HPV in Men: Oral Cancer a Growing Concern

The human papillomavirus (HPV), a group of more than 150 related viruses, can affect both men and women.

Some types of HPV can cause common skin warts, some can cause genital warts, and some can cause certain types of cancer.

Of particular concern for men in the United States is the recent rise in the number of cases of oropharyngeal cancer linked to HPV infection. Oropharyngeal cancer is cancer that develops on the back and sides of the throat, tonsils, and base of the tongue.

While it’s not known exactly why the incidence of this type of cancer is increasing, it’s believed to be the result of more people engaging in sexual activity with more partners than in years past, combined with an increase in oral sex practices. Consequently, more people have oral HPV infections, some of which put them at risk of cancer, according to Mount Sinai.

Heavy tobacco and alcohol use also raise the risk of oropharyngeal cancer, but they do not appear to be the cause of the upward trend in cases.

Men appear to be more likely than women to develop an oral HPV infection, according to the Centers for Disease Control and Prevention (CDC). Between 2011 and 2014, 11.5 percent of men in the United States were estimated to have an oral HPV infection, compared with just 3.3 percent of women.

Not all oral HPV infections lead to cancer. But the National Cancer Institute estimates that in 2022 there will be about 54,000 new cases of oropharyngeal cancer, and about 11,230 people will die from the disease. Those numbers represent an estimated 2.8 percent of all new cancer cases and 1.8 percent of all cancer deaths.

In 2019, an estimated 410,376 people were living with oropharyngeal cancer in the United States. The lifetime risk of developing this type of cancer was estimated to be 1.2 percent for men and women combined.

In research studies, oral HPV infections are detected by having study subjects rinse and gargle with a solution that is then examined for the presence of HPV.

But because such tests are not done routinely by doctors or dentists, oropharyngeal cancers caused by HPV are generally discovered only when they cause symptoms.

Signs and symptoms of oropharyngeal cancer include:

• Persistent sore throat, hoarseness, or coughing
• Persistent ear pain
• Pain or difficulty with chewing or swallowing
• Unexplained weight loss
• A lump in the neck
• Difficulty opening the mouth fully
• Change in voice

According to Johns Hopkins Medicine, most people with oropharyngeal cancer notice a lump or mass in their neck as the first sign. If you develop a lump in your neck that lasts for longer than two weeks, see an otolaryngologist (head and neck surgeon) for an evaluation.

American men have even higher rates of genital HPV infection than they do oral HPV.

According to the CDC, in 2013 and 2014, the prevalence of any genital HPV infection among U.S. adults ages 18 to 59 was 42.5 percent. Among men, the prevalence was 45.2 percent, and among women it was 39.9 percent. More than 40 types of HPV are transmitted through direct sexual contact, including vaginal, anal, and oral sex.

According to the CDC, men who have sex with men are more likely to contract HPV, as are men with weakened immune systems, including those with HIV.

Genital HPV infection in men is responsible for more than 60 percent of penile cancer cases and more than 90 percent of anal cancer cases, per the CDC.

Genital HPV infection can also cause genital warts, with HPV types 6 and 11 being responsible for 90 percent of genital warts, per the CDC.

Penile cancer initially causes tissue changes in the penis — including changes in color and thickening of the skin — and may later cause penile growths or sores.

Signs of anal cancer include anal bleeding, pain, itching, or discharge, along with swollen lymph nodes in the anal or genital area and changes in bowel habits and stool.

If you observe any of these signs or symptoms, see your doctor.

Anal, penile, and oropharyngeal cancers caused by HPV are treated with standard cancer therapies, including chemotherapy, radiation therapy, and surgery.

In men, genital warts — which may appear weeks to months after HPV is contracted — grow inside or around the anus, on the upper thighs and in the groin area, and on the scrotum and penis, including under the foreskin and inside the urethral opening. (The urethra is the tube through which urine exits the body.)

Genital warts may be:

• Clearly visible or too small to see
• Flat or raised
• Cauliflower-like in appearance (when they grow in clusters)
• Tender, painful, or itchy

If warts grow in the urethral opening, they can cause abnormal urine flow as well as bleeding from the urethra.

The types of HPV that cause genital warts can also cause a condition called recurrent respiratory papillomatosis, a rare but life-threatening disease in which warts form in the respiratory tract, potentially blocking the airway.

Genital warts can be treated with various self-applied or doctor-applied topical medications. Surgical treatment may be required for difficult-to-treat warts.

RELATED: Learn More About HPV Treatment

The most effective way for anyone to prevent getting genital warts and HPV-related cancers is to get the HPV vaccine at the recommended age.

Gardasil 9, the HPV vaccine currently available in the United States, protects against HPV types 16, 18, 31, 33, 45, 52, and 58, all of which can cause cancer, as well as types 6 and 11, which cause genital warts.

The CDC recommends that all young people get the HPV vaccine at age 11 or 12. If you didn’t get the complete series of vaccines at that age (or earlier), you can still get it through age 26.

The HPV vaccine is also approved for adults up to age 45, based on a discussion with your healthcare provider about whether it makes sense for you.

For men of all ages, limiting your number of sex partners can lower your exposure to HPV, and using condoms or dental dams during sex is partially protective against HPV infection.

A new type of underwear made of stretchy latex and designed to prevent sexually transmitted infections during oral sex may provide another option. It was cleared by the U.S. Food and Drug Administration in May 2022. While men can wear these protective panties, they are sized primarily for women.

Additional reporting by Quinn Phillips.