As with vulvar cancer, the association between penile cancers and HPV varies considerably by histology. Almost 100% of basaloid and warty penile cancers are associated with oncogenic HPV types, whereas only 30–40% of verrucous and keratinizing squamous cell cancers are associated with HPV. (10) HPV 16 is the predominant type found in HPV-associated tumors. Penile cancers are relatively rare in the U.S. with an annual incidence of approximately 1 per 100,000. Hispanics have the highest incidence with 1.3 per 100,000 and Asian Pacific Islanders have the lowest with .4 per 100,000. Penile cancers represent only 0.4–0.6% of all male cancers in the U.S. and Europe. The incidence is almost 20-fold in South American, African and Asian men. In Brazil, the incidence is 3 per 100,000. In Uganda, 1% of men will develop penile cancer. Although the exact reasons for the variation in incidence are not elucidated, circumcision is protective against penile cancer and likely plays a large role. (11) Other risks for penile cancer include smoking, high risk sexual activity and phimosis. These risks may vary by histology, but few studies have examined risk by subtypes. (14) One study found that a reported history of priapism was also associated with penile cancer. (12, 13) Like cervical cancer, penile cancer under the age of 20 is extremely rare with a mean age of 63–67 years. (13) In addition, to anogenital cancers, HPV is associated with oropharyngeal cancers in both men and women. (15) Overall, HPV is associated with approximately 25% of head and neck cancers. The tonsil and the base of the tongue are the most common sites of HPV-associated cancers in the oral cavity with approximately 50% being associated with HPV. Among whites and blacks, 5.1 and 6.8, men per 100,000, respectively, were diagnosed with HPV-associated head and neck cancers between 1998 and 2003 (www.cdc.org). In contrast, 1.7 per 100,000 Asian/Pacific Islander men were diagnosed. Sexual behaviors in both men and women are associated with increased risk of these cancers including multiple sexual partners and reporting oral sex. Among men, having sex with other men is a risk factor. (16)

To date there have not been any prospective cohort studies in which high-grade anal intra-epithelial neoplasia (HGAIN) has been allowed to progress to cancer. Therefore the frequency and time frame during which HGAIN progresses to invasive cancer are not known in different risk groups. Several observational studies have demonstrated the precancerous potential of HGAIN. (28) Although anal cytology screening in MSM is performed in many centers, screening for HGAIN in men and women remains controversial since the progression rate of HGAIN to invasive cancer is not known. If cytology is performed, it is recommended that a diagnosis of atypical cells of undetermined significance or greater be the indication for evaluation using high resolution anoscopy. Clearly studies are needed to better assess the utility of screening in these groups. (29) This is true for oropharyngeal and penile cancers as well. No screening guidelines exist for either cancer.

These findings support the premise that the quadrivalent vaccine can reduce HPV disease and carriage in men. Given these data, American Committee for Immunization Practices (ACIP) gave a permissive recommendation for boys aged 11–12 years with a catch up of 13–26 years of age. Permissive recommendation allows for the use of the vaccine but stops short of placing it on the routine vaccination schedule. However, in the case of the quadrivalent vaccine, the ACIP also recommended that the cost of the vaccine be covered for boys eligible for the Vaccines for Children program.