What an interesting question you are posing!
Let?s start with female HPV infection first. While the HPV virus is
found in almost all cases of cervical cancer, not all HPV infections
result in cancer. It can take up to 20 years after infection for
cervical cancer changes to appear. About 10% of HPV infected women
develop cervical dysplasia (abnormal cell growth, which can become a
precursor to cancer). Of those 10%, only a small number go on to
develop cervical cancer. Socioeconomic, behavioral and cultural
factors come into play. Smoking greatly increases chances of many
types of cancer, and cervical and penile cancer are among those types.
Immunosuppressed patients (those with immunodeficient diseases, such
as HIV, leukemias, lymphomas, etc.) and pregnant women are also at
higher risk. Some studies have implicated oral contraceptives as a
risk factor for cervical cancer.
Some variants of HPV cause more troubles than others. Types HPV-16
and HPV-18 are the most risky, causing most cases of penile cancer.
HPV-6 and HPV-11 are considered low risk for cancer, as are HPV- 42,
HPV- 43, HPV-35, and HPV- 45. HPV-31 and HPV-33 types are classified
as ?probably carcinogenic? ?Types other than HPV-16 and HPV-18 are
unlikely to cause any complications. Over 80% of sexual partners will
develop the infection after exposure to an infected individual. The
American Cancer Society
Now, for some reassuring news -- according to information from the
Cervical Cancer Consortium Europe (CCCE), if one partner in a
relationship is infected with HPV, it is highly likely that the other
partner will be positive for HPV as well. It is also possible for a
partner to build immunologicial defenses against HPV, and not be
infected. Having repeated contact with the same partner does not
appear to increase the risk of becoming infected.
?This is valuable information for couples in a stable relationship who
do not need to have undue concerns about maintaining their sexual
contact. However, new relationships may introduce a different HPV
type, which can place the woman at increased risk of cervical disease
or cervical cancer.?
According to the CDC, current sexual partners of an infected person,
are probably already infected. ?Most recurrences within a patient are
believed to be caused by activation of latent virus present in
adjacent normal skin, rather than re-infection by a partner. As
always, an annual Pap smear screening test is recommended for all
sexually active women, and its importance should be emphasized in
women with a history of exposure to HPV.
?In terms of whether or not these or other HPV types might cause
cancer of the penis in men, there is still ongoing research to
determine this for sure?
?The exact prevalence of HPV infection is impossible to define.
Studies reporting these statistics have produced widely disparate
results due to differing sensitivities in the methods used for
detecting HPV infection, the frequency of HPV screening within a given
population, and differences in the populations studied.?
Cleveland Clinic Journal of Medicine
93% of male partners of women with early cervical cancer, had the
equivalent form, suggesting that neoplasia (pre-cancer, early cancer)
is sexually transmitted.
?Penile tumors tend to grow slowly. When found at an early stage,
these tumors can usually be cured. Squamous cell penile cancers can
develop anywhere on the penis, but most develop on the foreskin (in
men who have not been circumcised) or on the glans.?American Cancer
This site, from THE JOURNAL OF FAMILY PRACTICE, Volume 44, Number 4:
Pages 407-409, April 1997. gives a case study of an elderly man with
carcinoma of the penis. On this site is a table with risk factors for
developing penile cancer. This is the closest data I was able to find
as far as a lifetime risk of developing penile cancer.
The Digene test your friend?s fiancé had performed is not FDA approved
for male testing. However, a PCR test can be run on your friend.
Forces of Nature
Male HPV testing:
An old fashioned, non-reliable and non-recommended test for HPV in
your friend, would be to thoroughly wet paper towels with white
vinegar and wrap them around the shaft of the penis. Leave the towels
in place for a few minutes, and observe for white spots. This is NOT a
scientifically controlled test, and is not specific, nor highly
sensitive. Doctors coat the cervix with a vinegar type solution
(dilute acetic acid) to check for cervical warts in women. A negative
home test result can NOT rule out HPV however.
About circumcision: Studies can be found that argue for or against
circumcision?s role in HPV and/or penile cancer:
?Ironically, Denmark, in spite of its low circumcision rate, currently
has a lower incidence of penile cancer than the United States, where
60% to 80% of men are circumcised?
Journal of Family Practice
?In Paraguay, for instance, it (penile cancer) is the most common
urogenital malignancy, accounting for over 50% of male cancers!?
?"Further study is needed to determine whether routine circumcision
can reduce the risks of HIV and HPV infections and other sexually
Alan Gutmacher Institute
?Only circumcision was found associated with a decreased risk of HPV
among men and cervical cancer among their wives in a large
multi-centric study conducted by the IARC in five countries.?
Instituto Nacional de Salud Pública
While some may believe that a circumcised man is a lower risk of
contracting cancer, this is debated by many. ?Post-circumcision cancer
may occur at the circumcision scar. The cause is unknown. One may
hypothesize that the circumcision scar tissue is less resistant to
penetration of HPV which then transfers DNA to the human cell and
starting the growth of the neoplasm.?
?The sexual behaviour of the woman?s male partner may also increase
the risk of exposure (10) for it has been known that partners of men
that develop penile carcinoma are at high risk of developing carcinoma
of the cervix.?
Geneva Foundation for Medical Education and Research
According to Dr. SYDNEY S. GELLIS, of New England Medical Center
Hospital, ?It is an uncontestable fact at this point that there are
more deaths from complications of circumcision than from cancer of the
?? it has also come to light that around 10 to 15% of American men do
not know their own circumcisional status, some making claims that they
have had the operation when they have not, and vice versa. This
difficulty is related neither to myopia nor to the combination of
gross obesity and a short memory.?
An interesting aside, when a husband is HPV DNA positive, the wife has
a 5 times greater chance of contracting cervical cancer, according to
one study in Spain
Journal of the National Cancer Institute
?Squamous cell carcinoma of the penis is a rare malignancy in the
United States, accounting for only 0.4% of all cancers in men. The
mean age at diagnosis was 63 years; 62% were white and 38% African
American. Eighty-nine percent of our population was uncircumcised?
?Condoms provide almost no protection against contracting the disease during sex.?
?But the virus can still be spread through skin that is not covered by a condom.?
See Pages 29, 48 , 52 for additional information. (However, on Page 4,
there is a misprint: The illustration is identified as a Gram Stain of
HPV. This illustration actually depicts wbhit blood cells, infected
with Gram Negative Intracellular cocci, better known as gonorrhea or
GC. Gram stain is not used to identify viruses, nor can viruses be
seen without the aid of an electron microscope.)
Assosciation of Public Health Laboratories
HPV vaccine is on the horizon:
A University of Arizona study found: ?The researchers detected HPV in
samples taken from 28% of the men. However, only 12% of the men
carried forms of the virus linked to cancer. HPV may be more of a
transient infection in men than in women, she noted, and the two sexes
may have different immune responses to the virus. ?
Without intending to sound cavalier, if your friend and his fiancé
have already been intimate, especially without the dubious protection
of a condom, it is likely he is already infected.(He can be tested
too) HPV is a shedding virus, and can live outside the body. As such,
can be transmitted by towels and clothing contact. Many women don?t
know they carry the HPV virus and some infections may be sub-clinical
without any visible expression. I?m afraid there are no hard
statistics on incidence of penile cancer in partners of women with
HPV. ?Even if you do have one or more risk factors for penile cancer,
it is impossible to know for sure how much that risk factor
contributes to causing the cancer. On the other hand, some men who
develop penile cancer have no known risk factors.?
American Cancer Society
Since HPV can be, especially in the absence of warts, a symptom-less
infection in men, it is also possible for your friend to have been
previously infected. ?Most of the time, males will not have any
symptoms or health risks, such as cancer, with the "high-risk" types
of HPV. We recommend that sexual partners be examined by a physician.
If warts are found on examination, the partner can be treated. If
warts are not found, the male may still carry HPV but show no signs of
it. HPV prevention strategies include maintaining integrity of the
skin, maintaining a healthy lifestyle (proper nutrition and exercise
to keep the immune system strong), cessation of smoking and the
consistent use of condoms during sexual intercourse.?
So, causeimcurious, while I admire your concern for your friend, I am
unable to supply you with an exact risk factor number. It would even
be difficult to give you a accurate low, medum, or high estimate.
There is a lot of research on women contracting HPV/cervical cancer
from male partners, but in comparison, little information on males
contracting HPV/penile cancer from female partners.
I would suggest that your friend and his fiancé practice what is
called ?Watchful waiting?, abstain from smoking, keep themselves as
healthy as possible, and get regular checkups. Your male friend can
get tested, to ease his mind. The possibility he was infected prior to
meeting his fiancé also exists. Keep in mind that penile cancer is
rare, 1 in 100,000 men develop penile cancer (not taking into account
having an infected partner), as you already knew, but many times it is
cureable. 1 in 2 men will develop heart disease, 4 in 10 men will
develop prostate cancer, and at age 60 to 65, you have a one in six
chance and from 66 to 70, the chance increases to one in five. In your
70's, the chance of getting Alzheimer's Disease is one in three. At
age 80, half the people still alive will probably get the disease.
Short of breaking up or remaining celibate, your friend runs a risk,
although it does appear to be a small one, for penile cancer. Please
have your friend consult his doctor for testing and further
If any part of my answer is unclear, please request an Answer
Clarification, before rating. This will allow me to assist you
further, if possible. I wish your friend and his fiance all the best!
Penile carcinoma statistics
penile HPV-DNA prevalence cervical cancer
Penile Human Papillomavirus Infection
risk penile cancer
Clarification of Answer by
20 Feb 2004 22:33 PST
Hi there, becauseimcurious,
Thank you for your clarification. First, I want to apologize if it
appeared that I assumed your friend had already been exposed to HPV
with his fiancé. I actually did not assume this to be true, and
intended only to convey ? If he had?? I certainly respect his
personal, moral and religious beliefs.
The new information certainly changes my view of the situation, and
the fact that your friend has never been exposed to HPV makes this
even more of a dilemma! No amount of research can veil the fact that
to avoid HPV infection, your friend will have to abstain from being
intimate with his fiancé. The chances of penile cancer will certainly
increase once he is exposed to HPV, but the fact that your friend is a
non-smoker is a huge plus. The fact that he is uncircumcised appears
not to be a risk for him, depending on which information you find
Back to the figures?.You are a better mathematician than I ! I'm not
sure that your friend's chances would be a great deal greater than 1
in 100,000. Because HPV is often asymptomatic, and many people don't
even know they have it, it is certain that some of the men in that
100,000 group were exposed to HPV.
I can only conclude that the site that stated the lifetime risk of
penile cancer in the US is 1 in 1 1437 is in error. Every other site
agrees with the 1 in 100,000 figure. The 1400 number seems to be the
number of new cases of penile cancer each year in the US, not the
statistical risk. Many sites state the 1 man in 100,000 will develop
penile cancer, while around 1400 new cases of penile cancer are
diagnosed each year, with 200-400 deaths annually in the US.
?The American Cancer Society (ACS) estimates that less than 1,500 men
develop penile cancer each year and 200 die in the United States. The
rate in this country is 1 in 100,000 men, according to ACS?
?Penile cancer occurs at the rate of 1 in 100,000 males in the U.S.
circumcised or not?
?The disease is relatively rare, accounting for less than 1 percent of
all male cancers. Nearly 400 men died from penile cancer in 1990?
?Male breast cancer amounted to 1,400 cases, with 260 deaths, so
American men are more likely to suffer and die of breast cancer than
penile cancer ? See the chart on this page that states that there are
1,400 new cases of penile caner annually in the US, with 200 deaths.
??affecting only one man out of 100,000 and accounting for only 200
cancer deaths in North America each year.?
?In North America the rate of penile cancer has been estimated to be 1 in 100,000?
There is some of contradictory data, however.
The Journal of Family Practice, as quoted in the original answer
above, states that Danish men have fewer incidences of penile cancer
than American men.
Yet, this site states ?This incidence of penile cancer(in the US) is
similar to the rates in Denmark?
??penile carcinoma, which approximately one in 400?900 uncircumcised
men will get during their lifetime (US and Swedish data).? And ?A
quarter of those affected will die from it while the rest will need at
least partial penile amputation. (This should not be confused with the
often quoted, but misleading, annual incidence figures of one in 100
000 for developed nations).?
This Hospice web site does a good job of explaining risk factors and
incidence. ?Over one million people get cancer each year.
Approximately one out of every two American men and one out of every
three American women will have some type of cancer at some point
during their lifetime. Anyone can get cancer at any age; however,
about 77% of all cancers are diagnosed in people age of 55 and older.
Although cancer occurs in Americans of all racial and ethnic groups,
the rate of cancer occurrence (called the incidence rate) varies from
group to group.?
?But today about three hundred men a year still develop this cancer
in the UK, and approximately a hundred die from it.? This site has a
chart, from the UK, showing that while rates of penile cancers cases
have gone up slightly, from 1990 to 1997, the number of deaths
I found this ?How to Avoid Penile Cancer? on a Vanderbuilt University
page. It is worth reading.
??it is reasonable to suspect that avoiding sexual practices likely to
result in human papillomavirus (HPV) infection might lower penile
?"Carcinoma of the penis is so rare among the Jewish population that
its occurrence warrants comment (Licklider, 1961). Neonatal
circumcision is a universal practice in this population?
?At present, there is no treatment that can eradicate HPV from
the body. The immune system begins to limit viral activity
within 6 months after infection. There is evidence that 90%
of infected people will clear their infection within two years, but
it is not known whether this means the virus is gone from the
body. Some may keep it for life. There are differing opinions on
how long HPV may remain in the body.?
I hope this has made things clearer for you, but I see no easy answer
for your friend. What a predicament for you all! Please feel free to
request another Answer Clarification if I can assist you further.
Clarification of Answer by
21 Feb 2004 15:31 PST
Now that you have cornered me?.I believe your cousin should put the
penile cancer fear aside for a bit, and consider the relationship
first. He loves his fiancé, and I imagine he is looking forward to a
long and loving marriage, and possibly a family of their own. I?ve
tried to remain clinical when researching your question, but since you
are putting the burden on me to ?make or break? the wedding, I will
share my thoughts. What are the lifetime chances of finding another
woman with whom your cousin can share his life? Will he regret losing
this woman if he decides not to marry her? What if another woman did
not have HPV, but after marriage contracted a different contagious
disease (TB, hepatitis, etc) would your cousin leave her to avoid his
own infection? (Doubtful) What does the fiancé think about this
dilemma? It is quite possible that your cousin could marry another
woman and still contract penile cancer in later life. It is also
possible your cousin could meet and marry another woman who had an
undetected case of HPV . Incidence is high among the general
population. (See a reference to one study near the end of this
clarification) What if a meteorite fell out of the sky and killed your
cousin in a few years. Would he want to have given up a chance at
You see, becauseimcurious, I am a romantic. I can?t feel right about
letting a good relationship perish, for what seems to be slim chances
of a rare and largely curable disease. We can?t know what will happen
tomorrow. Who knows if your cousin will find love again?
Since I don?t put a considerable amount of faith in numbers, nor am I
a statistician or a soothsayer, I would have to make a guess as to
which numbers are correct. I would guess the lifetime risk is greater
than 1 in 100,000 but much less than 1 in 900, perhaps a 1 in 75,000
chance.To me, this is a slim chance. (You can see there are plenty of
contradictory statements regarding risk) Your cousin has several
things going for him: He is young, 27, and he is a non-smoker, who has
never been exposed to any other STD, including HPV. If he is
ultra-conservative, he probably has taken good care of himself, and is
well nourished. He is not worried about the HPV aspect, but he is
worried that the HPV may lead to penile cancer.
Do you get the feeling that I believe he should marry his true love?
Yes, I honestly feel a good relationship is worth the risk. That?s my
story and I?m sticking to it!
Other Things to Consider:
I am not endorsing this medication, in fact, I have never heard of
this medication before. It may be helpful. Please read about it and
ask your cousin?s fiancé to speak to her doctor about it. It purports
to inhibit dysplasia in the female cervix, and may possibly kill HPV.
Men can use this medication as well.
HAART(highly active antiretroviral therapy):
This antiretroviral therapy is currently being researched. Most of the
studies involve women with HIV and HPV, and may or may not by useful
in your cousin?s fiance?s case. It is worth reading about, and
discussing with her doctor.
?In a prospective cohort study of 741 women, investigators found that
successful antiretroviral therapy reduced progression and increased
regression of cervical HPV (Minkoff). The findings of another study
implied that HAART benefits women who already have advanced cervical
dysplasia. For 168 French women on HAART, the 12-month cervical
dysplasia regression rate was 24% for high-grade dysplasia and 15% for
low-grade dysplasia. This was twice as high as for HIV-positive women
on less effective or no HIV therapy (Heard). Another study linked
lower rates of HPV-positive biopsies with long-term HAART, suggesting
that length of therapy may be a factor (Uberti-Foppa).?
American Foundation for AIDS Research
Colposcopy and Conization:
?Conization for cervical intraepithelial neoplasia is followed by
disappearance of human papillomavirus deoxyribonucleic acid and a
decline in serum and cervical mucus antibodies against human
Health Science Report
Extra reading for your cousin:
PEARLY PENILE PAPULES:
Don't confuse this with HPV warts: "Pearly penile papules are
frequently misdiagnosed as genital warts but are merely a normal
anatomical variant in men. They appear as small, dome-shaped to
filiform skin-colored papules that typically are located on the sulcus
or corona of the glans penis. Lesions are generally arranged
circumferentially in one or several rows.
?Pearly penile papules have no malignant potential. They are not
contracted or spread through sexual activity. Lesions are observed
more frequently in uncircumcised males; however, the mechanisms
underlying their development remain unknown. Pearly penile papules are
noted most commonly in males in their second or third decades, with a
gradual decrease in frequency with aging.
The incidence of pearly penile papules reportedly ranges from 8-48%.
Several reports suggest an increased incidence in uncircumcised versus
circumcised men (22% vs 12%, respectively). One study found an
increase in frequency in black versus white men, in those circumcised
(21% vs 7%, respectively) and uncircumcised (44% vs 33%,
This study followed 608 college women for 3 years, and gave them a
medical check up every 6 months, with a PAP smear each year. At the
end of three years, 43% were positive for HPV.
?What about pregnancy, HPV, and cervical dysplasia?
· For some pregnant women, cervical dysplasia may increase. This may
be due to hormone changes during pregnancy, but this is not proven.
· If a woman has an abnormal Pap smear during pregnancy, even if it's
severely abnormal, many health care providers will not do treatment.
They will just monitor the cervix closely with a colposcope during the
· Sometime (a few weeks) after delivery of the baby, the provider will
look at the cervix again and do another Pap smear or another biopsy.
Many times after pregnancy, the cell changes will have spontaneously
resolved - and no treatment will be necessary.
· The reason that many health care providers do not want to do
treatment during pregnancy is because it may accidentally cause early
· The types of HPV that can cause cell changes on the cervix and
genital skin have not been found to cause problems for babies.
Penile Intraepithelial Neoplasia (PIN) and penile cancer:
· Cancer of the penis is extremely rare in the United States, and HPV
is not always the cause
· There are some cases of cell changes (neoplasia) on the penis, which
are caused by "high-risk" types of HPV.
· Most males do not ever experience symptoms or health risks if they
get one or more "high-risk" types of HPV.
· Penile neoplasia can be treated.
· There is not a cancer screening for the penis because cancer of the
penis is extremely rare, and because it is difficult to get a good
cell sample from the penis.
American Social Health Organization
There you go! Let me know the date of the wedding, and I will raise a
cup, in absentia, to the happy couple.