It's estimated that 90% of sexually active people will be infected with HPV at some point in their lives. While the virus is often seen as a women's health issue, it affects men as well.

Following Breast Cancer Awareness Month, Pink October, comes Blue November, also known as Movember, a time dedicated to raising awareness about male cancers. While the focus usually falls on prostate and testicular cancer, far fewer people are aware of the cancer risks linked to the Human Papilloma Virus (HPV).

HPV is responsible for nearly all cervical cancer cases, killing around 15,000 women in the EU each year. But although it's often dismissed as a women's health issue, HPV affects everyone. According to the United States' Centers for Disease Control and Prevention (CDC), the virus is linked to 91% of anal cancers and 70% of oropharyngeal cancers, 75% of vaginal, 69% of vulvar, and up to 63% of penile cancer cases.

And yet, despite the scale of the problem, many men remain unaware of the risks. Studies estimate that one in three males over 15 carries HPV, and that men account for up to 30% of all HPV-related cancers. Still, public discourse rarely addresses HPV as a universal health threat.

To shed light on the issue, we spoke with Audrey Gustin, Scientific Manager at Fondation Cancer, about how HPV is transmitted, how protection works, and why testing remains so challenging.

A virus not like the others

"There are around 200 types of HPV, but only 12 pose a risk of lesion", Gustin explains. "Most of the time, an HPV infection clears on its own, but in some cases it can lead to lesions. These can be genital warts, or depending on the HPV type and whether the infection persists they can also develop into cancers."

And while most people will be infected at some point, most won't know. "There is no specific test to detect this type of lesion, at least in men. In women, there is the Pap smear, which can detect cervical cancer", explains Gustin. Pap smears help detect abnormal changes in cervical cells; other types of HPV infections beyond the cervix cannot be detected in this way, and the only way to diagnose them is through visible signs, such as warts.

However, even in cases where an infection can be visibly determined, it's not likely it'll be treated: "In 90% of cases, the infection will resolve itself", says Gustin. She explains that treatments are limited even when a diagnosis is possible. Genital warts can be treated with creams or surgically removed, and laser treatments can sometimes be used for throat papillomas. But if cancer develops, treatment is far more severe: "It will truly be a cancer treatment that is specific to the location, the individual, and their clinical profile."

How is it transmitted?

HPV differs from other STIs in how it spreads, Gustin explains: "There's no way to fully avoid infection. We can reduce the likelihood, notably by using condoms, because HPV is mainly transmitted through infected skin-to-skin contact, which can occur at the level of the oral mucous membranes as well as the genital ones."

She emphasises that condoms alone don't offer full protection: "Condoms are put on at a certain point, when foreplay may already have taken place. There's a whole other dimension to sexual contact where contamination can occur."

Vaccination as the single most effective solution

"The most important is to act preemptively, it's really about getting vaccinated", says Gustin.

The World Health Organisation (WHO) has recommended the HPV vaccine for girls since 2006. In Luxembourg, vaccination was rolled out in 2007, however when it comes to male HPV infections, adoption took a decade longer.

"In 2018 Luxembourg began vaccinating boys as well", Gustin notes. The vaccine is recommended for young people aged 9 to 14, with catch-up possible until age 20. "It is completely free of charge and is carried out by general practitioners", she says.

Overall, while vaccination of young men only started in 2018, numbers remain lower than among women. Especially in the 15-20 age bracket. Still Luxembourg's vaccination rates are globally high among young people, "We have reached a vaccination rate of more than 80% among 15 year old girls and over 70% among boys", Gustin notes. The WHO's goal is to reach 90% by 2030. "We're not so far from the target."

While Luxembourg's vaccination rate is higher than the EU average, challenges remain. "There are efforts still to be made", she says, referring to a recent Health Directorate report. "It noted that some parents of young people still struggle to access clear information about HPV, about the need for vaccination, and about why it matters."

When should you get vaccinated as an adult? 

For adults over 20, vaccination is no longer recommended by the WHO, as it is most effective before sexual activity begins. Still, Gustin says it can be worthwhile: "It can still protect. Even if someone is already infected with one or two types, the vaccine offers protection against nine types in total. So it remains useful."

Certain groups should especially consider vaccination, even as adults, such as immunocompromised patients, where otherwise asymptomatic infections could have more serious consequences. Other groups, like men who have sex with men should also consider the vaccine as adults, "Among them, the rate of cancer cause by HPV is five to ten times higher than among other men. In these populations, it's true that the reflection needs to be a little more thorough." Explains Gustin.

It’s worth noting, however, that after age 20 the vaccine is no longer free. "It costs €128 per injection, and the HPV vaccine consists of two doses six to twelve months apart. So it amounts to a few hundred euros," Gustin says.

If you are affected by this or would simply like to learn more about cancer, in Luxembourg the Fondation Cancer provides resources and regularly organizes events on the topic.