The challenging approach to the management of male partners of HPV-positive women

ABSTRACT

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection globally, with significant implications for both individual and public health. While management protocols for HPV-positive women are well-defined, limited and controversial guidance exists for their male partners, creating challenges in clinical practice. This commentary aims to turn the attention to the clinical, psychological, and preventive considerations for male partners of HPV-positive women, emphasizing the need for evidence-based recommendations. It presents the psychological impact of HPV on couples, and the role of preventive measures such as vaccination. Key focus areas included partner notification, HPV testing in men, and risk-reduction strategies. HPV infections in male partners can lead to conditions ranging from genital warts to HPV-associated cancers. Despite the absence of routine HPV testing for men, targeted interventions, including vaccination, have demonstrated effectiveness in reducing HPV transmission and associated cancer risks. The management of male partners of HPV-positive women remains an underexplored and controversial domain, necessitating the development of comprehensive, evidence-based guidelines. Integrating vaccination, partner counseling, and targeted clinical approaches could address existing gaps and ensure equitable care for both partners.

Introduction

Management protocols for women diagnosed with human papillomavirus (HPV) through cervical cancer screening are well-established; however, the implications of this sexually transmitted infection for the male partners remain inadequately defined. Evidence-based guidelines addressing aspects such as sexual practices and partner notification are notably lacking. This absence not only creates challenges for patients but also poses significant difficulties for healthcare providers in offering consistent and evidence-based care.^1,2

A positive cervico-vaginal high-risk HPV test in a woman raises substantial clinical and psychological concerns, both for the individual and her partners. The lack of clear recommendations for managing male partners often leaves patients, their partners, and clinicians without sufficient guidance.

In this paper we provide an evidence-based commentary of the impact and clinical approach to a positive HPV test in women, and highlight current perspectives, existing recommendations, controversies and critical gaps in knowledge regarding the management of male partners of women infected with high-risk HPV.

Emotional impact of a positive HPV result

A positive HPV diagnosis can lead to significant emotional distress, often exceeding the anxiety associated with an abnormal cervical cytology result. This heightened response may stem from the relatively limited public awareness of HPV and the absence of a direct antiviral treatment for the infection.³ Studies have shown that HPV-positive individuals exhibit elevated cortisol levels, suggesting a physiological stress response.⁴ Furthermore, these individuals have been linked to an increased risk of cardiovascular disease, even after adjusting for established risk factors.⁵

Addressing the emotional burden and anxiety experienced by HPV carriers and their partners is crucial. Developing targeted interventions to mitigate these psychological effects should be a priority in HPV management and education efforts.

HPV-Associated neoplasia

HPV is the most common sexually transmitted infection, responsible for 4.5% of all cancers worldwide.^6,7

While most HPV infections clear naturally, persistent oncogenic infections can progress to life-threatening disease. Nearly 99% of cervical cancers and many cancers of the vagina, vulva, anus, penis, and oropharynx are HPV-related. HPV also causes nonmalignant conditions, such as genital warts and recurrent respiratory papillomatosis (RRP). Cervical cancer, the fourth most common cancer in women, accounts for approximately 560,000 new cases annually.⁸ Annually, HPV-related cases include 20,000 anal cancers 20,000 oral cancers, and 6 million genital warts, most of which are preventable through vaccination.⁹

Cervical cancer and prevention strategies

Vaccination

HPV vaccination has the potential to eliminate most of the cases of cervical cancer and its precursor lesions.¹⁰ Vaccination before HPV exposure prevents most HPV-related malignancies and lesions. Even in adults already exposed, 18 to 45 years of age, vaccination remains beneficial. Recognized by the WHO as safe and effective, the vaccine prevents over 95% of HPV-related malignancies, precursor lesions, and genital warts.^11–18

Current screening for prevention of cervical cancer

While vaccination provides primary prevention, cervical screening remains essential. Persistent high risk HPV infections may cause high-grade squamous intraepithelial lesions (HSIL),¹⁹ detectable via high-risk HPV testing, which has largely replaced cytology due to higher sensitivity and negative predictive value. Screening enables early intervention, reducing cancer risk and providing health and economic benefits.

In most countries, HPV testing begins at ages 25–30 and is performed every 3–5 years until ages 65–70. Women with HSIL history should be screened every 3 years for 20–25 years post-diagnosis, regardless of age. Women over 65 lacking recent screening are also eligible.^20,21

Management of positive HPV DNA results

A positive HPV DNA result indicates infection but not necessarily disease. High-risk HPV detection is followed by cytology to assess for abnormal cells and determine the need for monitoring or colposcopy. New triage strategies, including HPV RNA, p16/Ki67 and methylation markers, aim to reduce unnecessary colposcopy referrals and better stratify the risk of disease.⁶

Implications for the partner of HPV-Positive women

The management of HPV infection extends beyond the individual, and the question of how to manage the partner(s) of a woman with a positive HPV DNA result has garnered increasing attention. While clinical guidelines for managing HPV in women are well-established, there remains a lack of clear guidelines for managing their male partners. This gap underscores the need for further research and the development of evidence-based recommendations to provide equitable care for both partners.

Should the male partner Be informed of the woman’s HPV status?

A common concern among women diagnosed with HPV is whether they should inform their partners about the infection and its implications for their sexual health and relationship. The Centers for Disease Control and Prevention (CDC) does not mandate disclosure, reasoning that partner notification does not directly prevent HPV-related diseases and the origin of an HPV infection is often impossible to determine.²²

An additional consideration is that disclosing the HPV infection to a partner could potentially lead to mistrust within the relationship. Therefore, the decision to share such information should be approached with sensitivity and careful consideration of the potential emotional and relational consequences. In some cases, minimizing or avoiding disclosure may be deemed appropriate.

However, emerging evidence suggests that disclosure may offer certain benefits. Partners of women with precancerous lesions or cervical cancer may face an increased risk of developing oropharyngeal cancer.^23,24 Although routine screening for oropharyngeal cancer is not currently available, and precursor lesions remain poorly defined, vaccinating the partner before HPV infection could potentially lower the risk of this malignancy. This preventative approach aligns with the demonstrated efficacy of the HPV vaccine in reducing the incidence of cervical cancer.

Men diagnosed with visible HPV-related conditions, such as genital warts or cancers like oropharyngeal, anal, or penile cancers, should inform their partners, as these conditions strongly suggest the presence of high-risk HPV types that are likely to infect the woman partner.²⁵ Disclosure may also open avenues for mutual support and prevention, including vaccination and condom use.

Should the partner Be tested for HPV?

The CDC advises against routine HPV testing in male partners due to the lack of standardized, reliable methods and the absence of established management pathways for HPV-positive men.²⁴ HPV testing in men is recommended only with a meaningful clinical indication and must be accompanied by appropriate counseling, namely in HIV-positive men who also have sex with men (MSM). In this population, anal HPV testing and/or cytology, coupled with high-resolution anoscopy, can identify precancerous anal lesions and reduce the risk of anal cancer²⁵ and infection of sperm by HPV.²⁶ Expanding this targeted approach to other high-risk groups may warrant further investigation.

HPV transmission in long-term relationships

In long-term relationships, the current sexual partner is often suspected as the source of infection. Indeed, studies reveal that 68% of monogamous couples share the same HPV strains.²⁷ However, HPV’s transmission dynamics are complex. Latency, reactivation of past infections, as well as non-monogamous behaviors must be considered, and these factors render impossible the identifying the infection source.^28,29

Partners should be informed that a positive HPV test does not necessarily indicate a recent infection. Reactivation of latent HPV from a previous partner is a plausible explanation, even when preceded by a long history of negative tests. Counseling should focus on these nuances to alleviate unnecessary blame or distress.

Condom use and HPV transmission to the partner

According to the CDC, consistent condom use reduces the risk of HPV transmission and accelerates viral clearance in infected individuals.³⁰ Consistent condoms use significantly decreases HPV transmission and facilitates regression of low-grade cervical lesions.³¹ Informing partners about these benefits may encourage condom use, though compliance is often challenging in established relationships, where introducing condom use may raise issues of trust.

It is also important to note that HPV can be transmitted through non-penetrative sexual activities and oral sex, meaning that condoms provide only partial protection.

Should the partner of an HPV-Positive woman Be vaccinated?

In the Austrian National Vaccination Plan, HPV vaccination is already recommended for: people with risk of exposure: sexual activity, multiple partners, known infection of sexual partners.³²

Men infected with HPV increase the risk of cervical cancer in their female partners. Vaccination has been shown in systematic reviews and meta-analyses to reduce the recurrence of HPV-related lesions in women, even those previously exposed to the virus.^33,34 Long term follow-up of randomized controlled trials evaluating the clinical efficacy of post treatment vaccination is still pending.

Furthermore, vaccinating male partners of HPV-positive women may reduce transmission within couples.^35,36 Mutual vaccination of both partners could enhance protection against HPV types covered by the vaccine while stabilizing the partnership by sharing the responsibility for prevention.^37–40

Thus, vaccination should be considered for both HPV-positive women and their partners.

Conclusion

The management of the partner of an HPV-positive woman remains an area of uncertainty and controversy, despite well-established protocols for the woman herself. Current recommendations discourage routine HPV testing in male partners due to the lack of reliable testing methods and therapeutic interventions. Our viewpoint is that while partner notification is not mandatory, disclosure may be beneficial in specific cases, particularly if the male partner is at higher risk for HPV-related cancers such as oropharyngeal, anal, or penile cancers.

Vaccination of both partners presents a promising strategy, depending on their age. Preliminary studies show reduction in the transmission of HPV in vaccinated women.³⁵ It offers mutual protection and potentially reducing cancer risks for both individuals. Further research is needed to develop comprehensive, evidence-based guidelines for managing male partners of different ages, addressing both clinical and psychological aspects of HPV in relationships.

Biographies

Jacob Bornstein, MD,MPA, is a Full Professor and Emeritus Vice Dean of the Faculty of Medicine at Bar-Ilan University, Israel, a Gynecologist and a Colposcopist, and Head of the Gynecological Pain Research Laboratory, Board Member of the National Israeli Academy of Science in Medicine, Chairman of the Israeli Society for the Study of Sexually Transmitted Diseases, chair of the Colposcopy Nomenclature Committee of the IFCPC.

Pedro Vieira-Baptista is a gynecologist at Hospital Lusíadas Porto, Portugal, specializing in lower genital tract diseases. From 2017 to 2024, he served as Secretary General of the International Society for the Study of Vulvovaginal Disease (ISSVD) and is currently the President-elect for the 2026–2028 term. Colleen K Stockdale, MD, MS is Clinical Professor, Department of Obstetrics and Gynecology, University of Iowa Health Care. Dr. Stockdale is Past President of the ASCCP and the International Society for the Study of Vulvovaginal Disease (ISSVD).

Mario Preti, MD, Associate Professor, Department of Surgical Sciences, University of Torino, Italy. Dr. Preti is Past President of the International Society for the Study of Vulvovaginal Disease (ISSVD).

Elmar Joura, MD, Associate Professor, Department of Obstetrics and Gynecology, Comprehensive Cancer Center, Medical University of Vienna, Austria. Dr. Joura is Head of Colposcopy and Vulvar Clinic and Past President of the European College for the Study of Vulvovaginal Disease (ECSVD).

Eduardo Schejter, MD, M.H.A. in health system administration. Head of Women’s Health Center and Lower genital tract unit, Maccabi Health Service, Tel Aviv. Former Chairman of the Israel Colposcopy and Cervical Pathology Society. Gynecological adviser at the Department of patient safety and risk management, Maccabi HMO.

Funding Statement

The author(s) reported there is no funding associated with the work featured in this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

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

Abbreviations

The following abbreviations are used in this manuscript:

CDC	Centers of Disease Control
HPV	Human Papillomavirus
MSM	men who have sex with men