Abstract
While much is known about the natural history of cervical human papillomavirus (HPV) infection and its consequences, including cervical intraepithelial neoplasia and cervical cancer, relatively little is known about the natural history of anogenital HPV infection and diseases in men. In part this reflects difficulties in penile sampling and visual assessment of penile lesions. Anal HPV infection and disease also remain poorly understood. Although HPV is transmitted sexually and infects the genitals of both sexes, the cervix remains biologically more vulnerable to malignant transformation than does the penis or anus in men. An understanding of male HPV infection is therefore important in terms of reducing transmission of HPV to women and improving women's health. However, it is also important due to the burden of disease in men, who may develop both penile and anal cancer, particularly among HIV-positive men who have sex with men. Improved sampling techniques of the male genitalia and cohort studies in progress should provide important information on the natural history of anogenital HPV infection and disease in men, including risk factors for HPV acquisition and transmission. The impact of HPV vaccination in women on male anogenital HPV infection will also need to be assessed.
Highlights
The most common cause of human papillomavirus (HPV)-associated mortality is cancer of the cervix, and most of the attention of clinicians and researchers has appropriately been directed toward this disease and its precursors
Consistent with a relationship between penile and cervical HPV infection, male condom use has been shown to promote regression of human papillomavirus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia [9], and male circumcision is associated with a reduced risk of cervical cancer in their current female partners [21]
Similar to the classification system used for cervical cytology, anal cytology is classified as normal, atypical squamous cells of undetermined significance (ASCUS), atypical squamous cells- cannot rule out highgrade disease (ASC-H), low-grade squamous intraepithelial lesions (LSIL), high-grade squamous intraepithelial lesions (HSIL) and invasive carcinoma
Summary
The most common cause of HPV-associated mortality is cancer of the cervix, and most of the attention of clinicians and researchers has appropriately been directed toward this disease and its precursors. An understanding of anogenital HPV infection in men is critical to reducing the risk of HPV transmission to women. Similar to women, men suffer the consequences of anogenital HPV infection in the form of anogenital condyloma, intraepithelial neoplasia and cancer. Recognition and treatment of anogenital HPV-associated lesions in men is critical to reducing the burden of disease in men and treatment of penile lesions has the potential, albeit as. Consistent with the above, the benefits could include reduced HPV transmission to women and increase in “herd immunity”, as well as reduced penile and anal cancer incidence. Even in the absence of vaccinating men, a high penetrance of the vaccine in women would likely affect the prevalence and incidence of male anogenital disease in the future, and this will need to be the subject of further study
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