[Question #6765] Positive Male HPV Urine Test

12 months ago
Hi, I recently visited my Urologist and he ran a newly developed HPV urine test through MolecularTesting Labs in Washington. They claim to be the only ones in the USA who can run an HPV test for males. The results came back POSITIVE for HPV 16. The only information they gave was that it tests for HPV in the urethra. This test was run because in 2015 I had 4 brown spots on the penis shaft that were biopsied and identified as bowenoid papulosis. They were removed and have not come back since. Both my urologist and dermatologist have no idea what course of action to take regarding this Positive HPV 16 urine test.  I was hoping that one of you could help me shed some light on this.  Here are my questions:

1. Does this positive test mean there may be actual lesions inside my urethra?
2. Can this lead to cancer? HPV 16 is a high risk  for cancer
3. I assume that since I have a positive result 5 years after the spots on the penile shaft that this means the virus is persistent and that my body will not clear it?
4. Is a urethroscopy the only way to identify lesions if there are any?
5. What would you recommend as a course of action or treatment? 

Besides doing what seems to me to be a VERY invasive and painful investigation, I'm at a loss of where to go with this test result. There is little to no info available anywhere on it. I'm scared to just leave it alone with the hopes that it will just go away or not turn into cancer. Any advice you can give would be greatly appreciated.

Here is more info on the testing method used: The Roche Cobas HPV Test is a qualitative in vitro test for the detection of Human Papilloma virus in urine specimens. The test utilizes amplification of target DNA by Polymerase Chain Reaction and nucleic acid hybridization for the detection of 14 high-risk HPV types. The test specifically identifies HPV types 16 and 18 while concurrently detecting the rest of the high risk types (31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68). 
Edward W. Hook M.D.
Edward W. Hook M.D.
12 months ago

Welcome to the Forum.  As I suspect you know, Bowenoid papulosis  is an HPV 16-associated problem involving the skin of the penis.  While most of the time it is a benign process, on rare occasions it can gradually progress to cancer of the penile skin.  To my knowledge, there are no data on the prevalence of HPV in the urine because testing is not routine.  Presumably your positive urine test is a reflection of infection of the urethral lining.  In women who are the group best studied, HPV infections tend to resolve over time, sometimes taking several years to do so.  I have not personally managed urethral HPV infections and given your past diagnosis of Bowenoid papulosis, I would be inclined to follow this over time.  If the positive urine test persists, further evaluation, primarily to rule out cancer or pre-cancerous lesions.  I would suggest that your urologist and/or dermatologist may have colleagues within their professional networks who might be best prepared to recommend the way forward for you.  In answer to your specific questions:

1. Does this positive test mean there may be actual lesions inside my urethra?
No.  the presence of HPV in your urethra may not be associated with visible lesions. 

2. Can this lead to cancer? HPV 16 is a high risk  for cancer
For HPV most of the data are from women in whom 'high" risk means that a small proportion (less than 3%) of untreated infections may progress to cancer over time.  I have no doubt that urethral infections occur and urethral carcinoma can follow but would guess that this too is rare, particularly given the high frequency of HPV 16 infections and the rarity of urethral carcinoma.  Urethral cancer is best diagnoses by biopsy performed using urethroscopy.

3. I assume that since I have a positive result 5 years after the spots on the penile shaft that this means the virus is persistent and that my body will not clear it?
Perhaps.  We can't be sure.

4. Is a urethroscopy the only way to identify lesions if there are any?
Urethroscopy looking for lesions and a biopsy would seem to be reasonable although your urologist is the best source of information on this. 

5. What would you recommend as a course of action or treatment? 
If lesions are present and if they show precancerous lesions there are a variety of treatment approaches which again, I would look to your urologist for advice on.  If the are no lesions or if lesions are present and no precancerous changes are present, it may be reasonable to follow the lesions with periodic repeat testing to see if it clears without therapy.

sorry I don't have more information on this topic.  Hope my comments are helpful.  EWH


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12 months ago
This answer actually helps me a great deal. Thank you. One last question please. I got the Gardasil 4 HPV vaccine ( 3 doses) after the initial penile shaft lesions appeared and recently got 1 shot of the Gardasil 9 vaccine to cover the other strains. Do you know if the vaccine offers any therapeutic help in pre existing HPV cases (Getting the vaccine after you already have HPV)?
Edward W. Hook M.D.
Edward W. Hook M.D.
12 months ago
Thanks.  Your situation is a challenging one as there is so little testing done in men, particularly with respect to the urethra/urine.  One might infer that your infection was most likely present before you received your HPV vaccine as the vaccine is so effective in preventing infection and the impact of vaccination on established infections is modest and still a topic of investigation.  Some investigators believe that the vaccine may help clearance of infection in persons infected before receipt of vaccine but the effect has been hard to prove and is likely modest at best.  EWH ---