[Question #3952] Penile Cancer and Regular annual Urology Checkup

34 months ago
I know pretty much every sexually active adult will have HPV. HPV 16 and 18 are responsible for Penile cancer. Of all Penile Cancer, only 40% is responsible for HPV. Penile Cancer is an extremely rare cancer. With this facts: Let's talk about screening measures for penile cancer and some hard facts.

1. I am thinking to visit urologist yearly to get checked for penile cancer symptoms.
2. Let's say people get penile cancer.  Is it completely treatable?  I heard that Penile cancer is one of the easily treatable and can cure even before it becomes cancer.
3. I changed my lifestyle:  No drinking and no smoking, which I guess will put me in a lower risk for penile cancer.
4. What other things people should know about penile cancer?

34 months ago
5. Also, if my partner had a normal pap, can they still transmit HPV to me? 
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
Sorry to see you return to the forum after the reasoned, science based reassurance you had about HPV in three previous threads over the past month. In the last one, you were asked to please not keep asking questions on the same topic or with obvious answers. Let's definitely make this your last one, OK?

Also, duplicate accounts are not permitted. One of yours will be deleted; I will ask the forum administrator to contact you about it.

We are experts on HPV transmission and prevention, not on penile cancer. A dermatologist, urologist, or perhaps a website that emphasizes cancer, dermatology, or urology might be more helpful. Overall, penile cancer is rare, even in men infected with high risk HPV. I believe you are correct that 40-50% of penile cancer is caused by HPV. There are several types of penile cancer and the association with HPV ranges from 12% to 75% depending on type. Here is a review article that I found which you might find helpful:  http://www.cancernetwork.com/oncology-journal/contemporary-review-hpv-and-penile-cancer. 

1. To my knowledge, experts do not recommend yearly exams to check for penile cancer. It should be sufficient to just be on the lookout for growths or un-healing penile sores and see a doctor if any such thing appears. I don't know what dermatologists or other penile cancer experts recommend.

2. My understanding is the same as yours. Almost all cases are easily curable without disfiguring or harmful surgery, unless an obvious abnormality is neglected for many months or years.

3. Not smoking does indeed reduce the risk of HPV disease, so maybe some benefit in preventing penile cancer caused by HPV. However, there are no data on this. Alcohol intake has no known effect or HPV nor, to my knowledge, penile cancer risk.

4. I don't have any advice on this. The article above may be helpful.

5. This question demonstrates that you still are abnormally obsessed with HPV. A normal pap smear makes genital HPV very unlikely, but does not completely rule out the possibility that transmissible HPV is present. But since almost all HPV infections in men are harmless, this shouldn't matter to you and certainly should not have any impact on your sexual practices with your wife. Just let this topic go! HPV is never going to be an important health issue for you.

HHH, MD
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34 months ago
My apologies. I am having a hard time making peace with it.  I swear to God. I will NEVER come back. Please answer my final question. My doc said warts causing HPV is usually transmittable even during protected sex, not cancer-causing HPV because warts come in the genetial area that is not covered by condoms. She said I do not need to worry about any Cancer-causing strains since I had protected sex.  My question: What strains Condoms protect?  Is there any study for it?  If condoms do not protect low-risk strain, I honestly do not care. I am not worried about low-risk strain.  I like the expert answer in this.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
I'm afraid you misunderstood your doctor. Are you sure you're not interpreting her words in a hopeful manner? Or perhaps she just doesn't understand HPV transmission.

I am not aware of data that show any difference in transmission risk for high-risk versus low risk types of HPV, with or without condoms. For all HPV types, infection can be located pretty much anywhere on genital skin, from the tip of the penis to the shaft, scrotum, and anal area; in women, the cervix, vaginal opening, labia minor, labia major, and anal area. Because HPV can be in widespread genital areas, condoms allow contact between uncovered skin of both partners. Therefore, condoms reduce risk but do not entirely prevent STDs transmitted skin to skin, like HPV and genital herpes. There is no known difference between high and low risk types.

Having genital HPV is a normal, expected result of being sexually active. It cannot be entirely prevented. Some high risk types (e.g. HPV16) are among the most common types, even more common than many low risk types. But don't get hung up on the words "high risk". Even with these types, fewer than 1 in a thousand infected people get cancer. For example, having a high risk HPV type is much lower risk for cancer than smoking is for lung cancer. Look around to all your friends and co-workers, or imagine yourself in a sports stadium looking at thousands of other fans. Half of them have HPV, and most of these are infected with high risk types. Very few of them will ever get cancer due to HPV. It's a normal part of life.

If you continue to have such a "hard time making peace" with all this, and if it interferes with your life as much as it seems to be doing, please consider professional counseling. When the risk is so low, it is not normal to remain so fearful in the face of the reasoned, science based reassurance you have had. I suggest counseling out of compassion, not criticism.
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34 months ago
I am already under psychotherapy.  

Can you please give comments on these two:

1.  HPV testing for males based on urine 



2.  Crispr based HPV detection from Jennifer Doudna,  founder of crispr 


They are releasing the kit soon  from this company 







H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
34 months ago
The urine test is nonsense, since most infections in men don't involve the urine or inside of the genital tract. Experts do not recommend any kind of testing for asymptomatic genital HPV in men. If negative, these tests do NOT prove HIV is absent:  no test detects all HPV infections. And if positive, with no symptoms, what are you going to do? There is no treatment and nothing to be done to change the low risk of a serious outcome, or to prevent transmission. Do you really think it would be helpful if the millions and millions of people with asymptomatic genital HPV knew for sure that they are infected or what type(s) of HPV they have? Discuss these issues with your psychotherapist before you consider spending good money on useless testing for HPV.

That completes the two follow-up replies included with each thread and so ends this discussion. Let's make this your last question about HPV. But I do hope the discussion has been helpful.

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