New Study Suggests Male Foreskin is a Reservoir for HPV; May Have Implications for Vaccinations and Circumcisions

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A new study presented at the annual meeting of the American Urological Association suggests that male foreskin is a reservoir for HPV, the human papillomavirus.  Researchers in Australia examined the foreskin of 133 males between 7 months and 82 years who had undergone circumcision to treat phimosis, a condition in which the foreskin cannot be pulled back from the head of the penis. They found that nearly one third of them contained HPV, the virus that causes genital warts. The researchers cautioned, however, that just because HPV was present does not mean it was transmissible. 

HPV is one of the most common sexually transmitted diseases (STDs); the U.S. Centers for Disease Control and Prevention (CDC) estimates that half of sexually active people in the United States will have HPV at some point in their lives.  Most cases resolve themselves without any long term health consequences; however, some strains of HPV can lead to cervical cancer in women and, in rare cases, penile cancer in men. 

In the United Sates, there are two vaccines available to protect women from the strains of HPV that cause cervical cancer. The CDC recommends that girls be vaccinated at 11 or 12, though this has caused some controversy (in large part because of the sexual nature of transmission and the early age of vaccination).  One of the vaccines, Gardasil, has also been approved for use in boys, though the CDC does not recommend that all boys be vaccinated. 

The authors of this study say that this new evidence suggests that it is important to vaccinate boys as well.

"Our study revealed the occurrence of subclinical genital low- and high-risk HPV infections in boys and men, which could be a reservoir for HPV-associated diseases.  Since it is proven that viral transfer results from sexual contact, it is advisable to vaccinate not only girls but also boys before adolescence."

The study also raises the issue of whether male circumcision should be promoted as a method of STD prevention. In recent years, studies have shown that male circumcision can reduce the risk of transmission of HIV, HPV, and herpes. While there are public health efforts to increase the practice among men in some areas, most notably in Africa, the American Academy of Pediatrics says the medical benefits are insufficient to recommend the procedure for all infant males in the United States. Opponents of circumcision suggest that it is unnecessary and can reduce sexual sensitivity in adults. In fact, circumcision rates have been dropping dramatically in this country. While over 90 percent of infant males in the United States were circumcised in the 1970s this was down to 64 percent in 1995 and just 33 percent in 2009.

Some public health experts say that this new study will likely not change circumcision practices.  Dr. Jonathan L. Temte, professor of family medicine at the University of Wisconsin School of Medicine and Public Health, explained to USA Today, “What this doesn't tell us is anything regarding the relative risk of having a partner who's circumcised vs. uncircumcised." He went on to say: "I don't think this changes the argument very much regarding pros vs. cons on circumcision."


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