Abstract
Despite the morbidity associated with anogenital condylomas and the mortality associated with anal, penile, and cervical carcinoma as a direct consequence of human papillomavirus (HPV), the US Centers for Disease Control and Prevention currently does not recommend routine screening for HPV in immuno competent men. However, findings of emerging research focusing on the high-risk populations of men who have sex with men and men who test positive for human immunodeficiency virus, in whom HPV infection is pervasive and persistent, suggest that these populations may benefit from screening. Therefore, HPV screening, including anal cytology, should be considered for these men in settings where appropriate follow-up, including high-resolution anoscopy, is available.
Human papillomavirus (HPV) is the most common sexually transmitted disease worldwide, with more than 100 types of HPV identified.
1 Approximately 30 HPV types affect the anogenital area.
1 More than 99% of cervical cancers and approximately 88% of anal cancers are associated with HPV; the most common oncogenic subtypes are 16 and 18.
2-4 Anogenital HPV is categorized as latent (asymptomatic), clinical, or subclinical. Most cases of HPV infection are latent, transient, and detectable only with tests for viral DNA, enabling HPV to be transmitted unknowingly among millions of sexually active adults. Clinical lesions, most commonly caused by HPV types 6 and 11, are visibly apparent and result in anogenital condylomas, or
condylomata acuminata, rather than malignancies.
1 Subclinical lesions, including the oncogenic types of HPV, are identified on examination after the application of acetic acid solution (3%-5%), a procedure known as acetowhitening. Using this technique, researchers have documented that 50% to 77% of steady male partners of women with HPV infection, cervical neoplasia, or both have subclinical HPV infection.
5
Despite the morbidity associated with anogenital condylomas and the mortality associated with anal and cervical carcinomas as direct consequences of HPV infection, the US Centers for Disease Control and Prevention currently does not recommend screening men for HPV.
6 The infectious disease literature supports this stance on several grounds: the high prevalence of infection, the lack of a test approved by the US Food and Drug Administration for the detection of HPV in men, and the absence of adequate therapy for established infection.
7 Effective treatment algorithms for cervical Papanicolaou tests, HPV DNA testing, and colposcopy have been endorsed for women because of the contribution of HPV infection to cervical dysplasia and carcinoma, but similar recommendations are lacking for men. Although routine HPV testing is not necessary for men in the general population, findings from emerging research in high-risk populations of men who have sex with men (MSM) and men who test positive for human immunodeficiency virus (HIV) suggest that HPV infection is pervasive and persistent in these groups, warranting the adoption of additional screening measures.