[Question #876] HPV risk for penile cancer

53 months ago
Hi Doc,

I've always come here for help. And I need it again. I've had max 20 escort encounters. Always protected expect for some oral.  It's been a month and I've left these encounters. 

I am HSV2 positive, circumcised male. And since I was trying to be more sexually educated and responsible I learned about HPV prevalence and risks and that's when I came across penile cancer and the thought of it has been eating me since I have had so many partners in the last 6 months. Before 6 months I have had no sexual history of any sort.

How valid are my concerns? I'm scared that I was reinfected again and again with HPV and different strains that could put me at higher risk for penile cancer. Just don't know what to think and hope.
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Welcome back to the forum.

Penile cancer is very rare, with only about 2,300 cases per year in the US. For comparison, prostate cancer is almost 100 times more common and colon/rectal cancer nearly 50 times more common than penile cancer. Probably 90% of people acquire genital HPV, which means that few cases of penile cancer occur among over 150 million men who have had penile HPV. Repeated HPV has little effect on risk of progression to cancer. Also, the main risk is in uncircumcised men -- but even without circumcision, the risk is very low. Further, penile cancer is rarely a serious threat. Most cases are diagnosed early and cured by minor surgery (not penile amputation or anything dramatic) or even chemical treatment.

Continue to use common sense precautions against HPV, i.e. consistent condom use for your escort exposures. Beyond that, all men should be aware of unusual bumps on the penis or ulcers (sores) that do not heal promptly. If anything like that develops, see a doctor. With these precautions, you will be 100% protected against penile cancer. 

Best regards--  HHH, MD
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53 months ago
To add, I'm not visiting escorts anymore.  I was concerned about the fact that there are different HPV strains and if I am getting infected by different ones as well and not just a particular one. Also worried about symptoms that I won't see but the cancer is growing so I don't know when to go to a doctor and get an early treatment.
53 months ago
Also, I went to a doctor today for a physical exam. There are very small barely visible possible warts right under the heat of my penis. If I magnify it looks like 2 warts otherwise anyone else looking would ignore it.  My concern: if my immune system was not able to fight of genital warts then does that put me at bigger risk for penile cancer?
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Multiple HPV infections makes no difference. As I said above, repeated HIV infection does not increase risk. Penile cancer is always visible to the naked eye. You can't develop cancer without seeing it.

I don't understand what your doctor has diagnosed and am inclined to doubt you have warts. Anything that small probably is not abnormal. But even if you have warts, it does not indicate an increased risk for penile cancer.

You came here for reassurance. I've done my best. Accept it or not, I don't care. But this isn't a debate and I have no patience for people who will not listen to reason and believe what experts tell them. Let me know if you have any other concerns, but do not expect a sensitive response if you're just going to argue about it.

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53 months ago
I apologize if I offended you. I do accept your advice just do that quite later. I am however thankful for your advice nonetheless. Just to be sure when you say multiple HPV doesn't affect risk you mean different HPV strains right? 

I read that sometimes someone will not develop symptoms till it's too late or not everyone develops bumps or sores,  your stance is still the same I.e it will be visible to the naked eye?

You mentioned most cases are easily treated with minor surgery or chemical treatment. Since I am young I am worried about fertility. Can you comment on that?

I have stopped visiting escorts but as I mentioned I have visited 20. Since you deal with people with STDs I wanted to know if that number is too high. How many partners do people generally have and what is considered abnormal and what is considered risky. In your opinion are young men more at risk due to escorts? I'm asking these questions so I can educate others as well along with myself. 

Again I apologize and thank your very much!
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
53 months ago
Except sometimes for malignant melanoma (which is unrelated to HPV), virtually all cancers of the skin, penile or anywhere else, become visible to the naked eye in plenty of time to remove or otherwise cure them before they spread and causes any serious problem. Such treatments have no effect on fertility.

You are at no more risk of multiple HPV infections than most of the population. Twenty sex partners (escorts and others) is not an especially high number for many men; there are plenty who by age 30-40 have had hundreds of sex partners, escorts and otherwise. They are also not at high risk of penile cancer. Your low risk applies regardless of how many HPV infections you may have had.

"Escort" usually is a term used for expenseive female sex workers by appointment, distinguishing them from other sex workers like brothel workers, street walkers, bar pick-ups, etc. Escorts often are at low risk for STDs, because they tend to have low risk clients (e.g. married men who are mostly monogamous), use condoms regularly, and get tested often for STDs and HIV. Their risk for HPV probably remains pretty high, but no higher than any other sexually active female. Of course you should use common sense precautions (condoms, etc) if you continue such exposures, and get tested for common STDs from time to time (gonorrhea, chlamydia, syphilis, HIV).

There's no need for apology. But you do need to think objectively and not panic over things you can't control and that are at low risk for serious outcome. HPV is an important STD, but not because of penile cancer. We're all going to die, but regardless of your sexual lifestyle, penile cancer is almost certainly not going to be the illness that carries you off someday.

That completes the two follow-ups included with each question, and so ends this thread. Take care and stay safe.

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