HPV and cancer risks for men.
Credit: Photograph by Guido Vitti

The next time you think about going down on a woman, think about this: She is almost certain to have been infected at some point with a virus that could, years from now, give you throat cancer.

The most common sexually transmitted disease in the U.S., human papillomavirus, or HPV, has been blamed for a recent, rapid increase in the incidence of throat cancer – a disease that used to be rare in people who didn't drink or smoke excessively. According to data from 2004, the most recent available, rates of HPV-related throat cancer had risen 225 percent in the previous 16 years, with men suffering the most cases. Researchers point to the increasing popularity of oral sex – often seen as safer than intercourse – among heterosexual couples, a trend that may soon lead to more male fatalities in industrialized nations from HPV-related infections than female ones – a surprising turnaround after decades when women suffered higher death rates from the virus, which also causes cervical cancer through vaginal sex.

UPDATE: HPV Prevention for Men

Most people who contract HPV get rid of the virus within a few years without side effects or complications, and the number of men infected with HPV who actually develop cancer is still very small. The bad news, however, is that researchers believe there is virtually nothing a heterosexual man with a normal sex life can do to avoid HPV infection. Virgins who have done nothing but open-mouthed kissing have been found to be infected. One study even discovered that kissing may increase your risk of oral infection more than having intercourse. How about monogamy? Sorry, but that one's out, too. A study of coeds at the University of Washington found that half of women who had had only one sexual partner were infected with the virus after three years of partnership. Even fooling around can be risky, since skin under the fingernails can contain the virus. Condoms are helpful, but HPV can attach to so many different surfaces that even they are not foolproof.

A large part of the problem is HPV's universality. The Centers for Disease Control and Prevention approximates that 80 percent of women in the U.S. have been exposed to the virus by age 50, an estimate that some researchers think is low. No one is quite sure what the exposure rate among men is, although guys tend to become infected more readily than women: Studies of college students found active infections in half of women and nearly two-thirds of men. "If you're sexually active, in all probability, you have already been exposed," said Dr. Maura L. Gillison, a professor of medicine at Ohio State University's comprehensive cancer center.

While there are more than 100 strains of the HPV virus, most oral cancers result from HPV-16. Those who test positive for HPV-16 are 14 times as likely to develop oral cancer as those who do not. (There are at least seven other strains known to cause cancers, including cervical, anal, penile, and vulvar, as well as six more suspected of doing so.)

Unlike cervical cancer, which can be detected with a Pap smear, there is no test that can easily identify HPV-related throat cancer. By the time those with the disease become aware that they're sick, cancer has often spread to their lymph nodes. Surgery can be disfiguring, and chemotherapy and radiation are exhausting and debilitating. And while HPV-related throat cancers are generally more curable than those that result from smoking or alcohol use, 40 percent of the 36,000 people diagnosed each year with oral cancer will die from the disease within five years. Between 1992 and 2001 – in the most recent data available – oral cancer ranked as the seventh most common cancer among men in the U.S.

In 2007, Kevin McConnell, 51, of Annapolis, Maryland, developed what he thought was a terrible earache. After the pain spread to his neck and tongue, he saw a doctor who referred him to a specialist. Although the specialist found no evidence of cancer, he sent him for two brain scans, both of which were negative. Three weeks later, McConnell developed a lesion on his tongue that spurred him to see an expert at Johns Hopkins, who told him he had a 3.5-centimeter tumor that was cancerous and life-threatening. After seven weeks of intensive radiation and treatments, McConnell has recovered and is in remission, but he says he gets mixed reactions when he tells women he dates that he had oral cancer as a result of an HPV infection. "I've had some people freak out about it and say they don't want to date me," he says, pointing out – accurately – that most of these women have probably already had the virus themselves.

Although there's little you can do to decrease the possibility of contracting HPV, researchers have identified risk factors. Losing your virginity at an early age and having many sexual partners boost your chances; so do tobacco use and a history of genital warts. But many mysteries remain, including why men who use marijuana seem to be at greater risk for HPV-related oral cancers and what role race might play. A 2009 study, for ­example, found that white men are almost nine times as likely as black men to suffer HPV-related oral cancers. Whether this disparity is owing to a difference in sexual behavior is unknown.