How HPV Is Associated With Penile Cancer

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Not all penile cancers are caused by human papillomavirus (HPV), and these cancers remain relatively rare in the developed world. However, research suggests about 40% of all penile cancers are linked to HPV, particularly the HPV16 strain. For this reason, it's possible that HPV may be a contributing factor.

This article looks at what cancer of the penis is, and why there may be a link to the sexually transmitted HPV. It also looks at how to protect yourself and reduce your risk of penile cancer.

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What Penile Cancer Is

Penile cancer remains rare in the developed world. It accounts for less than 1% of all cancers in men. Just 2,000 cases are diagnosed in the United States each year, with about 450 people dying because of the cancer or its spread to other parts of the body. When diagnosed and treated early, penile cancer has a five-year survival rate of over 80%.

There are differences because there are seven kinds of penile cancer, although squamous cell carcinomas account for about 95% of all cases.

Penile cancers usually begin with lesions, or sores, on the head or shaft of the penis. These sores may look like white patches, as in the case of the early-stage Bowen's disease. They may be red bumps that look more like a rash, or the skin may be crusty. It's common for smelly fluid to be leaking from the sores. There may be pain when urinating too. These symptoms usually lead men to call their doctor.

The HPV Connection

There are more than 200 known strains of HPV and not all of them are linked with penile cancer. In fact, it's just about 15 of them that are currently known to be high-risk for cancer. More than one study has found the HPV16 strain is most common in men who get cancer, followed by the HPV18 strain. These two account for at least a third of all squamous-cell penile cancers, by far the most common type.

Scientists have long demonstrated that there is a behavioral component to penile cancer risk. A 2008 study in Denmark found a link between penile cancer and heterosexual oral sex. Oral sex is associated with HPV infection, and oral cancer is also indirectly caused by HPV. It's another reason to suspect that HPV plays a role in penile cancer risk.

It remains unclear whether HPV-related penis cancers are more invasive than non-viral cancers. Some studies have shown that these cancers may be more likely to spread to the lymph nodes. This type of invasive cancer is generally associated with worse outcomes. Other studies, however, have found the opposite result, and instead concluded that HPV-related tumors are less aggressive.

Recap

There is still much to know, but years of research have already found evidence linking HPV infection to some cancers, including cancers of the penis. Because HPV is a sexually transmitted disease, and its high-risk strains may lead to cancer, it's important to prevent it. Fortunately, a vaccine is available to help protect at least some men from penile cancer.

Reducing Your Risk

There are two basic ways to reduce your risk for HPV-related penis cancers. The first is to consistently practice safe sex. Using condoms for vaginal sex, anal sex, and oral sex will reduce the likelihood of you being exposed to penile HPV.

The second thing you can do is talk to your doctor about getting an HPV vaccine. This may offer more benefit for men who have not become sexually active or have had relatively few sexual partners. Men who have had many partners have likely been exposed already because HPV is an extremely common STD.

Other Risk Factors

Penis cancer is also associated with other sexual risk factors and men's health conditions, such as phimosis and balanitis. Smoking and HIV infection are additional risk factors.

Summary

Although penile cancer is rare, there is a clear link to HPV. But just as there are seven different kinds of penile cancer, there are also many different strains of HPV. Only some of them, including HPV16, have been linked to cancer of the penis.

Penile cancer has a good general survival rate but, as with other cancers, it depends on what type. Outcomes may also depend on how long it's been developing, and your own age and health condition. Your doctor will help you navigate what penile cancer can mean for your health and overall quality of life.

A Word From Verywell

It's rare for a man in North America or Europe to have penile cancer. The diagnosis is far more common in parts of Asia, Africa, and South America, with the Brazilian state of Maranhão having one of the highest rates in the world.

That said, the risk is made greater by a sexually transmitted HPV infection. The fact that these infections are rare is little comfort if you're experiencing painful sores or other upsetting symptoms. Be sure to tell your doctor right away so you can find out why.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Iorga L, Marcu RD, Diaconu CC, et al. Penile carcinoma and HPV infection (Review)Experimental and Therapeutic Medicine. 2020;20(1):91-96. doi: 10.3892/etm.2019.8181

Additional Reading
  • Madsen BS et al. (2008) "Risk factors for squamous cell carcinoma of the penis-population-based case-control study in Denmark." Cancer Epidemiology Biomarkers and Prevention 17:2683-2691.
  • Mentrikoski MJ, Stelow EB, Culp S, Frierson HF Jr, Cathro HP. Histologic and immunohistochemical assessment of penile carcinomas in a North American population. Am J Surg Pathol. 2014 Oct;38(10):1340-8.
  • Sanchez DF, Cañete S, Fernández-Nestosa MJ, Lezcano C, Rodríguez I, Barreto J, Alvarado-Cabrero I, Cubilla AL. HPV- and non-HPV-related subtypes of penile squamous cell carcinoma (SCC): Morphological features and differential diagnosis  according to the new WHO classification (2015). Semin Diagn Pathol. 2015 May;32(3):198-221. doi: 10.1053/j.semdp.2014.12.018.
  • Steinestel J, Al Ghazal A, Arndt A, Schnoeller TJ, Schrader AJ, Moeller P, Steinestel K. The role of histologic subtype, p16(INK4a) expression, and presence of human papillomavirus DNA in penile squamous cell carcinoma. BMC Cancer. 2015 Apr 3;15:220. doi: 10.1186/s12885-015-1268-z.
  • Vogt SL, Gravitt PE, Martinson NA, Hoffmann J, D'Souza G. Concordant Oral-Genital HPV Infection in South Africa Couples: Evidence for Transmission. Front Oncol. 2013 Dec 12;3:303. doi: 10.3389/fonc.2013.00303.