Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis

Abstract

Background: The epidemiology of human papillomavirus (HPV) in women has been well documented. Less is known about the epidemiology of HPV in men. We aim to provide updated global and regional pooled overall, type-specific, and age-specific prevalence estimates of genital HPV infection in men.

Methods: We conducted a systematic review and meta-analysis to assess the prevalence of genital HPV infection in the general male population. We searched Embase, Ovid MEDLINE, and the Global Index Medicus for studies published between Jan 1, 1995, and June 1, 2022. Inclusion criteria were population-based surveys in men aged 15 years or older or HPV prevalence studies with a sample size of at least 50 men with no HPV-related pathology or known risk factors for HPV infection that collected samples from anogenital sites and used PCR or hybrid capture 2 techniques for HPV DNA detection. Exclusion criteria were studies conducted among populations at increased risk of HPV infection, exclusively conducted among circumcised men, and based on urine or semen samples. We screened identified reports and extracted summary-level data from those that were eligible. Data were extracted by two researchers independently and reviewed by a third, and discrepancies were resolved by consensus. We extracted only data on mucosal α-genus HPVs. Global and regional age-specific prevalences for any HPV, high-risk (HR)-HPV, and individual HPV types were estimated using random-effects models for meta-analysis and grouped by UN Sustainable Development Goals geographical classification.

Findings: We identified 5685 publications from database searches, of which 65 studies (comprising 44 769 men) were included from 35 countries. The global pooled prevalence was 31% (95% CI 27-35) for any HPV and 21% (18-24) for HR-HPV. HPV-16 was the most prevalent HPV genotype (5%, 95% CI 4-7) followed by HPV-6 (4%, 3-5). HPV prevalence was high in young adults, reaching a maximum between the ages of 25 years and 29 years, and stabilised or slightly decreased thereafter. Pooled prevalence estimates were similar for the UN Sustainable Development Goal geographical regions of Europe and Northern America, Sub-Saharan Africa, Latin America and the Caribbean, and Australia and New Zealand (Oceania). The estimates for Eastern and South-Eastern Asia were half that of the other regions.

Interpretation: Almost one in three men worldwide are infected with at least one genital HPV type and around one in five men are infected with one or more HR-HPV types. Our findings show that HPV prevalence is high in men over the age of 15 years and support that sexually active men, regardless of age, are an important reservoir of HPV genital infection. These estimates emphasise the importance of incorporating men in comprehensive HPV prevention strategies to reduce HPV-related morbidity and mortality in men and ultimately achieve elimination of cervical cancer and other HPV-related diseases.

Funding: Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020.

Translations: For the Spanish and French translations of the abstract see Supplementary Materials section.

Figure 1

PRISMA flow diagram *4938 records were excluded during the screening of publication titles and 352 records were excluded during the screening of abstracts.

Figure 2

Pooled prevalence of HR-HPV types, HPV-6, and HPV-11 in men by region Regions are defined by the UN Sustainable Development Goals regional or subregional grouping. Europe and Northern America are shown separately, and Central America and South America were the only subregions for Latin America and the Caribbean. HR-HPV types were defined as types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59. HPV types are ranked by prevalence. Error bars represent the 95% CIs. Numbers of studies with available data for each HPV type and the number of men for whom data were contributed are shown in appendix 3 (p 6). HR-HPV=high-risk HPV. HPV=human papillomavirus.

Figure 3

Age-specific prevalence of genital HPV infection in men Global (A) and regional (B) prevalence of any HPV, HR-HPV, and HPV-16 by age group. Areas represent 95% CIs. Regions are defined by the UN Sustainable Development Goals regional or subregional grouping. Europe and Northern America are shown separately, and Central America and South America were the only subregions for Latin America and the Caribbean. The number of studies for which age-specific data were available, the number of men for whom data were contributed, and the countries included in each region are shown in appendix 3 (p 6). HR-HPV=high-risk HPV. HPV=human papillomavirus.