Papilloma virus infection also affects men. How is it transmitted? How can it be recognised? What are the symptoms? What consequences can it cause and why is it worth getting vaccinated?

Papilloma virus: what are HPVs?

HPV are a group of more than 100 DNA viruses that are extremely widespread throughout the world. They are the most common agents of sexually transmitted diseases.

Most infections are asymptomatic, but in some cases the infection, which persists for a very long time, may develop into a pathology of oncological interest.

Until the recent past, HPV was mainly considered an enemy of the female sex, as it is the pathogenic agent of cervical cancer; in contrast, little or no consideration was given to HPV-dependent pathology in men.

It was then observed that there are also manifestations associated with the infection in the male, which in some cases are even more frequent than in the female.

How is HPV transmitted?

Virus transmission can occur through direct sexual contact (95% of infected persons acquire the virus by this route) or through penetrative sexual intercourse: the use of a condom in these cases may reduce transmission, but would not be completely protective since contact could still occur.

It can also be transmitted by genito-genital, hand-genital and oral-genital contact, and finally by non-sexual routes: from mother to baby (vertical transmission) or by contact with contaminated objects.

HPV infection in men

HPV infection in men is mostly asymptomatic and without obvious lesions.

Benign manifestations of this infection are condylomata (wart-like growths), which are mainly found in the anus, penis and oral cavity.

In the absence of a proper screening test for the infection (as opposed to a Pap test or HPV test for women), examinations such as:

• anoscopy;
• anal swab;
• the acetic acid test;
• peniscopy;
• molecular biology investigations for HPV viral DNA.

The link between HPV and male urogenital cancers

There is some evidence to suggest a link between the presence of the Papilloma Virus and the development of urogenital cancers in men, including penile cancer, testicular cancer and urothelial carcinomas.

Papilloma virus and penile carcinoma

Penile cancer is a relatively rare disease in Western countries, with an incidence of between 0.1 and 1.5 per 100,000 men.

This incidence rate increases in developing countries to 3.7 per 100,000 men.

Papilloma virus DNA is detectable in about 1 in 2 cases of penile cancer and has been shown to be related to poor intimate hygiene or lack of circumcision.

Cigarette smoking and phimosis (the narrowing of the preputial orifice) are also factors related to the development of penile cancer, suggesting that an inflammatory environment may enhance tumour development.

The effect of circumcision: conflicting data on the papilloma virus

A controversial, but also interesting, aspect of circumcision concerns itself.

Several scientific studies show conflicting results on the protective effect of circumcision at birth on the development of penile cancer; however, what emerges from the scientific literature is that adult circumcised men have approximately a 35% lower risk of developing penile cancer than their uncircumcised counterparts.

For this reason, European guidelines suggest that circumcision should be discussed with patients as a preventive measure against Papilloma virus-related diseases.

HPV is not only linked to external genital tumours: viral DNA has been found in a statistically significant number of prostate biopsies and appears to increase the risk of prostate cancer by a factor of 1.85 to 7.7.

HPV, testicular cancer and urothelial carcinomas

Finally, there seems to be evidence of a possible association between testicular cancer and HPV viral infection and also urothelial carcinomas and HPV based on virus isolation in biological and tissue samples, although further studies would be needed to substantiate this association.

Male infertility and the papilloma virus

In addition to male genital epithelial areas, an increasing number of studies have reported the presence of HPV viral particles in seminal fluid.

It is thought that HPV may adhere to sperm at two distinct sites along the equatorial region of the sperm head, similar to other viruses that infect sperm.

Since the equatorial segment is where the sperm binds to and subsequently fuses with the oocyte’s plasma membrane, it can be assumed that there is probably a negative impact of HPV in both natural and assisted fertilisation.

A large number of studies have also shown that HPV infection correlates with poor sperm quality (reduced sperm motility, reduced total number of sperm, reduced number of sperm with normal morphology and reduced viability) and a higher incidence of anti-sperm antibodies (ASA) than in fertile men, suggesting an important role of HPV infection in male infertility.

Vaccination against the papilloma virus in men

Recent European guidelines suggest two possible vaccination approaches:

• prophylactically: vaccination should be carried out before sexual contact to prevent condylomas and genital warts; however, the vaccine has been shown to be effective regardless of previous contact with the virus. For this reason, the guidelines recommend vaccination in young adults and suggest that doctors implement communication strategies to increase awareness of the possibility and effectiveness of vaccination in men;
• for therapeutic purposes: it would be moderately effective against persistent HPV 16 infections and high-grade intraepithelial lesions; therefore, they recommend vaccination for men undergoing resection of high-grade anal intraepithelial lesions.

Read Also:

Spotting, Or Atypical Female Bleeding: What It Is And The Diagnostic Pathway

What Is The Papilloma Virus And How Can It Be Treated?

Source:

GSD