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20 October 2026

18 Pages

Understanding HPV in Men: A Review of the Prevalence, Risk Factors, Health Outcomes, Transmission, Diagnostics, and Vaccination Strategies

Department of Epidemiology and Disaster Medicine, Faculty of Public Health, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
Venereology2026, 5(4), 23;https://doi.org/10.3390/venereology5040023
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Abstract

Background/Objectives: Human papillomavirus (HPV) is the most common sexually transmitted viral infection worldwide, with an estimated 630 million people currently infected, and poses significant health risks for men. While many will naturally clear the infection within a couple of years, persistent cancerous HPV strains are linked to several oncological diseases. The aim is to synthesize existing research on HPV in men to better understand its prevalence, risk factors, associated health outcomes, transmission dynamics, diagnostics, and vaccination strategies. Methods: A non-systematic narrative review was conducted, utilizing relevant studies published between 2010 and 2025 identified using multiple databases (Web of Science, PubMed, Scopus, and Google Scholar) and official health/vaccine websites. Results: Approximately one-third of men globally carry genital HPV, and approximately one-fifth carry one or more high-risk HPV types. Prevalence peaks in younger men but remains high throughout all ages. Key risk factors include sexual behavior, circumcision status, condom use, HIV, smoking, lower education, and vaccination status. More than 80% of infections are asymptomatic, and many men remain unaware due to lack of recommended screening. Emerging strategies focus on high-risk groups, using anal Pap smears and HPV DNA testing. Vaccination in males shows high efficacy, especially when administered before exposure, supporting expanded vaccination programs for all genders. However, global HPV vaccination coverage in men remains suboptimal. Strategies to improve uptake include provider recommendations, education, tailored campaigns, school programs, reminder systems, cost reduction, catch-up vaccination, and open communication. Conclusions: Expanding male-targeted prevention is critical to reducing the global burden of HPV-related diseases.

1. Introduction

Human papillomavirus (HPV), a member of the Papillomaviridae family, is causing the most common sexually transmitted viral infection worldwide, with over 80% of sexually active people becoming infected at some point in their lives [1,2]. The virus has over 200 identified types that are broadly categorized into low-risk and high-risk based on their potential health outcomes [3]. Low-risk HPV types, such as HPV-6 and HPV-11, are typically associated with benign conditions like genital warts, while high-risk types, most commonly HPV-16 and HPV-18, are oncogenic and linked to various cancers, such as cervical, vaginal, anal, penile, and oropharyngeal cancers [1,2,3,4,5]. While most people will naturally clear an HPV infection within a couple of years, persistent infection with cancerous HPV strains causes up to 100% of cervical cancers, as well as significant percentages of the other previously mentioned oncological diseases [1,6]. This underlines the critical importance of early diagnosis and preventive strategies, including vaccination and regular screening, to reduce the burden of HPV and especially HPV-related cancers [6,7].
The global prevalence of HPV varies significantly by region, with substantial regional variation and elevated prevalence reported in parts of sub-Saharan Africa, Latin America, and Europe/Northern America [4], and even though prophylactic HPV vaccines are available and effective at preventing new infections and reducing HPV-related cancers [2,8], significant challenges remain in eliminating all infections and treating those already established to fully prevent cancer progression [2].
Although much of the research on HPV focuses on women due to its strong association with cervical cancer, HPV also poses significant health risks for men [9]. Recent studies have highlighted the significant burden of HPV-related diseases in men, since they can develop genital warts from low-risk HPV strains and are also susceptible to cancers caused by high-risk strains, including anal, penile, and oropharyngeal cancers [9,10]. An estimated 630 million people worldwide are currently infected, corresponding to a prevalence of approximately 9–13% [11]. Globally, approximately one-third of men are infected with at least one genital HPV type, while approximately one-fifth of all men carry one or more high-risk HPV types; among men with detectable genital HPV infection, the ratio of these pooled estimates suggests that approximately two-thirds may carry a high-risk type; however, this ratio should be interpreted cautiously because the estimates are pooled separately and are not a direct individual-level proportion [11,12]. For example, HPV-related oropharyngeal cancer is one of the most common HPV-associated cancers in men, with over 13,000 new cases diagnosed annually in the United States alone [5].
Men do not develop protective immunity after natural HPV infection, and prior infection with a specific HPV type significantly increases the risk of reinfection with the same type for years, regardless of sexual activity status [13]. This persistent susceptibility highlights the benefit of vaccinating boys before sexual debut and also suggests that vaccinating previously infected men could help reduce HPV prevalence and interrupt transmission cycles [14]. Additionally, HPV vaccination in males has demonstrated high efficacy in preventing HPV-related diseases, including genital warts and anal intraepithelial neoplasia, particularly among those vaccinated prior to exposure, supporting the expansion of vaccination programs to include all genders [15]. Despite these benefits, HPV vaccination coverage among males remains low globally, highlighting a public health gap [16].
Furthermore, HPV in men not only poses risks to their health, but they also play a critical role in the transmission and reinfection of their partners [11]. This shows the importance of addressing HPV in male populations and the need for gender-inclusive prevention strategies such as vaccination and sexual health education [11,12]. For example, an HPV prevention program for Korean students demonstrated that gender-tailored education significantly improved HPV knowledge, awareness of sexual rights, and prevention intentions [17]. Additionally, modeling studies show that HPV vaccination provides significant herd protection to women even at <60% coverage, while at >80%, 35–40% of the benefits directly protect men who have sex with men (MSM) from anal and oropharyngeal cancers, emphasizing the ethical importance of inclusive vaccination policies [18].
The aim of this literature review is to synthesize existing research on HPV in men to better understand its prevalence, risk factors, associated health outcomes, transmission dynamics, diagnostics, and vaccination strategies. By summarizing current knowledge, this review seeks to enhance public health education and guide future studies on HPV-related diseases in men.

2. Materials and Methods

A non-systematic narrative review was conducted. Data were retrieved from the Web of Science, PubMed, Scopus, and Google Scholar databases, along with official health and vaccine information websites (WHO, CDC, ECDC, etc.). Various combinations of keywords and key phrases, such as “HPV, men, HPV in men, vaccines, vaccination, recommendation, prevention, strategies, prevalence, epidemiology, MSM (men who have sex with men), HIV, immunocompromised, gender-neutral, strategies, risk factors, diagnostic methods, screening, diseases, genital warts, cancer, asymptomatic infections, modes of transmission, and partner dynamics”, were used to refine the search and identify relevant sources.
The review incorporated studies and reports published from 2010 through 2025 (inclusive), a period selected to capture contemporary evidence on male HPV epidemiology, diagnostics, prevention, and vaccination while retaining selected foundational studies published at the beginning of the period. This included reviews, systematic reviews, meta-analyses, and full-text articles, as well as official statements and articles on health and vaccine information websites. The inclusion criteria consisted of articles with information on HPV in men, with a focus on one or more of the following aspects: prevalence, risk factors, health outcomes, transmission, diagnostics, and vaccination strategies. Exclusion criteria comprised abstracts, short communications, patents, case reports, studies lacking essential information, articles focusing solely on HPV treatment or exclusively on women with no relevant information on the male population, and non-English publications. Relevant data from the selected publications were collated and synthesized qualitatively. Peer-reviewed studies were prioritized for epidemiological, clinical, and vaccine-effectiveness claims, while official websites and policy documents were retained primarily for vaccination schedules, program implementation, regulatory status, and WHO prequalification information.
As this was a non-systematic narrative review, records were screened and selected by the single author according to relevance to the review objectives. No independent duplicate screening was performed, and no formal procedure for resolving reviewer discrepancies was applicable. The selection process was iterative and focused on evidence judged to be clinically and epidemiologically relevant.

3. Results and Discussion

HPV poses significant health risks not just for women but also for men, and knowledge about male HPV prevalence, risk factors, health outcomes, transmission dynamics, diagnostics, and vaccination strategies targeted at the male population is crucial in addressing the substantial global burden of sexually transmitted HPV infection.

3.1. Prevalence

Globally, the pooled prevalence of genital HPV infection among men was approximately 31% (95% CI, 27–35%), while the pooled prevalence of high-risk HPV infection was approximately 21% (95% CI, 18–24%) [11,12,19,20]. According to a systematic review and meta-analysis regarding global and regional estimates of genital HPV among men, the highest prevalence is observed in Latin America, Sub-Saharan Africa, and Europe/Northern America (23% HR-HPV), whereas the lowest rates are in Eastern/South-Eastern Asia (10% HR-HPV) [12].
In a 2025 systematic review and meta-analysis of Chinese study-specific male populations, HPV prevalence reaches 52.5% (95% CI, 49.5–55.4) among male outpatients and 82.1% (95% CI, 73.7–89.3) in HIV-positive men who have sex with men (MSM) [21]. Central China reports the highest regional prevalence (57.3% in outpatients), while Hong Kong and Macau show lower rates (21.3%) due to earlier gender-neutral vaccination programs [21].
A review on HPV in males in Europe has shown pooled prevalence in the general population estimated at 12.4% (based on nine studies); however, studies published after 2000 showed a higher prevalence (28.5%) compared to earlier studies (8.8%), suggesting potential changes in detection methods or sexual behavior trends over time [22]. In high-risk male populations, which include men who have sex with men, men living with HIV, and those attending STI clinics, pooled HPV prevalence was significantly higher at 30.9% across 22 studies [22,23]. Although country-specific data from Eastern Europe remain limited, the available evidence does not support presenting Eastern Europe as a separately ranked region in the global comparison [12].
Sub-Saharan Africa also exhibits elevated HPV rates in men, driven by high HIV co-infection and limited prevention strategies [24]. A meta-analysis estimated the pooled prevalence of any HPV at 78.2% (95% CI, 54.2–91.6) among HIV-positive men and 49.4% (95% CI, 30.4–68.6) among HIV-negative men [25]. These pooled estimates were based on heterogeneous studies differing in geographic setting, HIV status, age, recruitment source, anatomical sampling site, and HPV detection method.
A comparative prospective study of cohorts of men from Brazil, Mexico, and the United States found that in Brazil, HPV prevalence among men was 60.2%, the highest compared to 49.2% in Mexico and 46.9% in the U.S., and HPV-16 prevalence was also highest in Brazil (9.2%) compared to Mexico (5.6%) and the U.S. (8.4%) [26].
Regarding the age distribution, even though HPV prevalence peaks in men aged 25–29 (35% for any HPV, 24% for HR-HPV) [12], it still remains high across all adult age groups, contrasting with the more prominent age-related decline seen in women. Prevalence rates are lower in males compared to females between the ages of 14 and 19 but higher in males between the ages of 40–49 and 50–59 [27]. Persistent infections are particularly common in older men with HIV [24].
The main prevalence estimates discussed above, together with the number of contributing studies, total sample sizes, and 95% confidence intervals, are summarized in Table 1.
Table 1. Summary of selected estimates of genital HPV prevalence among men.

3.2. Risk Factors

HPV infections in men are influenced by a range of behavioral factors. The key modifiable and non-modifiable risk factors associated with HPV infections in men and their impact are presented in Table 2.
Table 2. Risk factors influencing HPV in men and their impact.
The prevention of the risk factors of HPV in men includes targeted sexual health education to promote vaccination, condom use, and safe sex practices and reduce high-risk behaviors, as well as smoking cessation and circumcision to further reduce transmission and HPV-related morbidity in men and overall [20,30,31,32,33].
Since studies have shown that individuals with lower educational levels have lower odds of being aware of HPV, its risks, and methods of prevention, this can lead to behaviors that increase the risk of HPV infection, such as unprotected sexual practices and lower rates of HPV vaccination [30]. Incorporating HPV education into school curricula [34,35,36], community-based health education programs (especially in rural and underserved areas), mass media campaigns, and accessible vaccination programs [35] can significantly help in the prevention of HPV. Available vaccines and vaccination strategies for men are discussed in the final section of the review.
Sex education specifically can be paramount in lowering HPV prevalence in men and women [36,37]. Promoting safe sex practices through education can help men understand the risks associated with unprotected sex and the importance of protecting themselves and their partners from HPV and other STIs [38], especially since HIV is associated with a higher risk of HPV. Even though barrier methods do not fully protect against the transmission of the virus, studies have shown that consistent condom use is linked to a lower prevalence of HPV infections, including oncogenic types [39]. Among men with no steady sex partners, consistent condom use was associated with about a 50% lower risk of acquiring any HPV types over a 12-month period [40]. Also, carrageenan-based lubricants have been studied for their potential in preventing HPV transmission due to their ability to inhibit HPV transmission and have been investigated as a possible adjunctive prevention strategy, demonstrating a 36% reduction in the risk of incident genital HPV infections among women [41], but a study involving men who have sex with men did not show a protective effect of carrageenan-based gels against anal HPV infections [42]. Despite that, these findings may be relevant to male HPV prevention because HPV is transmitted through sexual contact between partners. However, the available evidence does not establish a preventive effect of carrageenan-based topical barriers in heterosexual men, and this question requires direct evaluation in this population.
Several studies, including randomized controlled trials (RCTs) in Africa, have shown that male circumcision can reduce the incidence of HPV infections and is associated with higher rates of HPV clearance. For example, in a randomized controlled trial in Kenya, male circumcision was associated with reduced penile HPV incidence and persistence during 24 months of follow-up compared with the control group [43].
In addition, since smoking is associated with a lower probability of clearing HPV infections and a higher risk of developing HPV-related cancers, public health initiatives should emphasize the importance of quitting smoking, especially for men with HPV or at high risk of HPV [4,20,29].

3.3. HPV-Related Diseases

  • Genital Warts
Genital warts are small, visible, flesh-colored or whitish bumps on the penis, scrotum, anus, or surrounding areas. Caused by low-risk HPV-6/11 in over 90% of cases, they have been reported to affect 1.3–72.9% of men, but this wide range refers to genital HPV DNA detection rather than clinically apparent warts [28,33,44,45]. In the HIM study, 14.8% of men developed at least one genital wart during follow-up, and HPV-6 and HPV-11 were the most frequently detected types in warts [10]. The risk of genital warts is predominantly associated with unsafe sexual practices [20,21,28].
In immunocompromised individuals, particularly HIV-positive men, oral mucosal warts represent a significant clinical concern [21,24]. Unlike in immunocompetent hosts, oral HPV manifestations in HIV-positive patients present with higher persistence and increased severity, serving as an indicator of cellular immune suppression and heightened transmission risk [21,24]. Furthermore, oral HPV transmission frequently occurs via penetrative or non-penetrative contact, including oral–genital exposure, which contributes to co-occurring infections across mucosal sites [32].
  • Cancers
Penile cancer is predominantly of squamous cell origin and is strongly linked to HR-HPV types (HPV-16/18) in 30–50% of cases, with HPV-16 being the most common. The risk of this neoplasm in men is amplified by phimosis, poor hygiene, lack of circumcision, compromised immune system, smoking, and socioeconomic status [28,46].
As for anal cancer, HPV-16 drives over 80% of cases, with MSM and HIV-positive men at highest risk [21,24]. The prevalence of HPV in anal cancers is estimated to be around 90%, with smoking also reported as a risk factor alongside HIV infection and receptive anal intercourse [4]. Understanding the morphological range linked to HPV-related anal neoplasia is crucial for accurate identification and diagnosis [47].
Oropharyngeal cancer is also predominantly linked to HPV16, with men being more frequently affected than women [48]. For example, in China, HPV-16 accounts for 70–90% of cases, now surpassing cervical cancer incidence in some regions [21]. The incidence of HPV-positive oropharyngeal cancer is rising, especially among young men in developed countries [49], with an increased risk due to tobacco and alcohol use, multiple unsafe oral sexual contacts, and HIV co-infection [21,49].
  • Other conditions
Preliminary and inconsistent evidence has linked HPV detection in semen in a Chinese study, where HPV-16 detected in sperm samples was associated with reduced motility and abnormal morphology [21], though evidence is limited and inconclusive. Also, recurrent respiratory papillomatosis, a rare but severe condition caused by HPV-6/11 via vertical transmission, has been reported [28].
The psychological burden of HPV-related diseases, particularly genital warts and cancer diagnoses, should not be underestimated and may require supportive care [50].
  • Asymptomatic infections
Since over 80% of infections are subclinical, many men are unaware of their carrier status, especially since there are no official screenings recommended for the male population [10,33,38]. The reported prevalence of asymptomatic infections in heterosexual men with HPV-positive female partners is 37.1%, especially when the partner is positive for genital HPV [33]. Persistent infections with high-risk HPV types (e.g., HPV-16 and 18) are common, particularly in unvaccinated individuals, and asymptomatic men drive community transmission, emphasizing the public health impact and role of men in HPV transmission [33].

3.4. Modes of Transmission and Partner Dynamics

Men act as both carriers and vectors of HPV, contributing significantly to the epidemiological chain of the virus [51]. HPV transmission in men occurs mainly through sexual contact, and the probability of transmission is estimated to be around 40% (range 5–100%) across different populations, including heterosexual and homosexual individuals [52], even though the estimate represents a broad synthesis across heterogeneous populations and should not be interpreted as a universal per-contact probability. From the penetrative routes, vaginal, anal, and oral sex are primary pathways for genital and oral HPV transmission [32,53]. High-risk HPV types (e.g., HPV-16) are frequently transmitted via orogenital contact, with oral–genital transmission rates increasing with sexual frequency [32]. As for non-penetrative routes, it is important to mention that skin-to-skin contact with infected genital or oral mucosa can transmit HPV, even without visible lesions [32,53].
Oral–oral transmission through deep kissing and oral–anal contact is associated with oral HPV transmission, though less commonly than standard sexual routes, and evidence for autoinoculation is limited, with some data suggesting indirect transmission via hands carrying viral particles, though this route is less impactful compared to sexual exposure [32].
Sexual partners’ genital HPV is linked to 2–3× higher male infection risk [33,54] and having a partner with oral HPV reportedly poses a 28.6% higher transmission likelihood [54]. In one prospective study of heterosexual couples, female-to-male transmission rates (17.4/100 person-months) exceed male-to-female rates (4.9/100 person-months), and male partners of women with cervical cancer face a 2.7× higher risk of developing HPV-associated oropharyngeal cancers [32]. Similar comparative data for MSM are unavailable in the reviewed literature; however, the high prevalence of anal HPV suggests efficient transmission within this group, with studies indicating that up to 78.4% to 88% of MSM have at least one anal HPV genotype [55,56]. Furthermore, nonmonogamous relationships and multiple sexual partners elevate transmission risk [20,54].

3.5. Diagnostic Methods and Screening

Diagnostic methods for HPV detection in men include PCR (polymerase chain reaction), visual inspection, and anal Pap smear.
PCR is the most sensitive method for detecting HPV DNA in men [57], often used with penile brushing (PB), urethral brushing (UB), and semen sampling [58,59]. Even though there is no consensus on optimal sampling sites for routine screening, PB is considered the most effective approach, with UB and semen sampling providing additional information when used in combination, since different anatomical sites have varying detection rates [58,59]. However, semen contains PCR inhibitors that can lead to false-negative results if not properly controlled, complicating semen-based HPV testing [59].
For genital warts, visual inspection through clinical examination is commonly used to identify visible lesions [60,61]. Dermoscopy is a widely used technique that involves examining the skin with a specialized microscope that helps to identify characteristic patterns in genital warts, such as dilated vessels surrounded by a whitish halo [62]. Reflectance confocal microscopy (RCM) provides high-resolution images of the epidermis and superficial dermis and can identify features like koilocytes, which are hallmarks of HPV infection [60,61]. Optical coherence tomography (OCT), particularly the newer LC-OCT (line-field confocal optical coherence tomography), offers detailed imaging of skin layers, helping to differentiate genital warts from other lesions [62]. However, since most HPV infections are asymptomatic [33,63], these methods are less effective for detecting subclinical infections [46].
Anal Pap smears (cytology) may be considered for selected high-risk populations, such as people living with HIV and MSM, to screen for anal dysplasia and cancer [64]. Even though this method is not routine for all men, it is crucial for those at increased risk [65]. The clinical and economic value of anal screening depends on test performance, screening frequency, referral thresholds, availability of high-resolution anoscopy, treatment effectiveness, and the resources required for follow-up, and evidence that screening asymptomatic men reduces anal cancer incidence or mortality remains limited.
Screening may help identify asymptomatic carriers and prevent transmission, especially in selected high-risk populations. However, there is no routine established HPV screening method recommended for men, unlike women, where cervical screening is standard [46], which complicates early detection and prevention efforts. One of the biggest challenges is the lack of approved screening methods for men and the absence of a widely accepted protocol for HPV screening in asymptomatic men. Emerging strategies focus on targeting high-risk populations, such as MSM, with anal Pap smears and HPV DNA testing [51,65]. For HIV-positive MSM, screening is recommended every 1–2 years, and for HIV-negative MSM, screening is suggested every 2–3 years [66]. In addition, research into saliva or oral rinse testing for HPV may offer new avenues for screening, particularly for oropharyngeal HPV detection [65].

3.6. HPV Vaccines and Vaccination Strategies

Worldwide, there are six licensed prophylactic HPV vaccines: three bivalent, two quadrivalent, and one nonavalent vaccine [67,68]. In the majority of the world, the three licensed HPV vaccines available are as follows:
Cervarix (bivalent) targets HPV-16 and HPV-18, with demonstrated cross-protection against HPV-31 and HPV-45. It induces a strong immune response due to its adjuvant system (AS04) [69,70].
Gardasil (quadrivalent) protects against HPV types 6, 11, 16, and 18. It is effective in preventing genital warts caused by HPV-6 and HPV-11, as well as precancerous lesions associated with HPV-16 and HPV-18. Gardasil has been shown to prevent anal cell changes in men, which are precursors to anal cancer [69,71].
Gardasil 9 (nonavalent) offers protection against the same types as Gardasil plus HPV-31, 33, 45, 52, and 58. This expanded coverage provides nearly 100% effectiveness against cervical, vulvar, and vaginal infections and precancers caused by these targeted types [71].
Cervarix (bivalent) is neither approved nor recommended for use in males in the United States, where the CDC recommends the quadrivalent (Gardasil) and nonavalent (Gardasil 9) HPV vaccines for males instead [72,73]. However, in some regions, such as the European Union, Cervarix (bivalent) is authorized for use in both males and females from age 9 to protect against HPV-related conditions like anal cancer [31,73].
As for the other 3 vaccines, all recommended for both genders, Walrinvax is a bivalent HPV vaccine manufactured by Yunnan Walvax Biotechnology Co., Ltd. (Zerun Bio), approved in China in March 2022 and primarily used there, but since receiving WHO prequalification in August 2024, the vaccine is eligible for global distribution [74,75]. In October 2024, WHO added another bivalent vaccine, Cecolin (developed by Xiamen Innovax), for single-dose use, expanding options for simplified vaccination schedules [76]. The vaccine was developed in China in 2019 and is currently available in China, Bangladesh, Morocco, Nepal, Thailand, the Democratic Republic of the Congo, and Cambodia [77]. Cervavac, the quadrivalent HPV vaccine developed by the Serum Institute of India (SII), received approval from the Drugs Controller General of India (DGCI) in January 2023 and is currently primarily used there [78,79].
The WHO, as well as many regional/national health authorities/organizations in upper-middle- and high-income countries (CDC (U.S.), NHS (UK), ECDC (EU), Australia, and Canada), recommends HPV vaccination for all young adolescents aged 9 to 13/14 years (one to two doses), as well as catch-up vaccination available for those who did not get fully vaccinated when they were younger (two to three doses) and for risk group individuals (two to three doses) [68,80,81,82,83,84]. The HPV vaccination recommendations according to the WHO and different regional/national health authorities/organizations in upper-middle- and high-income countries are presented in Table 3 [68,80,81,82,83,84].
Table 3. HPV vaccination recommendations according to the WHO and different regional/national health authorities/organizations.
In April 2022, the WHO endorsed a single-dose HPV vaccination schedule for females aged 9–20 years, based on evidence suggesting that one dose provides comparable protection to two or three doses against HPV [85]. From September 2023, the UK moved to a single-dose HPV vaccination for both sexes, following advice from the Joint Committee on Vaccination and Immunisation (JCVI) [82]. Australia (since 2023) and Canada (since 2024) have also adopted a single-dose gender-neutral recommendation [83,84]. In China (since 2024), Cecolin (bivalent) is available for single-dose use, expanding options for simplified vaccination schedules [76].
The World Health Organization (WHO) has emphasized the importance of HPV vaccination for both genders, particularly in regions with low female coverage. The WHO aims for 90% of girls to be fully vaccinated by age 15 and recommends extending vaccination to boys as a secondary target group [86]. MSM and immunocompromised individuals are considered high-risk groups and should prioritize vaccination to reduce their risk of having and/or spreading HPV-related diseases [72].
Worldwide, as of 2023, 43 countries and four territories have implemented gender-neutral HPV vaccination programs, mostly in high-income and upper-middle-income countries [86,87,88]. In the European region, as of January 2025, 39 out of 53 countries offer HPV vaccination to both boys and girls [89]. In North America, the U.S. Advisory Committee on Immunization Practices (ACIP) has recommended gender-neutral HPV vaccination since 2011 [80]. As of 2022, the Brazilian Ministry of Health also expanded the vaccination program to include both boys and girls aged 9 to 14, making it gender-neutral [90]. In Southeast Asia, Bhutan is recognized as the first low- and middle-income country to introduce an HPV vaccination program including both boys and girls, starting in September 2020 [86]. South Korea and Hong Kong have also adopted gender-neutral HPV vaccination, recognizing its benefits in reducing HPV-related diseases in men [87,91]. Cameroon introduced HPV vaccination for both sexes in 2022, making it one of the few low- and middle-income countries to do so [92].
Despite the availability of effective vaccines and the gender-neutral recommendations in many regions in the world, HPV vaccination rates among men remain lower than those for women. Available global estimates for 2023 suggest approximately 7% first-dose coverage and 6% full-course coverage among boys, compared with approximately 27% and 20%, respectively, among girls; however, these estimates vary substantially by country and should not be interpreted as a direct estimate of vaccination among all adult men [93]. Barriers include lack of awareness, cost, and perceived risk, particularly in regions with limited gender-neutral vaccination policies [72].
Vaccination has been proven to significantly reduce the incidence of HPV-related diseases in men, including genital warts and anal precancerous lesions, and studies indicate that widespread vaccination can lead to herd immunity, benefiting both vaccinated and unvaccinated populations [80,94]. This can help reduce HPV transmission, particularly in regions like China and sub-Saharan Africa, where vaccination coverage remains low [21,24], as well as in other countries, territories, and regions with low coverage of HPV vaccination, especially in men. In addition, by preventing infection with high-risk HPV types, vaccination effectively reduces the risk of HPV-related cancers such as anal and oropharyngeal cancers in men [71,94]. HPV vaccines have shown high efficacy against anal intraepithelial neoplasia (AIN) and anal cancer, with efficacy rates ranging from 89.6% to 93.1% [31]. Another study found that, specifically, the quadrivalent vaccine (Gardasil) demonstrated an efficacy rate of 77.5% in preventing anal intraepithelial neoplasia (AIN) associated with high-risk HPV types among MSM [95]. The same vaccine has also been demonstrated to lower the occurrence of external genital lesions associated with HPV types 6, 11, 16, and 18 by approximately 90% in young males [94]. However, most post-2020 real-world and single-dose effectiveness data are derived from female populations, and direct long-term male-specific evidence, particularly for the nonavalent vaccine and single-dose schedules, remains more limited.
The strategies to improve awareness and access to HPV vaccines among male populations are presented in Table 4.
Table 4. Strategies to improve HPV vaccination rates in men.
An effective approach to this issue requires multi-level interventions and combinations of the presented strategies in order to improve awareness of HPV infections and vaccination options in men and boost vaccination rates among them.

4. Limitations

Because this was a narrative review, the search and selection process was not designed to identify every eligible publication, and no formal risk-of-bias assessment or study-level quantitative synthesis was undertaken. Consequently, selection bias and heterogeneity in study populations, sampling methods, HPV assays, and outcome definitions should be considered when interpreting the conclusions. The restriction to English-language publications may have resulted in language and regional bias, particularly for evidence from Latin America, China, and sub-Saharan Africa.
The included studies also differed substantially in population characteristics, geographic setting, recruitment methods, anatomical sampling sites, HPV assays, outcome definitions, and follow-up duration. Therefore, prevalence estimates and associations between risk factors and HPV infection are not directly comparable across studies, and findings from high-risk or clinic-based populations may not be generalizable to the broader male population. Several conclusions, particularly those concerning transmission, male infertility, screening, and vaccination coverage, are based on observational studies, modelling, indirect evidence, or policy reports and should therefore be interpreted as context-dependent rather than definitive causal evidence. These limitations were considered when synthesizing the findings and formulating the recommendations.
The review was conducted and written by a single author without independent duplicate screening, independent data extraction, or third-party verification. This structure increases the potential for selection bias and confirmation bias related to the author’s interpretation of the literature and choice of citations. The findings should therefore be interpreted as a qualitative narrative synthesis rather than as an exhaustive or fully reproducible assessment of all available evidence.

5. Conclusions

HPV infection is common in men, and high-risk types contribute to anal, penile, and oropharyngeal disease. Gender-neutral vaccination before sexual debut, together with sexual-health education, smoking cessation, condom use, and improved access to clinical care, should be prioritized, with schedules following national recommendations and distinguishing routine, catch-up, and immunocompromised groups. Routine HPV testing is not recommended for asymptomatic men; anal cancer screening may be considered for selected high-risk populations (e.g., people living with HIV, some MSM and transgender women) only within organized pathways that ensure appropriate diagnostics and treatment and acknowledge potential harms. Key evidence gaps remain in sampling methods, natural history at different sites, screening thresholds, male vaccine coverage, and uptake strategies and should be addressed in future research.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Data Availability Statement

No new data were created or analyzed in this study. Data sharing is not applicable to this article.

Conflicts of Interest

The author declares no conflicts of interest.

Abbreviations

The following abbreviations are used in this manuscript:
HPVHuman Papillomavirus
MSMMen Who Have Sex with Men
HIVHuman Immunodeficiency Virus
HPV DNAHuman Papillomavirus Deoxyribonucleic Acid
HR HPVHigh-Risk Human Papillomavirus
STISexually Transmitted Infection
PBPenile Brushing
UBUrethral Brushing
RCMReflectance Confocal Microscopy
OCTOptical Coherence Tomography
LC OCTLine Field Confocal Optical Coherence Tomography
WHOWorld Health Organization
CDCCenters for Disease Control and Prevention
ECDCEuropean Centre for Disease Prevention and Control
NHSNational Health Service
USUnited States
UKUnited Kingdom
JCVIJoint Committee on Vaccination and Immunisation
ACIPAdvisory Committee on Immunization Practices
AINAnal Intraepithelial Neoplasia

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