Male Genital HPV Infection Signs and Symptoms

Clinical Manifestations

Visible genital warts are the most common clinical manifestation of HPV infection in men, caused by HPV types 6 and 11 in over 90% of cases, and can appear as small, cauliflower-like growths on the penis, scrotum, perineum, and perianal skin 4, 5
The Centers for Disease Control and Prevention recommends that men with visible genital warts seek medical attention, as they can be painful, friable, or pruritic, though commonly asymptomatic 5
External genital areas, including the penis, scrotum, perineum, and perianal skin, are most commonly affected by HPV infection 5
Intra-anal warts are seen predominantly in men who have had receptive anal intercourse, and are distinct from perianal warts which can occur without anal sex history 4, 5
The American Cancer Society notes that urethral meatus warts can develop at the urethral opening 2
Oral cavity warts are less common but possible with HPV types 6 and 11 4, 5

HPV types 16, 18, 31, 33, and 35 rarely cause visible warts but are associated with penile, anal, and oral cancers, and may present as penile intraepithelial neoplasia or squamous cell carcinoma in situ 4, 5
Lesions that are pigmented, indurated, fixed, and ulcerated warrant biopsy to rule out malignancy, as recommended by the National Institutes of Health 4, 5

The Centers for Disease Control and Prevention states that no clinically validated test exists for men to determine if they have HPV infection, and diagnosis of genital warts is typically clinical, based on visual inspection 1, 4, 5
Biopsy is only needed when diagnosis is uncertain, lesions don't respond to standard therapy, disease worsens during therapy, patient is immunocompromised, or warts are pigmented/indurated/fixed/ulcerated, as recommended by the American Academy of Dermatology 4, 5

The World Health Organization notes that most sexually active adults will get HPV at some point in their lives, though most will never know it, and most HPV infections in men clear within one year 1, 2
The median time to clearance is 5.9 months, with 75% clearing within 12 months, according to the Centers for Disease Control and Prevention 6

The absence of visible signs does not mean absence of infection, as most infections are subclinical, and HPV can be transmitted even when no visible signs or symptoms are present, as noted by the American Sexual Health Association 1, 2, 6
Different HPV types have different clinical significance, and a diagnosis of HPV in one partner is not indicative of sexual infidelity, as infection could have been acquired years earlier, according to the National Institutes of Health 2, 4, 5, 6
Immunosuppression increases risk of persistent infection and clinical manifestations, as stated by the Centers for Disease Control and Prevention 5