New meta-analysis findings reveal a concerning trend: nearly one-third of men over 15 are carriers of Human Papillomavirus (HPV).
Additionally, 1 in 5 of these men carry high-risk HPV (HR-HPV), significantly elevating cancer risk. These shocking figures come from a comprehensive review of 65 studies spanning 35 countries. While the lowest prevalence rate is found in East and Southeast Asia at 15%, action should still be taken to tackle this.
The Disease Behind the Data
HPV is notorious for being the most common sexually transmitted viral infection worldwide. It’s not only rampant but can also lead to various types of cancer, including cervical, vulvar, and anal cancers. Although HPV is better known for affecting women, men are far from immune. More than 25% of cancers caused by HPV occur in men.
The most common oncogenic and preventable type globally in both men and women is HPV-16. The increasing roll-out of vaccines for young women and men has started to reduce the prevalence of specific genotypes targeted by these vaccines, improving HPV-related disease outcomes for both genders. Three vaccine formulations currently exist: a two-valent vaccine targeting HPV types 16 and 18, a four-valent vaccine targeting types 6, 11, 16, and 18, and a nine-valent vaccine targeting types 6, 11, 16, 18, 31, 33, 45, 52, and 58. All these vaccines target HPV-16 and HPV-18, which are most commonly associated with HPV-related cancers. By 2022, 45 countries had already introduced HPV vaccines for boys. Mathematical models suggest that gender-neutral vaccination could eventually eliminate the circulation of HPV types targeted by the vaccines.
Men experience peak prevalence between ages 25 and 29, and high prevalence continues up to age 50. Young men between 15 and 19 also exhibit high prevalence, indicating rapid infection rates following initial sexual activity. These patterns differ from women, where HPV prevalence peaks shortly after first sexual activity and generally declines with age, with some exceptions.
A Closer Look at the Asian Numbers
While the global prevalence is alarming, Asia presents a unique case. The meta-analysis showed that Eastern and South-Eastern Asia show the lowest prevalence for any HPV (15%) and high-risk HPV (10%). On the other hand, Sub-Saharan Africa shows the highest prevalence, at 37%, closely followed by Europe and Northern America at 36%.
Despite East and Southeast Asia’s lower prevalence rate, medical experts argue that this should not lead to complacency. Given Asia’s massive population, even a 15% prevalence rate could put many people at risk. Compared to other regions, Asia’s lower percentages seem less of a concern. Still, the sheer number of potential carriers due to population density makes this an urgent matter.
Men: An Overlooked Demographic
Despite the universal threat, fewer epidemiological studies focus on men. This gender gap in research is even more glaring in the Asian context, leading to what experts call “an invisible epidemic.” The data does show that men of all ages, if sexually active, can be a reservoir for HPV. This implies that simply focusing on the female population for HPV vaccinations is not enough.
The Age Factor
Interestingly, HPV prevalence among men seems to stabilise and even decrease after the age of 50. In contrast, among women, the prevalence peaks soon after the first sexual activity and declines with age. For men, however, high prevalence rates start young—28% in males between 15 and 19 years and surging to 35% between ages 25 and 29.
Vaccination: The Game-Changer
While France has extended its HPV vaccination programme to include boys between ages 11 and 14, Asia lags in these preventive measures. Vaccines like Cervarix and Gardasil 9 are effective against the most dangerous HPV types, including HPV-16, which is prevalent in 5% of men.
Takeaways for Asia
The urgency to include men in comprehensive HPV prevention strategies cannot be overstated. Failure to do so will not only perpetuate the cycle of HPV-related cancers but also undermine efforts to eradicate cervical cancer and other HPV-related diseases. The need is particularly acute in Asia, given its enormous population and lower prevalence rates, which might lead to complacency.
The Road Ahead
Going forward, experts advocate for including boys and men in vaccination drives and public health campaigns. It’s time to broaden our view and tackle HPV as a community rather than segregating it as a “women’s issue.” The data makes it abundantly clear: the risk is real, and the time to act is now.
The study is based on a systematic review of published surveys and unpublished data. While more data exists for women, only 65 studies from 35 countries provide data for heterosexual men. Most of the studies come from high-income countries, and only a few consider the impact of vaccines on men’s HPV prevalence. Therefore, this research is focused on studies representing the general male population of countries, noting high heterogeneity in high-risk HPV prevalence, ranging from 1% to 75%.
Despite these limitations, the researchers believe that the findings establish mean baseline HPV prevalences that can inform prevention strategies. These pooled estimates underscore the high prevalence of high-risk HPV in men, ranging from 20% to 30% across most regions. They highlight the need to strengthen prevention within broader STI control efforts and emphasise the limited data available for men in certain regions. As vaccine supplies increase and single-dose strategies undergo assessment, countries should consider incorporating vaccination for boys into national immunisation schedules. Future studies are essential to monitor prevalence trends in men, especially considering the expanding roll-out of vaccines to both girls and young women and the growing number of countries beginning to vaccinate boys.
