“Uncovering the Secret Link: “Is HPV the Hidden Cause of Male Infertility?”
Dr. Naresh Poondla, Ph.D
Background: Human Papillomavirus (HPV) is a prevalent sexually transmitted infection (STI) that affects both men and women, with approximately 6.2 million new cases occurring worldwide each year (Colón-López et al., 2011). Infertility is also a common health issue, with male infertility accounting for about 50% of cases, affecting approximately 16% of couples worldwide. As researchers and clinicians continue to explore the causes of male infertility, they are increasingly recognizing STIs as a potential factor (Tsevat et al., 2017).
Previous studies have found HPV DNA in semen and sperm cells, as well as in various regions of the male reproductive tract, such as the penile shaft, glans penis, and scrotum (Capra et al., 2019). These findings suggest that HPV may contribute to male infertility. Research has demonstrated that HPV DNA can be identified in the semen of 2–31% of men in the general population and in 10–35% of men receiving assisted reproductive technology (ART) for infertility (Muscianisi et al., 2021). Recent studies have also shown that HPV can be found in seminal fluid, and sperm infection can occur in sexually active asymptomatic males and infertile patients (Capra et al., 2019).
Symptoms:
Although HPV infection in males usually does not cause any symptoms, it can sometimes lead to male infertility (Yang et al., 2013). Indications of HPV infection in males can include symptoms such as the growth of small cauliflower-like warts on the penis, scrotum, or anus, which are caused by certain strains of HPV. Although genital warts do not usually result in infertility, they may be an indication of HPV infection.
Some men with HPV infection may experience discomfort or pain during sexual intercourse or urination, and abnormal discharge from the penis can also occur. HPV infection can decrease the number of sperm in semen, which can lead to infertility, and it can also cause changes in sperm shape and size, making it harder for sperm to fertilize an egg (Anic & Giuliano, 2011).
Diagnosis:
Diagnosing HPV infection in males can be challenging since it is often asymptomatic. However, several diagnostic tests can be used to detect HPV infections and assess the risk of male infertility. Here are some common methods for diagnosing HPV infection in males (Dixit et al., 2011).
During a physical examination, a healthcare professional may look for any visible signs of HPV infection, such as genital warts. In some cases, a healthcare professional may also perform a Pap smear on the penis to detect abnormal cells that may be associated with HPV infection. An HPV test may also be performed, which involves obtaining a sample of cells from the penis or anus, semen (spermatozoa, somatic cells and seminal plasma) and testing them for the presence of HPV.
Semen analysis can also help identify any abnormalities in the number, shape, or movement of sperm, which may indicate HPV-related male infertility. Additionally, a blood test may be used to detect antibodies against HPV, which can confirm the presence of the virus. Overall, a combination of these diagnostic tests can help identify HPV infections in males and assess the potential risk of infertility.
Treatment:
Managing HPV infection in males can be challenging as there is no known cure for the virus. However, several available treatments can help manage the symptoms of HPV infection and reduce the risk of male infertility. Some common treatments for HPV-related male infertility are as follows (Capra et al., 2019).
Topical medications may be recommended by healthcare professionals to treat visible signs of HPV infection, such as genital warts. These medications may include creams or solutions directly applied to the affected area. In some cases, surgical removal may be necessary to reduce the risk of male infertility, particularly when genital warts are large or widespread. Cryotherapy is another treatment that involves freezing the affected area with liquid nitrogen to destroy wart tissue. This treatment is typically used for smaller warts confined to a small area.
Interferon is a medication that can be injected directly into genital warts to help stimulate the immune system and reduce the risk of male infertility. Although there are no antiviral medications specifically designed to treat HPV infection, some antiviral medications may be used to help manage the symptoms of the infection and reduce the risk of male infertility. Overall, early detection and prompt treatment of HPV infection in males can help manage the symptoms and reduce the risk of male infertility.
Prevention:
To reduce the risk of male infertility associated with HPV infection, prevention is key. One effective prevention strategy is getting vaccinated against HPV, which is available for both males and females. The vaccine can prevent infection with the most common strains of the virus that can cause male infertility, and it is most effective when given before the onset of sexual activity (Kangni et al., 2022).
Using a barrier method of contraception, such as a condom, during sexual activity can also help reduce the risk of HPV infection and male infertility. Additionally, limiting the number of sexual partners can decrease the risk of HPV infection. Regular checkups with a healthcare professional can help detect any signs of HPV infection early and reduce the risk of male infertility. Maintaining a healthy lifestyle, including regular exercise, a healthy diet, and not smoking, can also boost the immune system and lower the risk of HPV-related male infertility.
Author:
Dr. Naresh Poondla, Ph.D (Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA).
March 4, 2023
References:
Anic, G. M., & Giuliano, A. R. (2011). Genital HPV infection and related lesions in men. Preventive Medicine, 53(SUPPL. 1), S36–S41. https://doi.org/10.1016/j.ypmed.2011.08.002
Capra, G., Schillaci, R., Bosco, L., Roccheri, M. C., Perino, A., & Ragusa, M. A. (2019). HPV infection in semen: Results from a new molecular approach. Epidemiology and Infection, 147(e177), 1–8. https://doi.org/10.1017/S0950268819000621
Colón-López, V., Ortiz, A. P., & Palefsky, J. (2011). Burden of Human Papillomavirus Infection and Related Comorbidities in Men: Implications for Research, Disease Prevention and Health Promotion among Hispanic Men. P R Health Sci J, 29(3), 232–240.
Dixit, R., Bhavsar, C., & Marfatia, Y. S. (2011). Laboratory diagnosis of human papillomavirus virus infection in female genital tract. Indian Journal of Sexually Transmitted Diseases, 32(1), 50–52. https://doi.org/10.4103/0253-7184.81257
Kangni, Z., Yue, H., and Zhengyu, L. (2022) Prevention and treatment of human papillomavirus in men benefits both men and women. Frontiers in Cellular and Infection Microbiology.https://doi.org/10.3389/fcimb.2022.1077651
Muscianisi, F., de Toni, L., Giorato, G., Carosso, A., Foresta, C., & Garolla, A. (2021). Is HPV the Novel Target in Male Idiopathic Infertility? A Systematic Review of the Literature. Frontiers in Endocrinology, 12, 1–9. https://doi.org/10.3389/fendo.2021.643539
Tsevat, D. G., Wiesenfeld, H. C., Parks, C., & Peipert, J. F. (2017). Sexually transmitted diseases and infertility. American Journal of Obstetrics and Gynecology, 216(1), 1–9. https://doi.org/10.1016/j.ajog.2016.08.008
Yang, Y., Jia, C. W., Ma, Y. M., Zhou, L. Y., & Wang, S. Y. (2013). Correlation between HPV sperm infection and male infertility. Asian Journal of Andrology, 15(4), 529–532. https://doi.org/10.1038/aja.2013.36