HPV infections in men: farewell to fertility?

With more than 200 known genotypes the human papillomaviruses are not only dermatologically relevant. HPV infection must be regarded as a systemic infection that can also be detected in the testicles or ejaculate of men. But does it also affect fertility?

Human papillomaviruses in semen, and its potential effects

With more than 200 known genotypes, the human papillomaviruses are by no means only dermatologically relevant warts. It is becoming increasingly clear that HPV infection must be regarded as a systemic infection that can also be detected in the testicles or ejaculate of men. But does the virus presence in these areas also influence fertility?

Human papillomaviruses (HPV) are also found in semen in up to 30% of men. Whether they influence fertility and sperm parameters are currently unclear. However, a recent study presented at the EAU Congress in Barcelona assess the effects of HPV infections on male fertility.

In their work, the researchers examined a total of 729 infertile men, from whom they determined not only hormone levels but also DNA fragmentation in the sperm as well as sperm quality.

Of the participating men, 15.5% tested positive for HPV, with 10.7% showing high-risk HPV and 4.8% low-risk HPV. At around 22%, HPV16 was the tumor-causing virus with the majority of infections. In addition, HPV43 (11%) and HPV42 and HPV56 were found, each with around 9%.

Forward sperm motility was restricted in HPV-positive men and a higher degree of DNA fragmentation occurred in the sperm of HPV-positive men (36%). These limitations were particularly pronounced in carriers of high-risk HPV types, where DNA fragmentation was even higher at 40%.

Is this important in practice?

HPV infection in men's ejaculate - especially the high-risk HPV types - affects sperm motility and increases the rate of DNA fragmentation. In the future, this should be taken into account in the diagnosis of primarily infertile men.

Furthermore, this work shows very impressively that HPV infection is by no means only a dermatologically limited manifestation, but rather a systemic disease.

Since last year in Germany, this systemic disease has also been countered by a systemically effective vaccination for boys aged 9 and over. The HPV infection is often referred to as "vaccination against cancer", but it primarily protects against infection by the tumor-associated HPV virus types found in the vaccine.

In men, HPV is mainly responsible for anal, penis and mouth and neck carcinomas to a not inconsiderable extent. However, there are further sources for cancer development in the case of mouth and neck tumors with alcohol and tobacco consumption. For this reason, patients should not be told about "cancer vaccination", but rather about a vaccination option that prevents infection with cancer-causing viruses.

P255: Boeri L et al., High-risk human papillomavirus in semen is associated with poor sperm progressive motility and a high sperm DNA fragmentation index in infertile men. EAU 2019, Barcelona

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