Summary: The prevention and treatment of male HPV should not be ignored!

It is well known that the prevention and treatment of HPV infection in both men and women (especially in male and female partners) has not received clinical attention. However, cross infection between husband and wife is more likely to lead to persistent infection of HPV, which leads to increased risk of high-grade cervical lesions and cervical cancer.

Recently, Li Zhengyu's team from the Department of Gynaecology of West China Second Hospital of Sichuan University published a review "Prevention and treatment of human papillomavirus in men benefits both men and women" in Frontiers in Cellular and Infection Microbiology (IF=6.073), which systematically summarized the existing cognition of Prevention and treatment of male HPV Infection, so as to promote the common health of couples.

Prevention of HPV

Condom

The main route of transmission of HPV is sexual transmission. As virus carriers and carriers, men are an important link in the epidemic transmission chain of HPV. Condoms can effectively physically block the transmission of HPV. Many studies have shown that condom use is essential to prevent the transmission and infection of HPV.

Quit smoking

Smoking is a known independent risk factor for HPV infection. Studies have shown that smoking more than 9 cigarettes a day is associated with male HPV infection. It suggests that smoking cessation or prevention of HPV infection in men plays an important role.

Male circumcision

A large number of studies have proved that male circumcision can effectively reduce the incidence of multiple HPV infections in men, thereby reducing the incidence of HPV related diseases. Therefore, the authors suggest that male circumcision should be included in the follow-up medical guidelines as a primary prevention measure for cervical cancer, penis cancer and other HPV related cancers.

HPV vaccine

So far, 107 countries have introduced HPV vaccination programs, among which the vaccination rate in developed countries is high. HPV vaccination plays an indispensable role in the prevention of female cervical cancer. However, HPV vaccine is not only the exclusive vaccine for women, but also the risk for men to develop various diseases after HPV infection. In addition, men vaccinated with HPV vaccine can also reduce women's risk of cervical cancer and benefit women. In recent years, more and more studies have shown that when the HPV vaccine coverage rate of adolescents reaches 75%, HPV16 infection in the general population will be eliminated. In addition, HPV vaccination can also indirectly protect the uninoculated population by vaccinating the susceptible population.

However, in real life, there are still many obstacles to achieve universal vaccination of men against HPV, including lack of awareness of HPV, prejudice against vaccine, various demographic and sociological factors and religious factors, fear of side effects and fear of costs. Therefore, it is necessary to strengthen the propaganda and education of the general population and improve the people's willingness to vaccinate. At the same time, the existing medical system should be optimized to improve the access rate of vaccines.

According to the recommendations of the Advisory Committee on Immunization Practice of the Centers for Disease Control and Prevention (ACIP), girls aged 11 or 12 should be routinely vaccinated with bivalent, tetravalent or ninvalent HPV vaccines, while men of the same age should be vaccinated with bivalent or tetravalent HPV vaccines. In addition, ACIP also recommends that women and men aged 13-26 who have not been vaccinated against HPV or have not completed three HPV vaccinations be vaccinated.

HPV detection

Because most HPV infections can subside without intervention, a positive result does not mean that the positive patient or his partner should be treated immediately. However, asymptomatic infection of HPV in men is considered to be an important reason for persistent infection of HPV in women, which will increase the risk of cervical cancer in women. In addition, HPV infection in men may cause genital warts, penis cancer and anal cancer. Therefore, it is necessary to screen men for HPV. However, at present, only standardized HPV screening is emphasized for women, and there is no routine HPV screening program for men. As far as the author knows, there is no reliable sampling point and standard sampling method for male detection, and the quality of samples can not be guaranteed.

Some researchers suggest that the samples collected from the external genitalia have a higher detection rate of HPV than those collected from the anus, so the penis is recommended as the best place to detect HPV. In addition, studies have shown that HPV DNA detection is the best method to detect male HPV infection, and the samples obtained from the distal urethra and penis surface by sampling brush are the best samples to detect male HPV infection.

Treatment of HPV related lesions

At present, the focus of treatment is to solve HPV related diseases of individuals, such as cervical cancer, vulvovaginal cancer and penis cancer. Surgery, radiotherapy, chemotherapy, targeted therapy and other methods have been widely used in clinical. However, there is no standard treatment for HPV infection only. However, a large number of studies on the treatment of HPV infection focus on immunotherapy, including toll like receptor agonists, therapeutic HPV vaccines, and immunosuppressive agents.

Through the summary of previous medical literature, epidemiological research, clinical research and clinical practice, this review found that more and more attention has been paid to male HPV infection and its impact on sexual partners.