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Van Bilsen WPH, Kovaleva A, Bleeker MCG, King AJ, Bruisten SM, Brokking W, De Vries HJC, Meijer CJLM, Schim Van Der Loeff MF. HPV infections and flat penile lesions of the penis in men who have sex with men. PAPILLOMAVIRUS RESEARCH 2019; 8:100173. [PMID: 31226447 PMCID: PMC6595232 DOI: 10.1016/j.pvr.2019.100173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/17/2019] [Accepted: 06/14/2019] [Indexed: 11/30/2022]
Abstract
Background Flat penile lesions (FPL) in heterosexual men are thought to play a role in the transmission of HPV. We investigated the association between FPL and penile HPV, and explored determinants of FPL in men who have sex with men (MSM). Methods In 2015–2016, MSM were recruited based on HIV and penile HPV status in a previous cohort. MSM self-completed a questionnaire. Peniscopy was performed after application of acetic acid to visualize FPL. Penile physician-collected samples were tested for HPV-DNA using the highly sensitive SPF10-PCR DEIA/LiPA25 system. HPV viral load (VL) was determined using a quantitative type-specific (q)PCR targeting the L1-region. Presence of HPV and HIV, HPV VL and circumcision status were compared between MSM with and without FPL. Results We included 116 MSM, of whom 59/116 (51%) MSM were HIV-positive and 54/116 (47%) had FPL. A penile HPV infection was present in 31/54 (57%) MSM with FPL and 34/62 (55%) MSM without FPL (p = 0.8). There was no difference between MSM with and without FPL regarding presence of penile HPV infection, HPV VL, HIV status or circumcision status (p > 0.05 for all). Conclusion Among MSM in Amsterdam, we found no association between FPL and penile HPV, HPV VL, HIV status or circumcision status.
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Affiliation(s)
- Ward P H Van Bilsen
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
| | - Alexandra Kovaleva
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Maaike C G Bleeker
- Department of Pathology, Amsterdam UMC, Vrije Universiteit-University Medical Center, Amsterdam, the Netherlands
| | - Audrey J King
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sylvia M Bruisten
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Wilma Brokking
- Department of Internal Medicine, DC Klinieken, Amsterdam, the Netherlands
| | - Henry J C De Vries
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Department of Dermatology, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Chris J L M Meijer
- Department of Pathology, Amsterdam UMC, Vrije Universiteit-University Medical Center, Amsterdam, the Netherlands
| | - Maarten F Schim Van Der Loeff
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands; Amsterdam Infection & Immunity Institute (AIII), Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
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2
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Hebnes JB, Olesen TB, Duun-Henriksen AK, Munk C, Norrild B, Kjaer SK. Prevalence of genital human papillomavirus among men in Europe: systematic review and meta-analysis. J Sex Med 2014; 11:2630-44. [PMID: 25088239 DOI: 10.1111/jsm.12652] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Human papillomavirus (HPV) is the commonest sexually transmitted infection worldwide and causes substantial morbidity in both sexes. Most European countries offer HPV vaccination for girls, but vaccine recommendations for boys are warranted. AIMS The aims of this study were to investigate the prevalence of genital HPV, identify parameters that affect the prevalence, and describe the type-specific prevalence among men in Europe. METHODS A systematic review and meta-analysis of the published literature in PubMed and Embase. MAIN OUTCOME MEASURES Genital HPV prevalence and factors influencing prevalence in general and high-risk male populations in Europe. RESULTS We included 31 articles that gave the prevalence of genital HPV DNA among men in northern, southern and western Europe; no studies from eastern Europe were identified. The pooled HPV prevalence among 1,863 men representing the general population (nine studies) was 12.4%, with large heterogeneity between studies (I(2) = 96.3%, P < 0.0001). The pooled HPV prevalence among 6,428 men in the high-risk population (22 studies) was 30.9%, also with substantial heterogeneity (I(2) = 95.6%, P < 0.0001). In unadjusted meta-regression analysis, the HPV prevalence in the general population was significantly higher in studies published after 2000 (28.5%) than in earlier studies (8.8%) (P = 0.0179). In the meta-regression analysis adjusted by publication year, the heterogeneity in the two population groups could not be explained by geographical region, anatomical sampling site, or HPV detection method. HPV16 was the most prevalent high-risk type in both populations. CONCLUSIONS HPV prevalence differs in male general and high-risk populations, but HPV16 and HPV18 are among the most common HPV types detected in both groups. Our findings contribute knowledge that may be useful as a baseline measure before the introduction of HPV vaccination for boys in Europe, and add to understanding of the epidemiology of HPV infection in men.
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Affiliation(s)
- Julie B Hebnes
- Unit of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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3
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Hartwig S, Syrjänen S, Dominiak-Felden G, Brotons M, Castellsagué X. Estimation of the epidemiological burden of human papillomavirus-related cancers and non-malignant diseases in men in Europe: a review. BMC Cancer 2012; 12:30. [PMID: 22260541 PMCID: PMC3293758 DOI: 10.1186/1471-2407-12-30] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 01/20/2012] [Indexed: 02/07/2023] Open
Abstract
Background The role of human papillomavirus (HPV) in malignant and non-malignant genital diseases in women is well known and the corresponding epidemiological burden has been widely described. However, less is known about the role of HPV in anal, penile and head and neck cancer, and the burden of malignant and non-malignant HPV-related diseases in men. The objective of this review is to estimate the epidemiological burden of HPV-related cancers and non-malignant diseases in men in Europe. Methods The annual number of new HPV-related cancers in men in Europe was estimated using Eurostat population data and applying cancer incidence rates published by the International Agency for Research on Cancer. The number of cancer cases attributable to HPV, and specifically to HPV16/18, was calculated based on the most relevant prevalence estimates. The annual number of new cases of genital warts was calculated from the most robust European studies; and latest HPV6/11 prevalence estimates were then applied. A literature review was also performed to retrieve exhaustive data on HPV infection at all anatomical sites under study, as well as incidence and prevalence of external genital warts, recurrent respiratory papillomatosis and HPV-related cancer trends in men in Europe. Results A total of 72, 694 new cancer cases at HPV-related anatomical sites were estimated to occur each year in men in Europe. 17,403 of these cancer cases could be attributable to HPV, with 15,497 of them specifically attributable to HPV16/18. In addition, between 286,682 and 325,722 new cases of genital warts attributable to HPV6/11were estimated to occur annually in men in Europe. Conclusions The overall estimated epidemiological burden of HPV-related cancers and non-malignant diseases is high in men in Europe. Approximately 30% of all new cancer cases attributable to HPV16/18 that occur yearly in Europe were estimated to occur in men. As in women, the vast majority of HPV-positive cancer in men is related to HPV16/18, while almost all HPV-related non-malignant diseases are due to HPV6/11. A substantial number of these malignant and non-malignant diseases may potentially be prevented by quadrivalent HPV vaccination.
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Affiliation(s)
- Susanne Hartwig
- Department of Epidemiology, Sanofi Pasteur MSD, Lyon, France.
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4
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Ott MA. Examining the development and sexual behavior of adolescent males. J Adolesc Health 2010; 46:S3-11. [PMID: 20307842 PMCID: PMC2858917 DOI: 10.1016/j.jadohealth.2010.01.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 01/19/2010] [Accepted: 01/21/2010] [Indexed: 11/17/2022]
Abstract
A careful examination of young men's sexuality by health professionals in pediatrics, primary care, and reproductive health is foundational to adolescent male sexual health and healthy development. Through a review of existing published data, this article provides background and a developmental framework for sexual health services for adolescent boys. The article first defines and provides an overview of adolescent boys' sexual health, and then discusses developmentally focused research on the following topics: (1) early romantic relationships and the evolution of power and influence within these relationships; (2) developmental "readiness" for sex and curiosity; (3) boys' need for closeness and intimacy; (4) adopting codes of masculinity; (5) boys' communicating about sex; and (6) contextual influences from peers, families, and providers. This article concludes by examining the implications of these data for sexual health promotion efforts for adolescent males, including human papillomavirus vaccination.
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Affiliation(s)
- Mary A Ott
- Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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5
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Palefsky JM. Human papillomavirus-related disease in men: not just a women's issue. J Adolesc Health 2010; 46:S12-9. [PMID: 20307839 PMCID: PMC2871537 DOI: 10.1016/j.jadohealth.2010.01.010] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 01/11/2010] [Accepted: 01/11/2010] [Indexed: 11/30/2022]
Abstract
The most common cause of mortality related to human papillomavirus (HPV) infection is cervical cancer. However, male HPV infection is also an important concern, both for the disease burden in men and for the risk of transmission to women. HPV is associated with a variety of cancers in men, including anal cancer and a subset of penile and oral cancers. The incidence of anal and oral cancers related to HPV is increasing in the general population and is growing even faster among individuals who are immunocompromised because of human immunodeficiency virus (HIV) infection. Penile HPV infection is very common among heterosexual men and remains high throughout a wide range of ages. Likewise, anal HPV infection and anal intraepithelial neoplasia are very common throughout a wide range of ages in both HIV-negative and HIV-positive men who have sex with men. Other HPV-related diseases of clinical importance in men include condylomata acuminata (genital warts) and recurrent respiratory papillomatosis. The quadrivalent HPV vaccine has been shown to be highly efficacious in the prevention of genital warts in women and precancerous lesions of the cervix, vulva, and vagina. In addition, recent interim data have shown that the quadrivalent HPV vaccine is highly effective in reducing external genital lesions in young men. Although the protective efficacy of HPV vaccination in men has not yet been fully established-pending the outcome of public policy discussions and cost-efficacy studies-there may be a strong rationale for vaccinating boys, similar to girls, at an early age when they have had limited or no prior sexual activity.
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Affiliation(s)
- Joel M Palefsky
- Department of Medicine, University of California, San Francisco, California 94143, USA.
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6
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Miralles-Guri C, Bruni L, Cubilla AL, Castellsagué X, Bosch FX, de Sanjosé S. Human papillomavirus prevalence and type distribution in penile carcinoma. J Clin Pathol 2009; 62:870-8. [PMID: 19706632 DOI: 10.1136/jcp.2008.063149] [Citation(s) in RCA: 244] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Penile carcinoma is an uncommon and potentially mutilating disease with a heterogeneous aetiology. Several risk factors have been established for its development. Human papillomavirus (HPV) infection seems to play an important role in the development of a subset of these carcinomas and its presence is thought to be related to the histological type. HPV prevalence in penile tumours is reported to be associated to a variety of morphological changes. Its determination will provide a better estimate for HPV related cancer burden and its preventable fraction. METHODS A systematic and comprehensive literature review of the major penile cancer studies published from 1986 until June 2008 evaluating the HPV prevalence among the different histological types was carried out. RESULTS 31 studies including 1466 penile carcinomas were reviewed. Global HPV prevalence was 46.9%. Relative contribution was: HPV-16 (60.23%), HPV-18 (13.35%), HPV-6/11 (8.13%), HPV-31 (1.16%), HPV-45 (1.16%), HPV-33 (0.97%), HPV-52 (0.58%), other types (2.47%). Assessment of multiple infections contribution is limited due to study design. Basaloid and warty squamous cell carcinomas were the most frequent HPV-related histological types, but keratinising and non-keratinising subtypes also showed prevalence rates of around 50%. CONCLUSIONS About half of the penile tumours were associated with HPV 16-18 with little presence of other genotypes. Research on the mechanisms behind penile carcinogenesis is warranted. Available HPV vaccines are likely to be effective in penile tumours.
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Affiliation(s)
- C Miralles-Guri
- Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program, Institut Català d' Oncologia, IDIBELL, L' Hospitalet de Ll, Barcelona, Spain
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7
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Penile cancer: epidemiology, pathogenesis and prevention. World J Urol 2008; 27:141-50. [DOI: 10.1007/s00345-008-0302-z] [Citation(s) in RCA: 237] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 06/09/2008] [Indexed: 11/25/2022] Open
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8
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Partridge JM, Koutsky LA. Genital human papillomavirus infection in men. THE LANCET. INFECTIOUS DISEASES 2006; 6:21-31. [PMID: 16377531 DOI: 10.1016/s1473-3099(05)70323-6] [Citation(s) in RCA: 188] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Genital human papillomavirus (HPV) infection, globally one of the most common sexually transmitted infections, is associated with cancers, genital warts, and other epithelial lesions. Although a consistent and coherent picture of the epidemiology and pathogenesis of genital HPV infections in women has developed over the past two decades, less is known about these infections in men. Available data suggest that, as with women, most genital HPV infections in men are symptomless and unapparent, and that HPV16 is probably the most frequently detected type. In populations of similar age, the prevalence of specific HPV types is usually lower in men than in women. Whether this observation relates to lower incidence or shorter duration of infection in men than in women has not yet been determined. Seroprevalence of specific anti-HPV antibodies also seems to be lower in men than in women of similar age, a difference that might be due to lower viral load, lower incidence or duration of infection or lower antibody responses, or both, in men compared with women. Differences in sexual behaviour may also be important predictors of genital HPV infection. With the anticipated availability of prophylactic HPV vaccines in the near future, it becomes increasingly important to understand the incidence and duration of HPV infections in men to develop cost-effective approaches to prevention through a combination of immunisation and promotion of risk-reduction strategies.
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Affiliation(s)
- Jeffrey M Partridge
- Department of Epidemiology, University of Washington HPV Research Group, University of Washington, Seattle, WA 98103, USA
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9
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Bleeker MCG, Snijders PFJ, Voorhorst FJ, Meijer CJLM. Flat penile lesions: The infectious “invisible” link in the transmission of human papillomavirus. Int J Cancer 2006; 119:2505-12. [PMID: 16988942 DOI: 10.1002/ijc.22209] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Although it has been widely accepted that high-risk human papillomavirus (hrHPV) is sexually transmitted, limited insight is available about the clinical manifestations of hrHPV infection in men and their contribution in the viral spread. Here, we reviewed the literature on the relationship between hrHPV and the presence of penile lesions. Flat penile lesions have similar predilection sites as HPV, often contain hrHPV as identified by DNA in situ hybridization in biopsy specimens, show a high association with hrHPV as identified by PCR in penile scrapes of lesional sites and are associated with high viral copy numbers. Absence of flat lesions is generally associated with very low HPV copy numbers or absence of HPV. Therefore, we argue that these lesions form the reservoir of hrHPV in men and contribute to the viral spread. Their bare visibility with the naked eye and their high degree of spontaneous healing explain why flat penile lesions have slipped the attention of the clinician. Combining an HPV DNA test with a visual inspection after acetic acid application offers a more reliable interpretation of a positive HPV test in men, as it helps to distinguish positivity that is very likely to reflect a productive HPV infection from potentially HPV infections with very low copy numbers or HPV contamination by the sex partner. Future trials of HPV vaccines in men should take into account not only the presence of penile HPV but also the presence of flat penile lesions as an outcome measure for the efficacy of a vaccine.
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Affiliation(s)
- Maaike C G Bleeker
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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10
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Fenton KA, Lowndes CM. Recent trends in the epidemiology of sexually transmitted infections in the European Union. Sex Transm Infect 2004; 80:255-63. [PMID: 15295121 PMCID: PMC1744866 DOI: 10.1136/sti.2004.009415] [Citation(s) in RCA: 194] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sexually transmitted infections (STIs) are a major public health problem in Europe. We review recent trends in the epidemiology of the major acute STIs in the European Union and Norway, their key determinants, and opportunities for enhancing STI prevention interventions in the region.
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Affiliation(s)
- K A Fenton
- HIV/STI Department, Health Protection Agency, Communicable Disease Surveillance Centre, 61 Colindale Avenue, London NW9 5EQ, UK.
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11
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12
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Aynaud O, Ionesco M, Barrasso R. Cytologic detection of human papillomavirus DNA in normal male urethral samples. Urology 2003; 61:1098-101. [PMID: 12809869 DOI: 10.1016/s0090-4295(03)00110-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To quantify the existence of human papillomavirus (HPV) infection without detectable lesions in the male urethra, and to verify the sensitivity and specificity of ureteral cytology. We compared the results of clinical and colposcopic examinations, ureteral cytology, and HPV DNA testing by polymerase chain reaction amplification in the male partners of women with genital HPV disease. METHODS A total of 110 cytobrush samples of urethral cells from male sexual partners of women with genital HPV-associated lesions were analyzed by cytology and for virologic detection of HPV 6/11, 42, 16/18 by polymerase chain reaction followed by Southern blot hybridization. The results were correlated with the presence or absence of genital HPV-associated lesions. RESULTS HPV DNA was detected in 1 sample (3%) from men without visible lesions, in 5 samples (15%) from men with penile lesions but without urethral lesions, and in 16 men with urethral lesions (78%). Cytology showed cellular changes suggesting HPV infection in 81% of men with urethral lesions, but also in 15% of men without lesions. CONCLUSIONS Our results show that HPV-DNA positivity in the absence of clinically or colposcopically detected lesions is a rare event. Although sensitive enough, cytology is not specific, and its use as a screening tool may lead to a high number of false-positive results.
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Affiliation(s)
- Olivier Aynaud
- Institut de Recherches sur les Pathologies des Organes Génitaux, Paris, France
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13
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Kumar B, Gupta S. The acetowhite test in genital human papillomavirus infection in men: what does it add? J Eur Acad Dermatol Venereol 2001; 15:27-9. [PMID: 11451317 DOI: 10.1046/j.1468-3083.2001.00196.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many genital human papillomavirus (HPV) infections are clinically invisible epithelial lesions. They remain so for a considerable time before some develop into clinically apparent lesions. The inapparent and asymptomatic nature of these lesions poses a problem in the detection and management of genital HPV infection. Without reliable, and readily available diagnostic methods, no definite therapeutic approach can be recommended or followed. The acetowhite test has been recommended to help determine the extent of the affected area. OBJECTIVE To evaluate the acetowhite test in detecting inapparent subclinical HPV involvement in male patients with clinically apparent warts. METHODS Two hundred and two uncircumcised patients with genital warts were included. Patients with concomitant inflammatory lesions were excluded. The warts and adjacent normal skin/mucosa of normal appearance were wrapped in gauze soaked in 5% acetic acid for about 3-5 min. The area was subsequently examined with a hand lens (x 8). RESULTS All of the 116 hyperplastic warts became acetowhite, as well as a narrow rim of surrounding skin. Few flat warts in dry areas only became dull white and none pure white. No whiteness was observed in the surrounding area. Only 15 of 26 flat warts in moist areas became acetowhite. One (eroded lesion) of 13 verruca vulgaris type lesions and none of the pigmented papules gave positive results to the acetowhite test. CONCLUSIONS The sensitivity of the acetowhite test for hyperplastic warts is very high, but for other types of warts is low. Detection of subclinical HPV-infected areas is difficult; the acetowhite test did not assist in the identification of additional areas of infection in our patients.
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Affiliation(s)
- B Kumar
- Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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14
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Abstract
The occurrence of human papillomavirus (HPV) among males was analysed with the polymerase chain reaction (PCR) method. Penile brush samples were taken once from 147 males attending for a control or for HPV non-related reasons, and consecutive samples were collected from 88 males re-attending the clinic. Of the males attending once, 13% (19/147) were HPV DNA positive and among the re-attenders 14% (12/88) were initially positive as compared with 33% (29/88) who were positive at least at one visit. Totally, 22 different HPV types were detected of which HPV 16 was most common, found in 6.4% (15/235), followed by HPV 42 found in 3.8% (9/235). Among 14 HPV-positive males with at least one follow-up, 7 had persistent infections with at least one HPV type, and transient HPV types were observed in 9; but in 5 of them new types appeared at follow-up. Among sexually-active males subclinical/latent HPV infection is common and repeated sampling increases its prevalence.
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Affiliation(s)
- A Wikström
- Department of Dermatovenereology, Karolinska Hospital, Stockholm, Sweden
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15
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GLOBAL EPIDEMIOLOGY OF SEXUALLY TRANSMITTED DISEASES. Sex Transm Dis 2000. [DOI: 10.1016/b978-012663330-6/50002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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16
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Pakendorf UW, Bornman MS, Du Plessis DJ. Prevalence of human papilloma virus in men attending the infertility clinic. Andrologia 1998; 30:11-4. [PMID: 9567165 DOI: 10.1111/j.1439-0272.1998.tb01376.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Subclinical human papilloma virus is a potential carcinogen in the male and female genital tract. The sexually active male infertility population represents a high risk group for harbouring this disease. To determine the prevalence of subclinical human papillomavirus in this group, penoscopy was done on 96 male patients visiting the infertility clinic. The feasibility of routine penoscopy as part of the infertility work-up was also investigated. Of the 96 patients 20 had aceto-white lesions on their penises with penoscopy. Thirteen patients (13.5%), 12 proven by biopsy of the aceto-white lesions, and one proven by fluid in situ hybridization on superficial epithelial cells of the distal urethra, were positive for human papillomavirus. Two of the 12 biopsy-positive cases were also proven positive by fluid in situ hybridization. It was concluded that human papillomavirus had a high prevalence amongst asymptomatic male patients attending the infertility clinic and that penoscopy should be included as routine investigation in the work-up of the male infertility patient.
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Affiliation(s)
- U W Pakendorf
- Department of Urology, University of Pretoria, South Africa
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17
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18
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Affiliation(s)
- R Barrasso
- Department of Obstetrics and Gynecology, Bichat University Hospital, Paris, France
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19
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Abstract
Penile HPV infection and disease are very common in sexually active men, and may be manifest in many forms. Treatment of clinically detectable lesions is advisable not only to relieve symptoms but also to prevent the spread of HPV infection to new sexual partners. Treatment of subclinical disease is more controversial but also may be advisable in some cases given the evidence that these lesions may also harbor infectious virus. In addition, subclinical disease may demonstrate intraepithelial neoplasia, which if left untreated may progress to invasive cancer in a small number of cases. Anal HPV infection and ASIL are very common in high-risk homosexual and bisexual men, particularly among those who are HIV positive. Parallels with cervical HPV infection and disease suggest that anal HSIL may be precancerous, and indeed anal cancer may be as common or more common in this high-risk group as cervical cancer is in women. Further studies are needed to elucidate the natural history of ASIL, the role of immunosuppression in progression to invasive cancer, optimal diagnostic methods, and optimal treatment regimens. Like cervical cancer, anal cancer may be a preventable disease, and implementation of a well-targeted screening program similar to that in place for cervical disease should be considered in the future when appropriate supporting data become available.
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Affiliation(s)
- J M Palefsky
- Department of Laboratory Medicine, University of California, San Francisco, USA
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20
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Wiener JS, Walther PJ. The Association of Oncogenic Human Papillomaviruses with Urologic Malignancy. Surg Oncol Clin N Am 1995. [DOI: 10.1016/s1055-3207(18)30452-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Van Doornum GJ, Prins M, Juffermans LH, Hooykaas C, van den Hoek JA, Coutinho RA, Quint WG. Regional distribution and incidence of human papillomavirus infections among heterosexual men and women with multiple sexual partners: a prospective study. Genitourin Med 1994; 70:240-6. [PMID: 7959707 PMCID: PMC1195247 DOI: 10.1136/sti.70.4.240] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess prevalence, incidence and potential risk factors of human papillomavirus (HPV) infection among heterosexual men and women with multiple partners and to identify niches of HPV-infection. DESIGN A prospective study of heterosexual men and women with multiple partners attending an STD clinic as participants in a study on HIV from May 1988 until January 1991. Routine STD examination and physical examination using colposcopy were performed, interviews with standardised questionnaires were administered. Specimens for HPV DNA detection by polymerase chain reaction were collected from multiple sites of the genital, anorectal and oral regions. In women cervical cytology was performed. SETTING The STD Clinic of the Municipal Health Service of Amsterdam. PARTICIPANTS 162 women and 85 men entered the study, 110 women and 48 men were followed up. RESULTS At entry of the study 37 (23%) women and 24 (28%) men were found positive for HPV DNA at any site. Only in one woman was oral presence of HPV DNA found during follow-up. Abnormal cervical cytology was observed in four women. In multivariate analysis, diagnosis of condylomata [odds ratio (OR) 5.61, 95% confidence interval (CI) 1.86 to 16.90)], reporting genital dermatological abnormalities (OR 3.72, 95% CI 1.38 to 9.99) and age (OR per year 0.93, 95% CI 0.88 to 0.99) predicted independently the presence of HPV DNA in women at entry of the study. In women 59 of the 99 (60%) HPV infections were observed in the genital region and 40% in the anorectal region: in men these figures were 65% and 35%, respectively. The incidence of HPV infection was 47.1 and 50.5 per 100 person-years for women and men respectively. At least 20/99 (20%) infections in women were intermediate or long persistent and only 3/48 (6%) HPV infections in men (P = 0.03). No risk factor for persistency could be determined, either in women or in men. CONCLUSIONS HPV infection was found to be a multicentric genital and/or anorectal event both in women and men. The oral presence of HPV DNA was detected only once in one of the participants. In women persistent HPV infection was more common than in men. Independent predictors for presence of HPV DNA in women were diagnosis of condylomata acuminata, reporting genital dermatologic abnormalities and age. Incidence of HPV infection in women turned out to be 47.1 infections per 100 person-years and for men 50.5 per 100 person-years.
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Affiliation(s)
- G J Van Doornum
- Municipal Health Service of Amsterdam, Department of Public Health, The Netherlands
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22
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Avila HA, Pereira JB, Thiemann O, De Paiva E, DeGrave W, Morel CM, Simpson L. Detection of Trypanosoma cruzi in blood specimens of chronic chagasic patients by polymerase chain reaction amplification of kinetoplast minicircle DNA: comparison with serology and xenodiagnosis. J Clin Microbiol 1993; 31:2421-6. [PMID: 8408566 PMCID: PMC265772 DOI: 10.1128/jcm.31.9.2421-2426.1993] [Citation(s) in RCA: 115] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A panel of 114 blood samples from chronic chagasic patients and nonchagasic patients was screened for Trypanosoma cruzi by xenodiagnostic, serologic, and polymerase chain reaction (PCR) amplification tests. Blood samples were preserved in a guanidine-EDTA buffer, and total blood DNA was isolated after chemical nuclease cleavage with 1,10-phenanthroline-copper ion and used as a template for PCR amplification of the conserved and variable regions of T. cruzi minicircle molecules. The PCR products were screened by Southern blot hybridization with a digoxigenin-labeled oligonucleotide probe specific for the conserved region of the minicircle. The method showed a sensitivity of 100% compared with the serologic test. In addition, all of the serology-positive, xenodiagnosis-negative samples were positive by PCR. This demonstrates that PCR amplification of T. cruzi kinetoplast minicircle DNA could replace xenodiagnosis for evaluation of parasitemia in chronic chagasic patients and could serve as a complement for serologic testing in the screening of blood bank donors.
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Affiliation(s)
- H A Avila
- Department of Biology, University of California, Los Angeles 90024
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23
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Geddy PM, Wells M, Lacey CJ. Lack of detection of human papillomavirus DNA in male urine samples. Genitourin Med 1993; 69:276-9. [PMID: 7721288 PMCID: PMC1195087 DOI: 10.1136/sti.69.4.276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate polymerase chain reaction (PCR) methodology for the detection of urethral human papillomavirus (HPV) infection by examining urinary sediment from males. SETTING Department of Genitourinary Medicine, Leeds General Infirmary. SUBJECTS 73 male patients attending for treatment of sexually transmitted diseases, including 14 patients with genital warts which did not involve the urethral meatus. METHODS Urinary sediment was tested for HPV DNA and human beta globin gene DNA by PCR methodology. A consensus primer set capable of detecting a wide range of HPV types was used. PCR product was analysed by gel electrophoresis and ethidium bromide staining. RESULTS HPV DNA was not detected in any of the specimens. Human beta globin gene DNA was identified in 40 of the 73 specimens (55%). CONCLUSIONS Screening urinary sediment for HPV DNA by PCR methodology with analysis of PCR product by gel electrophoresis and ethidium bromide staining is probably unhelpful for studying the prevalence of urethral HPV infection in men.
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Affiliation(s)
- P M Geddy
- Department of Clinical Medicine, University of Leeds, UK
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24
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Löwhagen GB, Bolmstedt A, Ryd W, Voog E. The prevalence of "high-risk" HPV types in penile condyloma-like lesions: correlation between HPV type and morphology. Genitourin Med 1993; 69:87-90. [PMID: 8389724 PMCID: PMC1195035 DOI: 10.1136/sti.69.2.87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To evaluate the prevalence of "high-risk" human papilloma virus (HPV) types in penile condyloma-like lesions and to correlate HPV types with clinical and histological features. DESIGN The study included 94 male patients with signs of penile HPV infection. From acuminate, papular and macular lesions, specimens were collected for HPV DNA hybridisation, using the dot blot and Southern blot techniques. Biopsy specimens from 51 cases were examined by light microscopy for signs of koilocytosis and dysplasia. SETTING The STD outpatient clinic of the Department of Dermatovenereology of Sahlgrenska Hospital, Göteborg, Sweden. RESULTS In 79 (90%) of 88 patients HPV DNA was detected by dot blot. Of 51 cases examined by histology 88% disclosed an evident koilocytosis. "High-risk" HPV types (16, 18, 31, 33, 35) were demonstrated in 8% of acuminate, 24% of papular and 56% of macular lesions. In 29% of 51 lesions examined histologically moderate to severe dysplasia was observed. There was a significant correlation between "high-risk" HPV types and dysplasia. CONCLUSION "High-risk" HPV types are prevalent in papular and especially macular penile condyloma-like lesions. The histological finding of koilocytosis concomitant with dysplasia strongly indicates infection with a "high-risk" HPV type. Although the risk of penile cancer is low, it is from an epidemiological point of view important to diagnose these lesions. Until simple tests for HPV typing are available, biopsy for light microscopy (histology) should be obtained liberally from papular and macular condyloma-like lesions. In atypical cases of balanoposthitis HPV aetiology should also be considered.
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Affiliation(s)
- G B Löwhagen
- Department of Dermatovenereology, University of Göteborg, Sweden
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25
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Costa S, Syrjänen S, Vendra C, Chang F, Guida G, Tervahauta A, Hippeläinen M, Syrjänen K. Detection of human papillomavirus infections in the male sexual partners of women attending an STD clinic in Bologna. Int J STD AIDS 1992; 3:338-46. [PMID: 1327174 DOI: 10.1177/095646249200300507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A series of 65 male sexual partners of 65 women attending an STD clinic in Bologna, Italy for examination and treatment of genital human papillomavirus (HPV)-infections during 1990-1991, were examined using peniscopy and surgical biopsy, the latter being analysed by light microscopy, in situ hybridization (ISH) and polymerase chain reaction (PCR) for HPV DNA. A detailed medical and sexual history was recorded from all men. Of the 65 men, 17 (26.2%) gave a history of a previous STD. The male partners with previous genital condylomata (14, 21.5% of men) were significantly associated with the detection of HPV DNA in the current lesions; 21.4% (3 of 14) and 10.2% (5 of 51) in those with and without previously treated condyloma, respectively. On colposcopy, 63 (96.9%) men presented with an abnormal pattern, the vast majority (49 of 65, 75.4%) showing an acetowhite lesion, and only 12 (18.5%) lesions being classified as condyloma acuminatum. HPV DNA was found, however, in only 4 of 12 (33.3%) condylomas by ISH and PCR, and in 4 of 49 (8.2%) and 6 of 49 (12.2%) acetowhite lesions by ISH and PCR, respectively. In a total of 41 (63%) patients, the biopsy was classified as non-HPV on light microscopy. HPV DNA detection rate was significantly higher in all morphologically HPV-suggestive lesions, compared with the non-HPV where ISH was invariably negative. PCR, however, disclosed HPV DNA in 4 of 41 (9.8%) cases. PIN (I or II) was present in 6 of 65 (9.2%) men.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Costa
- II Department of Obstetrics and Gynecology, University of Bologna, Italy
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26
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Young LS, Tierney RJ, Ellis JR, Winter H, Woodman CB. PCR for the detection of genital human papillomavirus infection: a mixed blessing. Ann Med 1992; 24:215-9. [PMID: 1320898 DOI: 10.3109/07853899209147825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- L S Young
- Department of Cancer Studies, University of Birmingham Medical School, U.K
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27
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van Doornum GJ, Hooykaas C, Juffermans LH, van der Lans SM, van der Linden MM, Coutinho RA, Quint WG. Prevalence of human papillomavirus infections among heterosexual men and women with multiple sexual partners. J Med Virol 1992; 37:13-21. [PMID: 1320094 DOI: 10.1002/jmv.1890370104] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A prospective study of 65 men and 111 women with multiple heterosexual partners was designed to assess the prevalence and potential risk factors of genital human papillomavirus (HPV) infections. In addition, the HPV reservoir in genital, rectal, and oral mucosa was examined. The specimens for the detection of HPV DNA were taken from different sites such as the urethra and coronal sulcus (men), cervix and labia minora (women), anus, rectum, tongue, and buccal mucosa (both men and women). Women underwent speculum examination and colposcopic evaluation of the anogenital region, and a smear for routine cytological classification was also taken. In men, the anogenital region was examined clinically and colposcopically. The polymerase chain reaction (PCR) was used for the detection of HPV types 6/11, 16, 18, and 33. A high prevalence of HPV infection at one or more sites was detected, in 32% of the male and in 23% of the female participants. Seventeen percent of the male distal urethral specimens were positive for HPV DNA. From the female cervical specimens 14% were found positive. Ten proctal specimens (five men and five women) were positive for HPV DNA without any discernible lesion. The persons from whom these samples were taken denied anal insertive intercourse. No oral manifestation of HPV infection was detected. In both men and women a difference between HPV DNA-positive and -negative persons was not found in relation to known risk factors associated HPV infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- G J van Doornum
- Municipal Health Service of Amsterdam, Department of Public Health, The Netherlands
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28
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Syrjänen S, Syrjänen K. Human Papillomavirus Infections of the Genital Tract: Clinical Significance and Diagnosis by Polymerase Chain Reaction. ACTA ACUST UNITED AC 1992. [DOI: 10.1007/978-3-642-84766-0_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
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