HPV and Genital Warts in Men: Symptoms and Treatment
What causes genital warts and what are the signs of HPV in men? Diagnosis, treatment options, why warts recur and the place of HPV vaccination in men explained.
HPV (Human Papilloma Virus) is the most commonly sexually transmitted virus family in the world. Its most visible consequence in men is genital warts. Because the subject feels embarrassing, most men delay seeing a doctor — yet genital warts are common, discussable and treatable. Early assessment both limits spread and makes protecting a partner easier.
What are genital warts and why do they occur?
Genital warts are benign growths of the skin and mucosa associated with low-risk HPV types (most often types 6 and 11). The virus is transmitted by skin-to-skin contact; condoms therefore reduce the risk but do not fully prevent transmission, because they do not cover the entire area of contact. Warts may appear anywhere from weeks to months after transmission, which is why it is usually impossible to pinpoint when infection occurred.
What are the symptoms of HPV in men?
- Painless, flesh-coloured or pinkish bumps on the penile shaft, glans, foreskin, scrotum or around the anus
- Cauliflower-like lesions, either single or in clusters
- Sometimes itching, irritation from friction or, rarely, bleeding
- Changes in urinary flow if warts are located at the opening of the urethra
Many HPV types, on the other hand, cause no symptoms at all. The absence of symptoms does not mean the virus is absent; this is why carriage can remain silent.
Does HPV cause cancer?
The low-risk types that cause warts and the high-risk types associated with cancer are different groups. In other words, having genital warts does not mean cancer will develop. That said, high-risk types have been associated with cancers of the penis, anus and head-and-neck region in men. The right approach is therefore not to panic but to have the lesion assessed by a doctor, to undergo further investigation where indicated, and to continue regular follow-up.
How is the diagnosis made?
Genital warts are usually diagnosed by examination. A biopsy may be requested for lesions that look suspicious, fail to respond to treatment or grow rapidly. If involvement of the urethral opening is suspected, endoscopic assessment may be performed; anal involvement may require additional evaluation. Screening for other sexually transmitted infections is also commonly recommended during assessment, since these infections can occur together.
How are genital warts treated?
Treatment is selected individually according to the number, site and size of the lesions:
- Topical medication: creams applied under medical supervision may be preferred for a limited number of superficial lesions.
- Cryotherapy (freezing): the lesion is frozen with liquid nitrogen; it can be performed in outpatient conditions.
- Electrocautery or laser: used effectively for widespread, thick or recurrent lesions.
- Surgical excision: applied for large lesions or where a sample is needed for diagnosis.
The aim is to clear visible lesions and relieve symptoms. The choice of method is made together, taking the patient's daily routine and the characteristics of the lesion into account.
Why can warts come back?
Treatment removes the visible lesion, but the virus may persist silently in the surrounding skin. Recurrence in the months following a procedure is therefore possible and is not a sign of failure. Smoking and conditions that suppress immunity may increase the likelihood of recurrence. The right approach is to attend planned follow-up visits, to seek review promptly when a new lesion is noticed, and to repeat treatment if needed.
Is the HPV vaccine given to men?
Yes. HPV vaccination is not exclusive to women; in men it can also be given to protect against the types that cause warts and the high-risk types associated with cancer. The protective value of the vaccine is highest before exposure to the virus; however, its role in people who already have a history of warts is assessed in discussion with the doctor. The vaccine is a means of prevention, not a treatment for existing lesions.
What should I do to protect my partner?
Consistent condom use during and after treatment reduces the risk of transmission. Assessment of the partner and information about vaccination are also recommended. It is important to discuss the subject openly within the relationship and in non-blaming terms: HPV is very common, and it is usually impossible to determine when transmission occurred. Arranging a urological assessment without delay when you notice a suspicious lesion both simplifies treatment and reduces anxiety.
Assoc. Prof. Zülfü Sertkaya practises in the field of urology and andrology in Istanbul; HPV and genital wart assessments are carried out with individualised planning and full confidentiality.