Why are there now more cases of the human papillomavirus in men over 45 years of age?

Human papillomavirus (HPV), the most common sexually transmitted infection (STI), now affects one in five men. STI specialists warned on Monday of an increase in diagnoses and associated lesions among men over 45, especially those in their 60s and 70s, who are predominantly heterosexual. In a press release, the Puigvert Foundation explains that those affected belong to generations that have not been protected by routine HPV vaccination and who, at the same time, have experienced a change in sexual behavior, with an "exponential increase in casual encounters and relationships after a divorce or the end of a relationship." According to experts, HPV is no longer a women's disease, as the prevalence among men is currently 45.8%, while among women it stands at 40.1%. The head of the STI Unit at the Puigvert Foundation, Álvaro Vives, explains that "it is increasingly common, after ending a long-term relationship, to have multiple sexual partners, participate in open relationships, use dating apps, or frequent swingers' clubs." The main pathologies associated with HPV are, in women, genital warts and cervical cancer, and in men, anal, penile, or head and neck cancer. The incidence of the latter type of tumor is increasing significantly among men aged 60 and 70, and it is predicted that more than one million new cases will be diagnosed annually by 2030. Vives also emphasizes that HPV transmission is not higher among gay men: "Sexual orientation does not constitute a risk group; sexual practices with numerous partners do," he asserts. Vaccination is recommended up to age 45.

HPV infection is asymptomatic in 80% of cases, and the disease can appear after 4 to 6 years. HPV vaccination was included in the official immunization schedule seventeen years ago for girls between the ages of 9 and 14, since this virus causes 99.9% of cervical cancer cases. However, boys can also transmit and become infected with HPV and develop cancers such as anal, penile, and oropharyngeal cancer, as well as non-cancerous genital warts. Therefore, since the 2022-23 school year, boys between the ages of 11 and 12 (i.e., those in their sixth year of primary school) have also been routinely vaccinated.

In addition, a catch-up vaccination campaign with a single dose has been established for all boys up to 18 years old (born in 2007 or later) and girls up to 24 years old (born in 2001 or later). These measures have allowed for the protection of younger generations, in whom a decrease in HPV infection and associated lesions is being observed.

But what about older generations? Currently, people between 27 and 45 years old who belong to several risk groups can also be vaccinated, according to the guidelines of health authorities. These are people with certain medical conditions or exposures that increase the likelihood of contracting the infection or developing HPV-related pathologies.

The vaccination schedule is specifically recommended for certain risk groups. For example, men who have sex with men up to age 25, and people who engage in prostitution, also up to age 25. It can also be administered to people with immunosuppression—due to WHIM syndrome, HIV infection, or having received a solid organ or bone marrow transplant—up to and including age 45, and women who have received any treatment for high-grade intraepithelial lesion of the cervix (C).