THE HUMAN PAPILLOMA VIRUS IN MEN
HPV, the most common sexually transmitted disease that exists, can cause genital warts and even cancer in different organs
A man infected with the human papilloma virus (HPV) can infect his sexual partner even when he has no visible symptoms of the condition in his genitals.
Many people do not know, but HPV is the most common sexually transmitted disease and both men and women are at risk. In fact, to be exposed to the virus is enough to have had intimate relationships with more than one person. And intimate risk relationships are not only limited to intercourse, which is penile-vaginal penetration, but also include oral and anal sex.
Although there are over 100 strains of HPV and most leave the body in a period of two years without causing damage, there are some subtypes that can cause genital warts or, in the worst case, cancer. The types of cancer that can develop from a high-risk HPV infection are: cervical, penile, vulva, vagina, anus, or oropharynx (back of the throat).
Although the incidence of this disease is very high, the urologist Leonel Guerrero regretted that many men do not go to the doctor to examine themselves when they have a lesion (wart) on their genitals due to ignorance or shame. "Many do not go because they think that (the injury) is a mole a little bigger or that it is not something so serious," explained the specialist.
In order to educate and clarify doubts about the impact of this virus on men, urologists Alberto Ramírez López and Leonel Guerrero explain how the disease is identified, how it is treated and what preventive measures should be taken into account.
How can a man know he has the virus?
A male may only know that he is infected with HPV if he develops visible warts in the genital area. However, it is more usual for man to have no symptoms even if he is infected.
"In most cases that men become infected, there are no symptoms. When there are symptoms, it usually presents as a genital wart. Its appearance can be like a slight protuberance or with a cauliflower shape, "Dr. Guerrero said.
"Sometimes, the person may be infected but has no manifestations for months or years. It is almost impossible to know when the person became infected, "the doctor added.
Are there tests to diagnose HPV in men?
Dr. Ramirez Lopez explained that currently there is no validated test to diagnose the virus in men. The disease is only diagnosed when the man develops warts. However, according to the doctor, most men who have the virus do not have visible warts.
On the other hand, for men who practice anal sex, there is a test called "Anal Papanicolaou" - which is like a type of scrape in the area - and can be performed at the request of the patient, said the specialist.
Can contagion be prevented?
Regarding prevention, it is recommended to vaccinate adolescents and young people, males and females, against HPV before they start having sex. The available vaccines protect against the most dangerous HPV subtypes, which are those that cause genital warts and cancer. The vaccine, which has proven to be safe and effective, is administered in three doses over a period of six months for patients between the ages of 11 and 26 years.
In what areas do the warts appear?
Warts may arise in the penis, scrotum or anus and, in general, are not painful. Guerrero indicated that, in cases where the wart is small and the strain of the virus is not aggressive, "it may disappear on its own." In other cases, the lesion may grow or spread in the area.
"If the man touches the area where the wart is and then touches another part, he is self-contracted," the urologist said.
Can a male be a carrier of the virus without affecting his health?
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Yes, but everything will depend on the virus subtype and how strong your immune system is. In addition, even if the infected man does not have symptoms of the virus, he can inoculate a woman and this woman, later, could develop genital warts or cancer due to HPV.
How is the disease treated?
"That he will be examined with a urologist or dermatologist to see what type of wart or injury he has," Dr. Guerrero recommended to those men who detect an injury to their genitals. HPV warts can appear on the penis, scrotum, or anus. "It is much more worrying when that lesion has different ulceration or pigmentation, we must pay more attention," he said.
The treatment may vary. If it is small lesions, Guerrero indicated that they can be treated with prescription topical medications (creams). In other cases, when they are larger warts, cryosurgery is used, which is the freezing of the warts, or surgical removal. These procedures can be performed by both urologists and dermatologists.
Who is most at risk?
Both doctors agreed that having multiple sexual partners and not using barrier methods, such as condoms, are high-risk behaviors that lead to the transmission of HPV in men.
It is important to emphasize that, although the condom is a recommended prevention practice, it is not 100% safe because it only protects the area it covers. "If there are injuries in other areas and they touch the skin, there will be contagion," Guerrero said.
The doctor added that a man who is infected with HPV could also have other sexually transmitted diseases.
Removal options
Cryosurgery The application of liquid nitrogen freezes the water found inside the warts, causing the destruction of the cells that make up the warts. The doctor will clean the area of the warts with a swab of alcohol. Apply the tip of an applicator with liquid nitrogen to each wart until a 5 mm margin of the surrounding skin freezes. The skin will freeze for an additional 30 seconds until it turns white and this will be followed by a thawing period in which the white areas will disappear. If the pain is tolerable, another freezing period will be performed.
One limitation of the treatment with cryotherapy is that this treatment does not destroy the papilloma virus completely, leaving the virus latent in the epithelium which contributes to the recurrence of the warts. The reappearance of warts occurs in 25-40% of cases.
Electrosurgery
This practice is used when there has been no success with other treatments. This uses a needle with high frequency electrical current to cut the warts. Your doctor will first apply local anesthesia to the area. Following the procedure, if necessary, your doctor is likely to prescribe painkillers.
It has been discovered that electrosurgery is effective for a small amount of lesions on the trunk of the penis.
10-25% podophyllin resin.
Podophyllin should be applied to each wart and allowed to air dry before the treated area comes into contact with clothing; Excessive application of this product or not allowing time for the product to dry may cause local irritation caused by the spread of the compound to adjacent areas.
The treatment can be repeated once a week if necessary. The area applied with podophyllin should be washed 1 to 4 hours after application to reduce local irritation.
Healing is achieved in 42-50% of cases. The frequency of reappearance of warts is 46 to 60% of cases.