why Men Should Care

Nattapong Sreamsukcharoenchai, MD
Phramongkutklao College Of Medicine

          Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) globally, affecting both men and women. It spreads primarily through sexual contact and skin-to-skin interaction involving the genital area, oral cavity, and anus.⁽¹⁾ Over 200 genotypes of HPV have been identified, categorized into low-risk types, which often cause benign genital warts, and high-risk types, which are associated with various cancers including cervical, anal, penile, oropharyngeal, vaginal, and vulvar cancers.⁽²⁾ While HPV prevention efforts historically focused on women, growing epidemiological and biomedical evidence underscores the importance of addressing HPV-related disease burden in men.

1. High Prevalence and Susceptibility in Men; HPV infection is remarkably common among sexually active individuals. Studies indicate that nearly all sexually active men and women will acquire HPV at some point in their lives, often without symptoms.⁽³⁾ Men are not only susceptible to infection but can also experience reinfection. Global data estimate that approximately 30% of men are infected with HPV, with the highest prevalence in the 25–29 age group. High-risk HPV prevalence in men is around 21%, particularly among those with multiple sexual partners, men who have sex with men (MSM), and immunocompromised individuals such as those living with HIV.⁽¹⁾

2. HPV-Related Diseases in Men; HPV causes direct health consequences in men, including genital warts, anal cancer, oropharyngeal cancer, and penile cancer. Persistent infection with high-risk HPV genotypes can lead to oncogenesis. It is estimated that about 5–5% of all cancers worldwide are attributable to HPV.⁽⁴⁾ Notably, oropharyngeal cancer is rising rapidly among men in high-income countries. It is now more prevalent among middle-aged men than cervical cancer is among women, and currently lacks effective screening tools, making prevention through vaccination critical.⁽⁵⁾

3. Men as Silent Transmitters; Men can unknowingly transmit HPV to their sexual partners. The virus can be spread through contact with areas not covered by condoms, and infection can occur even during the first sexual encounter. Since most infections are asymptomatic and there are no standard screening methods for men⁽⁶⁾, they can become silent carriers, perpetuating the transmission cycle.

4. Impact on Male Fertility; Emerging evidence links HPV infection to reduced male fertility. Studies report significantly lower sperm motility and morphology in HPV-positive individuals, alongside associations with increased risk of couple infertility and spontaneous pregnancy loss. HPV DNA has been detected in semen, implicating it in impaired reproductive outcomes.^(7,8)

HPV Vaccination for Men
          In Thailand and many other countries, two HPV vaccines are available: the quadrivalent (4vHPV) and the nonavalent (9vHPV) vaccines. The 4vHPV targets genotypes 6, 11, 16, and 18. Types 6 and 11 are primarily responsible for genital warts, while types 16 and 18 are strongly linked to multiple cancers. Clinical trials in males aged 16–26 demonstrated a 90.4% efficacy in preventing external genital lesions and near-complete seroconversion among HPV-naïve individuals.⁽⁹⁾

          The 9vHPV vaccine includes protection against five additional oncogenic types: 31, 33, 45, 52, and 58. It broadens cancer prevention coverage to approximately 90% of HPV-related malignancies. Evidence from CDC, WHO, and studies by Petrosky et al. show that 9vHPV offers equivalent safety but broader efficacy, especially beneficial for high-risk groups like MSM. Immunologically, both vaccines achieve close to 100% seroconversion, with minor side effects such as localized pain or swelling.^(10,11)

          Multiple countries implementing gender-neutral vaccination programs have reported reductions in genital warts and HPV-related diseases among both sexes^(12,13), demonstrating herd protection. WHO endorses vaccinating boys aged 9–14 or up to 26 years, particularly MSM and HIV-positive men. Countries with sufficient resources are encouraged to adopt the 9vHPV vaccine for maximal population-level protection.⁽¹⁴⁾

          Despite robust scientific support, male HPV vaccination faces challenges including low perceived risk among men, misconceptions that HPV is a women’s health issue, and lack of national policy support for vaccinating boys. Overcoming these barriers requires proactive public education, healthcare provider training, and inclusive messaging that highlights the benefits of male vaccination. Strengthening health equity means recognizing that HPV affects everyone, regardless of gender.

          HPV is not a gendered infection. Men play a dual role as potential sufferers and transmitters of the virus. Promoting HPV vaccination among men is a cost-effective public health strategy that protects individuals, their partners, and broader communities. Equal access to preventive care is essential in moving toward a gender-equitable healthcare system.⁽¹⁵⁾

Reference

1. Bruni L, Albero G, Rowley J, et al. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta‐ Lancet Glob Health. 2023;11(9):e1345‐e1362.

2. Working Group on the Evaluation of Carcinogenic Risks to Humans. Human papillomaviruses. IARC Monogr Eval Carcinog Risks Hum. 2007;90:1‐

3. Boda D, Docea AO, Calina D, et al. Human papilloma virus: apprehending the link with carcinogenesis and unveiling new research avenues (Review). Int J Oncol. 2018;52(3):637–655.

4. de Martel C, Plummer M, Vignat J, Franceschi S. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017;141(4):664–670.

5. Kwan T, et al. Prevention and treatment of human papillomavirus in men benefits both men and women. BMJ. 2023;381:e072832.

6. Centers for Disease Control and Prevention (CDC). Genital HPV Infection – Fact Sheet [Internet]. Atlanta: CDC; 2023 [cited 2025 May 28]. Available from: https://www.cdc.gov/sti/about/about-genital-hpv-infection.html

7. Garolla A, et al. Papillomavirus infection and male infertility: A systematic review. Health Sci Rep. 2024;7(3):e1536.

8. Isaguliants M, Krasnyak S, Smirnova O, Colonna V, Apolikhin O, Buonaguro FM. Genetic instability and anti‐HPV immune response as drivers of infertility associated with HPV infection. Infect Agent Cancer. 2021;16(1):29.

9. Giuliano AR, Palefsky JM, Goldstone S, Moreira ED Jr, Penny ME, Aranda C, et al. Efficacy of quadrivalent HPV vaccine against HPV infection and disease in males. N Engl J Med. 2011;364(5):401–11.

10. Huh WK, Joura EA, Giuliano AR, Iversen OE, de Andrade RP, Ault KA, et al. Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16–26 years: a randomised, double-blind trial. Lancet. 2017;390(10108):2143–59.

11. Van Damme P, Meijer CJLM, Kieninger D, Schuyleman A, Thomas F, Luxembourg A, et al. A phase III clinical trial of immunogenicity and safety of a 9-valent human papillomavirus vaccine in males. Pediatr Infect Dis J. 2015;34(9):992–8.

12. Ten years of human papillomavirus vaccination in the United States. J Infect Dis. 2016;214(12):1779–1786.

13. Economic evaluation of HPV vaccination in developed countries. Vaccine. 2023;41(Suppl 1):A8–A15.

14. World Health Organization. Human papillomavirus vaccines: WHO position paper, May 2017. Weekly Epidemiological Record. 2017;92(19):241–68.

15. Stanley M. HPV vaccine for men: Where to now? Hum Vaccin Immunother. 2014;10(7):2109–2111.