Male HPV Infections Run High in Coastal China, With Vaccine Gaps Persisting

Human papillomavirus is often discussed as a women’s health issue, dominated by the burden of cervical cancer, but a new retrospective study from southeastern China adds to a growing body of evidence that men carry a substantial and underappreciated share of the viral load. Researchers at the Affiliated Hospital of Putian University and the First Hospital of Putian City analyzed samples from 731 male outpatients treated between May 2023 and February 2026 and found that more than one in three was infected with at least one HPV genotype. The overall prevalence of 35.2 percent, reported in BMC Infectious Diseases, included single-genotype infections in 22.7 percent of patients and multiple-genotype infections in 12.5 percent, a pattern that underscores how frequently men harbor several viral types simultaneously.

The technical approach behind these numbers is worth noting. Rather than relying on a single broad screening assay, the team used polymerase chain reaction amplification combined with flow-through hybridization, a method that allows simultaneous detection and identification of 21 distinct HPV genotypes. This matters because HPV is not one pathogen but a family of more than 200 related viruses, only some of which are classified as high-risk for cancer. Distinguishing which genotypes circulate in a given population is essential for predicting how well existing vaccines will perform and for designing regional screening programs that target the types actually present.

The five most frequently detected genotypes among the men were HPV6, HPV52, HPV16, HPV51, and HPV42. This list mixes low-risk and high-risk types: HPV6 and HPV42 are classified as low-risk, typically associated with genital warts rather than malignancy, while HPV52, HPV16, and HPV51 belong to the high-risk category linked to anogenital and oropharyngeal cancers. HPV16 is the single most carcinogenic genotype worldwide and a dominant driver of HPV-positive cancers in both sexes. The fact that it ranks among the top types in these male outpatients reinforces why vaccination and, eventually, male screening remain central to cancer prevention efforts.

One of the study’s most striking findings is the overlap between the genotypes circulating in men and those previously reported in local women in the Putian region. The predominant types in the male cohort, including low-risk HPV6 and HPV42 and high-risk HPV52, HPV51, and HPV16, substantially mirror the genotype distribution described for females in the same area. Such concordance is consistent with sexual transmission within partner networks and suggests that vaccinating or screening only one sex leaves a persistent viral reservoir in the other. The authors argue that this overlap supports including men in HPV prevention strategies and may inform future evaluation of partner-oriented prevention approaches, in which couples are considered jointly rather than in isolation.

Age emerged as a significant axis of variation. Prevalence was highest among patients older than 60 years, a pattern that contrasts with the classic bimodal age distribution often described in women, where infection peaks in young adulthood and again around midlife. In men, clearance of infection can be less efficient with age, and cumulative exposure over a lifetime may raise the probability of detectable infection in older age groups. The researchers also conducted sensitivity analyses using broader age categories, combining the 51-to-60 and over-60 groups, to confirm the robustness of the association between older age and high-risk HPV infection, indicating that the age signal was not an artifact of how the categories were drawn.

Clinical diagnosis also shaped the picture. HPV prevalence varied significantly across the six diagnostic subgroups into which patients were stratified: warts, urinary tract infections, dermatitis, genital diseases, health check-ups, and others. The warts group showed the highest infection rate at 48.7 percent, dominated by HPV6 and HPV11, the two low-risk genotypes most classically responsible for condyloma acuminatum, or genital warts. That result is biologically coherent, since patients presenting with visible warts are, by definition, already expressing an HPV-driven lesion. More unexpected was the dermatitis group, which came in a close second at 46.5 percent and displayed remarkable genotype diversity, with HPV52, HPV16, HPV42, HPV51, and HPV59 all appearing among the detected types.

The dermatitis finding carried enough statistical weight to survive multivariable regression analysis. After adjusting for other variables, dermatitis was identified as an independent risk factor for high-risk HPV infection, with the authors reporting an adjusted odds ratio and controlling for confounding using generalized variance inflation factors to check for collinearity among predictors. The biological interpretation is not settled from these data alone, but plausible mechanisms include disruption of the skin barrier providing an easier entry point for virions, local immune dysregulation reducing viral clearance, or inflammatory conditions serving as a marker for behaviors or exposures that also raise HPV risk. Whatever the direction of causality, the association suggests that dermatology clinics could represent an underused point of contact for HPV testing in men.

The vaccine analysis is where the study’s public health implications become most concrete. China’s regional vaccination programs have historically focused on girls and women, and the 9-valent HPV vaccine, which protects against genotypes 6, 11, 16, 18, 31, 33, 45, 52, and 58, is the broadest formulation in widespread use. Yet even against this nine-type panel, the researchers calculated that 33.5 percent of HPV-positive men in the cohort carried at least one genotype not covered by the vaccine, and the coverage gap was nearly identical, at 33.9 percent, among men carrying high-risk types. In other words, roughly one third of infections, including those with cancer-associated potential, would not be prevented by the current nonavalent vaccine, a gap driven by types such as HPV51 and HPV59 that fall outside the formulation.

These coverage gaps do not diminish the case for vaccination, but they do complicate it. On one hand, the predominance of HPV6, HPV16, and HPV52 in the male cohort means the 9-valent vaccine would still address a majority of circulating infections, and HPV16 in particular is responsible for a disproportionate share of HPV-related cancers. On the other hand, the persistence of a substantial non-vaccine reservoir means that vaccination alone cannot eliminate transmission in this population, and the finding strengthens arguments for extending vaccination to boys and men, both to protect them directly against cancers and warts and to build herd protection that benefits unvaccinated partners.

The study has limitations inherent to its design. It was retrospective and drew exclusively on male outpatients at a single hospital in Putian, a prefecture-level city in Fujian Province, so the 35.2 percent prevalence cannot be generalized to the general male population, which typically shows lower rates than clinic-based cohorts. Patients visiting dermatology or urology clinics are more likely to have conditions related to or coinciding with HPV infection than men sampled at random. The ethics committee of the First Hospital of Putian City approved the study and granted an exemption from individual informed consent, and the authors declare no competing interests. Even with those caveats, the work fills a genuine gap: no previous research on male HPV prevalence in Putian had been reported, and region-specific genotype data of this kind are scarce across much of China.

The broader takeaway is that HPV epidemiology in men deserves the same granular, genotype-level attention that has long been applied to women. As vaccination programs expand and as oropharyngeal and anal cancers linked to HPV rise in many countries, understanding which types circulate in male populations, at which ages, and in association with which clinical conditions becomes essential for modeling transmission, forecasting vaccine impact, and deciding whether and when to introduce routine male screening. The Putian data, with their high prevalence, distinctive age gradient, dermatitis signal, and measurable vaccine gap, offer a template for the kind of local surveillance that global HPV control efforts will increasingly require.

Subject of Research: Prevalence and genotype distribution of human papillomavirus infection among male outpatients in Putian, Fujian Province, China

Article Title: Prevalence and genotype distribution characteristics of human papillomavirus infection among male outpatients in Putian, Fujian Province: a retrospective study

Article References: Chen, Y., Xiao, G., Chen, A., Zhang, R., & Zhang, L. (2026). Prevalence and genotype distribution characteristics of human papillomavirus infection among male outpatients in Putian, Fujian Province: a retrospective study. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14565-z

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14565-z

Keywords: HPV, human papillomavirus, male HPV prevalence, genotype distribution, HPV vaccination, 9-valent vaccine, high-risk HPV, genital warts, dermatitis, China, epidemiology, BMC Infectious Diseases