Penile cancer is a rare but serious malignancy that primarily affects the skin and tissues of the penis. A significant risk factor for the development of penile cancer is infection with the Human Papillomavirus (HPV), particularly high-risk strains such as HPV-16 and HPV-18. HPV is a common sexually transmitted infection that plays a critical role in the pathogenesis of various anogenital cancers. Understanding the relationship between HPV and penile cancer is essential for prevention, early detection, and effective treatment strategies.

Does HPV cause penile cancer in males?

Yes, Human Papillomavirus (HPV) can cause penile cancer in males, though not all cases are due to HPV.

Key Points:

• HPV is a major risk factor for penile cancer, especially certain high-risk strains like HPV-16 and HPV-18.
• HPV causes genetic changes in infected cells, which can lead to precancerous lesions and, over time, cancer.
• It’s estimated that about 30–50% of penile cancer cases are linked to HPV infection.
• HPV is transmitted primarily through sexual contact.

Additional Risk Factors:

Besides HPV, other factors can increase the risk of penile cancer, such as:

• Poor genital hygiene
• Smoking
• Uncircumcised status (especially with phimosis)
• Chronic inflammation or infections

Which types of HPV cause penile cancer?

The types of Human Papillomavirus (HPV) most commonly associated with penile cancer in males are the high-risk (oncogenic) types, particularly:

High-Risk HPV Types:

1. HPV-16 – The most common type found in penile cancer (detected in ~30–50% of HPV-positive cases).
2. HPV-18 – Also frequently associated, but less common than HPV-16.
3. HPV-31, HPV-33, HPV-45, and HPV-52 – Less common, but still considered high-risk and potentially involved in some cases.

These high-risk types can cause cellular changes (dysplasia) in penile epithelial tissue, which can progress to cancer if untreated.

Low-Risk HPV Types:

• HPV-6 and HPV-11 – These are typically associated with genital warts, not cancer. They are not classified as oncogenic but may co-occur with high-risk types in co-infections.

Summary Table:

Protection agaisnt HPV induced penile cancer in men

Protection against HPV-induced penile cancer in men focuses on prevention, early detection, and reducing risk factors. Here are the most effective strategies:

1. HPV Vaccination

• Best protection against high-risk HPV types (especially HPV-16 and HPV-18).
• Recommended for boys and girls starting at age 9–12, but can be given up to age 45.
• Vaccines like Gardasil 9 protect against 9 HPV types (7 high-risk and 2 low-risk).
• Even vaccinated individuals should continue safe practices, as vaccines don’t cover all HPV strains.

2. Safe Sexual Practices

• Use condoms: Reduces—but doesn’t eliminate—HPV transmission, as HPV can infect areas not covered by condoms.
• Limit number of sexual partners: Fewer partners lowers the chance of HPV exposure.
• Mutual monogamy with an uninfected partner also reduces risk.

3. Male Circumcision

• Studies show that circumcised men have a lower risk of acquiring and transmitting high-risk HPV.
• It may also reduce chronic inflammation and phimosis, which are other penile cancer risk factors.

4. Genital Hygiene

• Poor hygiene, especially under the foreskin, can increase the risk of persistent HPV infection and chronic inflammation.
• Regular washing can help reduce this risk, particularly in uncircumcised men.

5. Smoking Cessation

• Smoking impairs the immune response to HPV and increases the likelihood of progression from infection to cancer.
• Quitting smoking significantly reduces cancer risk.

6. Regular Medical Checkups

• Early detection of pre-cancerous lesions or persistent HPV infections can lead to timely treatment.
• Seek medical attention for unusual growths, sores, or color changes on the penis.

Summary Chart:

Risk factors for penile cancer caused by HPV

Here are the key risk factors for penile cancer caused by HPV:

1. Persistent Infection with High-Risk HPV Types

• HPV-16 and HPV-18 are the most carcinogenic.
• Long-term infection can lead to cellular changes (dysplasia) and eventually cancer.

2. Early Age of First Sexual Activity and Multiple Sexual Partners

• Increases lifetime risk of exposure to HPV.
• Greater number of partners raises the likelihood of contracting high-risk strains.

3. Lack of HPV Vaccination

• Unvaccinated individuals are more vulnerable to infection with cancer-causing HPV types.

4. Poor Genital Hygiene

• Especially in uncircumcised men, poor hygiene can lead to chronic irritation and inflammation, increasing HPV persistence and cancer risk.

5. Uncircumcised Status

• Increases risk of phimosis (tight foreskin), which can trap smegma and viruses, promoting chronic inflammation and HPV persistence.

6. Smoking

• Weakens the immune response to HPV.
• Smoking-related carcinogens may act synergistically with HPV to promote cancer development.

7. Immunosuppression

• Men with HIV or on immunosuppressive therapy (e.g. post-transplant) have a reduced ability to clear HPV infections, increasing cancer risk.

8. Co-infections

• Co-infection with other sexually transmitted infections (STIs) may increase susceptibility to HPV and its progression to cancer.

Summary Table:

Summary

Penile cancer is a rare but serious disease, and infection with high-risk types of Human Papillomavirus (HPV), especially HPV-16 and HPV-18, is a major contributing factor. HPV is transmitted through sexual contact and can cause cellular changes that may lead to cancer. Risk factors include early sexual activity, multiple partners, lack of vaccination, poor genital hygiene, smoking, and being uncircumcised. Prevention strategies such as HPV vaccination, safe sex practices, good hygiene, and regular medical checkups are key to reducing the risk of HPV-related penile cancer.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul – TURKIYE