Daniela

Men, people with penises – some myth-busting

Part II

In its most commonly used form, HPV testing for men is both unreliable and clinically pretty useless. We also have the reality that everyone has various strains of at any one time; everyone’s had previous infections. And we’ll probably all have future STD tests and infections. I’m reminded of a post on here where a well-meaning man had STD PCR testing from several regions of his genitals.

And it came back with a whole list of strains, most of which are probably doing nothing but just hanging out in the skin for a bit. I’m willing to bet if you PCR-tested any one of us, we’d probably receive a similar result. This young man was feeling dreadful, knowing he had all these STD infections and thinking about transmitting them to partners. But is he any different from any other guy out there? Does this information help him or his potential partners?

Potential Benefits of exams for High-Risk viruses

An argument can be made that if men were tested for the riskiest high-risk HPV types (e.g., 16/18), it would give partners a chance to get vaccinated before sex. This would benefit those who missed vaccination due to age or whose parents were against it. The medical outlook seems to suggest that if you’re over 30 (i.e., didn’t get vaccinated as a kid), you’re on your own, as the focus is more on vaccinating teens before their sexual debut, which makes practical sense. If you’re reading this and you’re not vaccinated, get on it, whether male, female, or otherwise.

There’s also an argument to be made for better STD oral screening/treatments, given the rising rates of oral cancers in men. Currently, oral testing is not recommended as cancer prevention because such a tiny % of infections ever become cancerous (Oral Cancer Foundation says 1%) and a test can’t tell you whether that will be you or not. Plus, we currently don’t have a treatment, so simply finding out you have oral HPV is, again, useless. Hopefully we will see treatment options such as a therapeutic vaccine in future.

Lack of exams for Low-Risk Strains

Remember that healthcare STD providers do not usually test women for low-risk strains. So it’s not just men who don’t have access to this facility.

I’m also going to put a note here that anal pap smears are a thing, and given the prevalence of high-risk HPV in MSM, these should probably be more widely available and promoted. Anal pap smears have a lot more clinical relevance than urethral swabs because they can find dysplasia that can then be monitored and treated in a similar way to cervical abnormalities.

Men can’t clear the virus. 

We’ve had a few posts recently with panicked assertions that ‘men can’t clear HPV’.

Let’s first address the ambiguity of the word ‘clear’. I prefer to say ‘immune suppress’ because we ultimately don’t know what happens to infections in the body, and ‘clear’ implies a particular outcome (eradication from the body), which is possible but not proven in tests.

Anyway, it’s simply not true that men do not immune suppress infections.

Numerous test studies show men’s immune systems suppress low—and high-risk STD infections. Men are less prone to persistent infections than women.

‘ in men, the median time to clearance of any-HPV infection was 7.5 months, with 66 and 90% of infections clearing within 12 and 24 months respectively.’

Men may be at a disadvantage in creating antibodies that prevent reinfection. For some reason, male bodies are bad at this, so it may take more exposure to a particular STD strain to make a solid immune response.

However, this does not mean that all men will have HPV forever. It just means your bodies process the infection in a slightly different way.

Men have fewer treatment options.

Unfortunately, this one is partially true. Imiquimod shows less effectiveness in wart treatments in men, possibly due to a slightly different immune response.

Nonetheless, it doesn’t mean the outlook is entirely bleak. It may mean trying a wider range of treatments or combinations.

Women carry all the stigma.

This is an interesting point of debate and, in some senses, may be true. HPV variant testing, as we mentioned earlier, is a relatively new thing regarding routine screening, and education hasn’t caught up. This leaves many women confused and upset at a diagnosis they weren’t expecting. The idea of having an STI can devastate you when you’ve been raised to believe that a sexually transmitted infection signifies dangerous, unhealthy, or immoral behaviour. Similarly, when women disclose to male partners, there can be shock, upset and judgement, again because of the education gap.

On the other hand, men are not being tested but also have HPV infections. And usually, only those with visible warts or other lesions know them. There is a lot of stigma on those men. So, saying one side has it worse than the other is perhaps unfair.

What’s clear is that, rather than engaging in stigma Olympics, there are a few things we need to address on a societal and cultural level:

  • An understanding that HPV affects LITERALLY EVERYONE and is therefore not a ‘women’s issue.’
  • An appreciation that an STD diagnosis is not weird, abnormal, disgusting or a sign of poor behaviour – it’s an unavoidable part of being human.
  • A wider movement for vaccination, including in adulthood, for men as well as women
  • A push for more testing and effective and easily available STD treatment for those already infected – including men