A 40-year-old man walks into his doctor’s room with a lump in his throat. He doesn’t smoke. He barely drinks. He has no family history of cancer. What he does have is a common virus he’s never been tested for, never been warned about and one that he never knew could lead to cancer.
This is not an unusual scenario.
It is happening in doctors’ rooms across South Africa and the world. The virus is called human papillomavirus, or HPV. It is one of the most common sexually transmitted infections worldwide and most individuals will be exposed to it at some point in their lives.
HPV infection is mostly talked about as a women’s issue because of its link to 95% of cervical cancer cases.
South Africa’s 2026-2030 strategy, which will soon be launched, acknowledges the link and aims to get girls vaccinated from the age of nine against HPV before they turn 15, according to the health department.
But men also get HPV — and boys, therefore, need to be vaccinated too.
Most men who have HPV don’t feel unwell or develop any symptoms. In many cases, the body clears HPV on its own within one to two years. But when it lingers, it can lead to serious health problems, including cancer.
Globally, about one in three men has at least one genital HPV type. And about one in five men carry one or more types of the virus that can cause cancer. The cancers can affect the penis, anus and back of the throat.
One of the types of HPV which can cause cancer — HPV-16 — is responsible for most HPV-driven genital and oral cancers in both men and women.
A simple HPV vaccination can prevent cancers and diseases caused by certain HPV types entirely, helping to curb such cancers in men which are rising worldwide.
But, despite overwhelming evidence, boys and men are largely excluded from HPV immunisation programmes in many countries, including South Africa.
How HPV affects men
HPV spreads through vaginal, oral and anal sex, as well as skin-to-skin contact during intimacy. Condoms don’t always protect people from getting infected with HPV because the virus can infect areas, such as the scrotum, vulva, perineum, anus and upper thighs, that condoms don’t cover.
Unlike for women in South Africa, men can’t get routine HPV-related cancer screening in the public sector.
Women who are 30 or older can get free cervical cancer screening (pap smear) once every 10 years at a government clinic. Those with HIV, can get a more frequent pap smear every three years, starting at diagnosis, because they have a higher chance of getting HPV — and cervical cancer — because they have weaker immune systems than HIV-negative people.
But for men, it’s a different story.
HPV-related cancers are often detected late in males because no routine screening exists, leaving them vulnerable to cancers that are harder to treat. Some doctors may recommend an anal pap smear, which is normally offered to men who have receptive anal sex, because this type of sex makes it easier for HPV to enter the body by infecting the anal lining.
In the US and other high-income countries, cancers of the throat caused by HPV in men are more common than cervical cancer in women, mainly in unvaccinated males.
The risk is even higher for men living with HIV, as HPV infections tend to last longer and are more likely to recur in people whose immune systems areunder strain.
HPV can also affect men in other ways. Research shows the virus can reduce fertility by damaging sperm, making it harder to conceive. There is also growing evidence linking HPV to prostate cancer, a disease that is rising rapidly: new cases are expected to rise by almost 65% between 2020 and 2040 worldwide.
The problem
But boys and men are mostly excluded from HPV immunisation programmes, often because of the World Health Organisation’s recommendations on vaccinating girls aged 9 to 14 against HPV; it is recommended for males and older women when feasible and affordable so that it doesn’t divert resources from vaccinating the primary target population.
South Africa has a successful government-funded school vaccination programme for girls in both public and private schools and between the ages of nine and 14.
This approach assumes that vaccinating girls will indirectly protect boys by reducing the spread of the virus, a concept known as herd immunity. This acts like a kind of community shield: if enough people are protected, the virus struggles to spread.
But relying on this strategy has serious gaps. Not everyone is vaccinated and viruses mutate, or change slightly over time, creating new versions and thus protection wanes over time.
Leaving boys and men out doesn’t just miss an opportunity to prevent cancer, it raises questions about gender equity and sends the message that protecting men’s health matters less.
Right now, boys in South Africa can get HPV vaccines only through the private healthcare sector, where it’s expensive, ranging between R1 102 to R2 365 a shot, depending on which of the three available vaccines in the country they use and how many doses they require. The vaccine is often not covered by medical aid schemes and out of reach for many families.
Although cost is often given as a reason not to expand vaccination to boys, this short-term thinking ignores the much higher long-term economic and social costs of treating cancer, lost income and preventable deaths.
Studies from other countries, such as China, show that vaccinating boys and men is not only effective but cost-effective. The study found vaccinating 14-year-old boys could avert up to 416 654 cancer cases.
South Africa has committed to giving everyone access to the same healthcare, regardless of how much they can pay, through the National Health Insurance Act. Protecting everyone from preventable diseases like HPV should be part of that promise.
Time to act
Many wealthy countries have adopted a gender-neutral HPV vaccination approach to curb the virus’s spread and reduce infections in men. This has led to the United Nations General Assembly supporting the inclusion of boys in HPV vaccination programmes globally.
Some African countries, including Cameroon and Mauritius, have started moving in this direction and Eswatini plans to follow in late 2026. Vaccinating both girls and boys offers two critical benefits.
First, it protects both males and females directly from HPV-related diseases. Second, it reduces the virus’s spread across the entire population.
Research shows that vaccinating both boys and girls can achieve the same level of protection in eight years that would otherwise take 20 years if only girls are vaccinated.
HPV is not just a women’s issue. It is a men’s health issue, too — one that is often silent but potentially life-threatening.
South Africa has made important progress but it is time to go further. Expanding HPV vaccination to include males, increasing public awareness and updating national and global policies are critical next steps.
Ignoring men in HPV prevention is no longer an option.
Damian Naidoo is a public health researcher, formerly with the KwaZulu-Natal department of health; Kaymarlin Govender is public health scientist and the research director at HEARD, at the University of KwaZulu-Natal; and Joanne E. Mantell is a research scientist in the department of psychiatry at Columbia University Irving Medical Centre.
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
From throat and anal cancers to reduced fertility, the human papillomavirus poses serious risks to men that go largely undetected and unvaccinated. South Africa vaccinates girls but boys are left out
