Human papillomavirus has been framed as a women's health topic for thirty years. Cervical screening exists, the vaccine was launched for girls, and public campaigns spoke to women. The result is a widespread belief among men that HPV is something they might pass on but do not need to worry about themselves.

That is wrong in two directions. HPV causes cancers in men (penile, anal, and increasingly oropharyngeal) and there is no routine screening test that finds those cancers early. For men, prevention is the whole strategy, because detection is not on offer.

What HPV is and how common it is

HPV is a family of over 200 related viruses, around 40 of which infect the genital and anal region. It is the most common sexually transmitted infection worldwide; most sexually active adults are exposed at some point, and the great majority clear the virus within one to two years without ever knowing they had it.

The strains split into two groups that behave very differently:

Low-risk strains, principally HPV 6 and 11, cause around 90% of genital warts. They do not cause cancer. They are visible, socially distressing and treatable.

High-risk strains, principally HPV 16 and 18 along with a dozen others, cause no visible signs at all. They can persist in the skin for years, gradually driving cellular changes that lead to cancer. They are invisible, silent, and the reason HPV matters medically.

The uncomfortable implication: the strains that cause the symptom men notice are not the strains that cause the harm.

The cancers HPV causes in men

Oropharyngeal cancer (cancer of the tonsils and base of tongue) is the fastest-growing HPV-associated cancer in men across developed countries. It is now more common in men than cervical cancer is in women in several populations. It is linked to oral sex, and it typically presents late, often as a painless lump in the neck rather than anything in the mouth. There is no screening test.

Anal cancer is strongly HPV-driven and disproportionately affects men who have sex with men, particularly those living with HIV. Anal cytology screening exists for high-risk groups but is not routine in the general population.

Penile cancer is rare but almost entirely HPV-related when it occurs. Risk is higher with phimosis and poor foreskin hygiene, which is one of several reasons persistent phimosis is worth addressing.

None of these has a population screening programme comparable to cervical screening. For women, HPV can be detected before it causes cancer. For men, in most cases, it cannot.

Genital warts

Warts appear weeks to months after exposure as soft, skin-coloured or slightly darker growths on the shaft, foreskin, glans, scrotum, groin or around the anus. They may be single or clustered, flat or cauliflower-textured. They are usually painless, though they can itch, catch on clothing or bleed.

Treatment options include topical agents applied at home, cryotherapy, electrocautery and laser. Choice depends on the number, size and location of lesions. All are effective at clearing visible warts; none eradicates the virus, which is why recurrence within the first few months is common and does not mean treatment failed.

Men frequently mistake normal anatomy for warts. Pearly penile papules form a symmetrical ring of small dome-shaped bumps around the corona, have been present since adolescence, and are entirely normal. Fordyce spots are small yellowish sebaceous glands on the shaft, also normal. Neither is infectious or requires treatment, and a brief examination distinguishes them from warts immediately. Our HPV and genital warts guide covers treatment in more depth.

Transmission: why condoms are not enough

HPV is transmitted by skin-to-skin genital contact, not by fluid exchange. Penetration is not required. That is why condoms (highly effective against HIV, chlamydia and gonorrhoea) provide only partial protection here: they cover the shaft but not the scrotum, groin or perianal skin, all of which can carry and transmit the virus.

It also explains why a diagnosis says nothing useful about when infection occurred. HPV can lie dormant for months or years. A man who develops warts in a monogamous relationship of five years has not necessarily been exposed recently, and treating a diagnosis as proof of infidelity is both common and frequently wrong. Clinicians see the damage that assumption does to relationships regularly.

Vaccination for men in Singapore

HPV vaccination is available to men in Singapore. The nine-valent vaccine covers HPV 6 and 11 (the wart-causing strains) and seven high-risk oncogenic strains including 16 and 18.

The vaccine works by preventing infection, so it gives the most benefit before exposure. That is why national programmes target adolescents. But "most benefit before exposure" is not the same as "no benefit afterwards": adults are unlikely to have been exposed to all nine covered strains, and vaccination still protects against the ones they have not met. International guidance generally supports shared decision-making about vaccination up to age 45.

Practical points for men considering it in Singapore:

Under 15 years: two doses. Age 15 and above: three doses over six months.
Vaccination is worth discussing even if you have already had warts, since it protects against the high-risk strains that warts do not indicate.
It does not treat existing infection or clear current warts.
Cost sits in the several-hundred-dollar range per dose in the private sector; MediSave covers only the older bivalent (2-strain) HPV vaccine under the national programme; the 9-valent vaccine used in most private clinics, including Hisential, is not MediSave-claimable.

Vaccinating men is not only about protecting partners. It is the only tool that meaningfully reduces a man's own risk of the anal and oropharyngeal cancers that have no screening programme.

Can men be tested for HPV?

Largely, no, and this catches people out. There is no approved routine HPV test for men equivalent to cervical HPV testing. What a doctor can do is examine for visible warts, assess anything suspicious, perform anal cytology in high-risk groups where it is indicated, and biopsy any lesion that looks abnormal.

That absence is precisely why vaccination, condom use and awareness of persistent lumps or ulcers carry more weight for men than for women. If something on the genitals or in the anal region has not resolved in a few weeks, it should be examined rather than watched.

What to do

If you have visible warts, get them assessed and treated. Self-treating with over-the-counter wart preparations meant for hands can burn genital skin badly. If you have never been vaccinated and you are under 45, have the conversation. If you have any persistent lump, ulcer or area of thickened skin on the penis or around the anus, or a persistent neck lump or sore throat that does not settle, get it examined.

And treat a wart diagnosis as an occasion for a full STI screen, because co-infection is common and the other infections are silent.

Telling a partner

HPV is unusual among sexually transmitted infections in that the disclosure conversation is often harder than the medical problem. Two facts make it easier.

The first is that timing is genuinely unknowable. Because the virus can lie dormant for years, a diagnosis today carries no information about when or with whom exposure occurred. Anyone framing it as evidence of recent infidelity, including yourself, is reading something into the diagnosis that is not there.

The second is that most adults have already been exposed. HPV is not a marker of unusual behaviour; it is close to a universal experience of being sexually active. A long-term partner has very likely already encountered the same strain, which is why couples are not routinely separated during treatment.

What is worth saying is practical: that you have visible warts and are having them treated, that transmission is by skin contact so condoms help but do not eliminate risk, and that vaccination is worth their considering if they have not had it. That is a short conversation, and it is considerably shorter than the one that follows a partner discovering it independently.

Reducing your risk in practice

Vaccination is the single most effective step, and it is the only one that addresses the high-risk strains you cannot detect. Beyond that, a few things measurably shift the odds.

Consistent condom use reduces transmission substantially even though it does not eliminate it, and it protects fully against the fluid-borne infections that frequently travel alongside HPV. Not smoking matters more than most men expect: tobacco impairs local immune clearance, and smokers are significantly more likely to have persistent rather than transient HPV infection, which is the pathway to cancer. Good foreskin hygiene, and treatment of persistent phimosis, reduce penile cancer risk. And men living with HIV, or otherwise immunosuppressed, clear HPV less reliably and should discuss anal screening with their doctor rather than relying on symptoms.

The general principle for men is unavoidable: because there is no screening test, everything useful happens before infection or at the point a lesion becomes visible. Anything on the genitals or perianal skin that has not resolved within a few weeks belongs in front of a doctor rather than in a search engine.

Care at Hisential

Hisential offers HPV and genital wart removal, HPV vaccination and full sexual health testing for men across Singapore, at 333A Orchard Road, #04-13 Mandarin Gallery, beside Somerset MRT. Consultation is from S$50 after GST, patients travel to us from across the island, and follow-up reviews can be handled by telehealth.

Frequently asked questions

Can men get tested for HPV in Singapore?

There is no routine HPV test for men. Doctors examine for visible warts and biopsy suspicious lesions; anal cytology is used in specific high-risk groups.

Should adult men get the HPV vaccine?

It is worth discussing up to around age 45. Benefit is greatest before exposure, but most adults have not encountered all nine strains the vaccine covers.

Do condoms prevent HPV?

Only partly. HPV spreads by skin-to-skin contact and condoms do not cover all the skin involved, though consistent use does reduce transmission.

Does having genital warts mean I am at risk of cancer?

Not directly. Warts are caused by low-risk strains that do not cause cancer. They do indicate exposure to HPV generally, which is a reason to consider vaccination.

Does a wart diagnosis mean my partner cheated?

No. HPV can remain dormant for months or years, so the timing of a diagnosis does not indicate when infection occurred.

Do warts come back after treatment?

Often within the first few months, because treatment removes visible lesions but the virus can persist in surrounding skin. Recurrence usually stops once the immune system clears the infection.

References

Ministry of Health Singapore, National Childhood and Adult Immunisation Schedules
Health Promotion Board Singapore, HPV vaccination information
World Health Organization, Human papillomavirus and cancer fact sheet
US Centers for Disease Control and Prevention, HPV and men

HPV - 女性だけの問題ではありません