Detection of high-risk human papillomavirus in the cervix and semen of sex partners

Seminal human papillomavirus infection and reproduction: a systematic review and meta-analysis

BACKGROUND

The impact of human papillomavirus (HPV) on male fertility and associated reproductive outcomes has not been clarified.

OBJECTIVES

To elucidate the prevalence of seminal HPV infection and assess the associated effects on seminal parameters, male infertility, and reproductive outcomes.

MATERIALS AND METHODS

A systematic review and meta-analysis was performed in accordance with PRISMA guidelines. A search was performed using PubMed, MEDLINE, SCOPUS, and Cochrane databases. Studies published until November 2019 were included. HPV prevalence, risk of infertility, seminal parameters, and reproductive outcomes were evaluated among the general population and infertile men.

RESULTS

Fifty studies met the inclusion criteria. The prevalence of seminal HPV infection is significantly higher in infertile compared to the general population (20.9% versus 8.2%). A significant association between seminal HPV infection and male infertility (OR 3.30, 95% CI 1.87-5.84), even when adjusting for female infertility (OR 3.02, 95% CI = 2.11-4.33) was founded. In addition, HPV infection is related to a significant decrease in progressive motility (DM -10.35, IC -13.75, -6.96), a low sperm morphology score (DM -2.46, 95% CI -3.83, -1.08), and a significant increase in the sperm DNA fragmentation index (7.24, 95% CI 4.44.10.03) compared with HPV-negative patients. It was also observed an increased risk of miscarriage (OR 5.13, 95% CI 2.40,10.94), and a reduced chance of ongoing pregnancy (OR 0.33, IC 95% 0.13,0,82) in patients undergoing ART with seminal HPV infection.

DISCUSSION

Infertile men have a higher prevalence of seminal HPV infection compared to the general population, regardless of the HPV genotype detected.

CONCLUSIONS

HPV in semen may have an impact in sperm quality and reproductive outcomes. Additional well-designed studies are warranted to improve the quality of evidence.

Human Papillomavirus Infection and Transmission Among Couples Through Heterosexual Activity (HITCH) Cohort Study: Protocol Describing Design, Methods, and Research Goals

BACKGROUND

Human papillomavirus (HPV) epidemiological research has generally been individual based, typically focusing on women, with couple-based research mostly consisting of cross-sectional assessment of prevalent HPV infection in both partners.

OBJECTIVE

The HPV Infection and Transmission among Couples through Heterosexual activity (HITCH) study was set up to investigate the transmissibility of HPV among young, recently formed couples in Montreal, Canada. This paper provides an overview of the HITCH cohort study design and procedures as well as a narrative summary of the most important findings.

METHODS

HITCH is a longitudinal investigation of HPV transmission in recently formed heterosexual partnerships initiated within 6-month pre-enrollment, a time at which considerable transmission is believed to occur. A total of 549 newly formed dyads were recruited (2005-2011) from postsecondary institutions, including 502 young women and their male partners. An additional 46 males were enrolled at follow-up, as some women enrolled a subsequent partner at follow-up. Women aged 18-24 years were followed for 24 months for acquisition of HPV types not present at enrollment, whereas men returned for a single follow-up visit at month 4, for a sum total of 3361 clinic visits. The last follow-up visit occurred in January 2014. Extensive sociodemographic, sexual behavioral, and medical history data were collected every 2-4 months using computer-assisted, self-administered questionnaires. Furthermore, participants provided genital, blood, oral, and hand specimens for HPV assessment.

RESULTS

Although in its early analysis stage, HITCH has produced important publications. Findings from HITCH have increased the available knowledge about the natural history of HPV transmission and its determinants, provided further evidence regarding oral-oral and oral-genital routes of HPV transmission, and supplied empirically valid epidemiological parameters of HPV transmission to assist mathematical modelers in health economic assessments. In addition, HITCH data were made available to several multistudy collaborations evaluating new HPV detection assays and evidence for-or-against HPV type replacement following the introduction of HPV vaccination.

CONCLUSIONS

HITCH will continue to offer a unique resource for research on HPV transmission.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR1-10.2196/11284.

Human papillomavirus in semen and the risk for male infertility: a systematic review and meta-analysis

Background

Human papillomavirus (HPV) is one of the most prevalent sexually transmitted viruses. Despite the increasing evidence of HPV prevalence in semen, the worldwide distribution of HPV types in semen and risk for male infertility remain inconclusive.

Methods

Four electronic databases were searched for English language studies conducted between January 1990 and December 2016 that reported HPV DNA prevalence in semen. Based on the PRISMA guidelines, HPV prevalence was estimated among general population and fertility clinic attendees, respectively, and heterogeneity testing was performed using Cochran’s Q and I² statistics. The association between HPV positivity and male infertility was evaluated by a meta-analysis of case-control studies.

Results

A total of 31 eligible studies comprising 5194 males were included. The overall prevalence of HPV DNA in semen was 11.4% (95% CI = 7.8-15.0%) in general population (n = 2122) and 20.4% (95% CI = 16.2-24.6%) in fertility clinic attendees (n = 3072). High-risk type prevalence was 10.0% (95% CI = 5.9-14.0%) and 15.5% (95% CI = 11.4-19.7%), respectively. HPV16 was the most common type, with a prevalence of 4.8% (95% CI = 1.7-7.8%) in general population and 6.0% (95% CI = 3.8-8.2%) in fertility clinic attendees. A significantly increased risk of infertility was found for males with HPV positivity in semen (OR = 2.93, 95% CI = 2.03-4.24).

Conclusions

Seminal HPV infection is common worldwide, which may contribute to the risk of male infertility.

Electronic supplementary material

The online version of this article (10.1186/s12879-017-2812-z) contains supplementary material, which is available to authorized users.

Concordance of HPV-DNA in cervical dysplasia or genital warts in women and their monogamous long-term male partners

Transmission of human papillomavirus (HPV) is a premise for development of cervical dysplasia and genital warts (GWs). This cross-sectional study assesses concordance of HPV types present in GWs or cervical dysplasia in women and genital infection of their monogamous male partners in conjunction with seroprevalence of HPV-6, -11, -16, and -18 antibodies. Blood was taken from both women and men, as well a smear of the urogenital area of men. HPV DNA detection in women was done in fixed paraffin embedded tissues under histological control. Of 143 couples who agreed to participate in the study, 68 met inclusion criteria. Type-specific concordance was observed in 32.5% (13/40) of couples in which women had genital warts and in 32.1% (9/28) of couples in which women had cervical dysplasia. In multivariate analysis only smoking in women was associated with concordance (P < 0.05). Prevalence of HPV-specific antibodies was high in male partners, but was not associated with presence of the same HPV type on their genitals. The same type-specific HPV antibodies were detected in 81.8% of men in couples with HPV-6 concordant genital warts, but only in 14.3% of men in couples with HPV-16 concordant cervical dysplasia (P < 0.01). These results suggest that type-specific HPV concordance in genital warts and cervical dysplasia lesions of women and genital infection of their male partners is common and similar. Higher seroconversion in couples with HPV-6 concordant genital warts compared with couples with HPV-16 concordant cervical dysplasia may be explained by viral load exposure.

Characteristics of carcinogenic human papillomavirus infection in Suzhou: Epidemiology, vaccine evaluation, and associated diseases

Human papillomavirus infection is a major health problem and caused substantial benign and malignancy diseases among female and male worldwide. We aim to investigate the epidemiology of high-risk human papillomavirus (HR-HPV) and related diseases in Suzhou population. As well as evaluating the potential benefit of a nine-valent HPV vaccine (regardless of HPV-6 and -11) in Suzhou. A total of 40,108 people aged 13-89 years were retrospectively examined by database retrieval from 2010 to 2015. Thirteen genotypes (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 66) of HR-HPV were detected using Tellgenplex™ xMAP™ HPV DNA Test assay. The overall prevalence of HR-HPV was 21.1%, the female and male account for 96.4% and 3.6%, respectively. The infection rate among male (25.6%, 367/1,432) was significantly higher than that among female (20.9%, 8,100/38,676), X²  = 17.341 (P < 0.001), with OR = 1.293, 95% CI (1.146-1.460). The five most frequent HR-HPV genotypes were HPV-16 (5.12%), -52 (5.07%), -58 (3.02%), -39 (2.00%), and -18 (1.74%). HR-HPV infection rate was peak in person aged <20 years, and second higher in person aged 51-60 years. Infection modes as HPV-16, -18, -31, -33, -45, -52, -58 alone or mixed accounted for 63.2%. The top three prevalent diseases in HR-HPV infected women were cervicitis, vaginitis, and cervical lesions, and in men were verruca, urethritis, and balanitis, respectively. This is the first study to demonstrate HPV infection status in Suzhou population. Both women and men had a large burden of HPV infection. The nine-valent HPV prophylactic vaccines may potentially prevent 63.2% HR-HPV infection in Suzhou. J. Med. Virol. 89:895-901, 2017. © 2016 Wiley Periodicals, Inc.

Male infertility: a public health issue caused by sexually transmitted pathogens

Sexually transmitted diseases (STDs) are caused by several pathogens, including bacteria, viruses and protozoa, and can induce male infertility through multiple pathophysiological mechanisms. Additionally, horizontal transmission of STD pathogens to sexual partners or vertical transmission to fetuses and neonates is possible. Chlamydia trachomatis, Ureaplasma spp., human papillomavirus, hepatitis B and hepatitis C viruses, HIV-1 and human cytomegalovirus have all been detected in semen from symptomatic and asymptomatic men with testicular, accessory gland and urethral infections. These pathogens are associated with poor sperm quality and decreased sperm concentration and motility. However, the effects of these STD agents on semen quality are unclear, as are the effects of herpes simplex virus type 1 and type 2, Neisseria gonorrhoeae, Mycoplasma spp., Treponema pallidum and Trichomonas vaginalis, because few studies have evaluated the influence of these pathogens on male infertility. Chronic or inadequately treated infections seem to be more relevant to infertility than acute infections are, although in many cases the exact aetiological agents remain unknown.

HPV-DNA sperm infection and infertility: from a systematic literature review to a possible clinical management proposal

The objectives of this study were to investigate the implications of human papillomavirus (HPV) sperm infection on male fertility, impairment of sperm parameters, and possible alteration of sperm nuclear status and to identify a possible effective management of infertile men with HPV sperm infection. We employed a systematic review and clinical management proposal at the Centers for Reproductive and Health care for treating infertile male patients with HPV infection. Literature search was carried out in electronic databases in the last two decades. We focused our attention on: (i) HPV sperm prevalence (ii) HPV-related alteration of sperm parameters; (iii) molecular mechanisms of HPV semen infection and infertility. The main outcome measures were HPV prevalence in infertile male patients and semen parameters. The prevalence of HPV sperm infection ranges between 2 and 31% in men from general population and between 10 and 35.7% in men affected by unexplained infertility. The presence of HPV in semen is associated with an impairment of sperm motility and the presence of anti-sperm antibodies. The molecular mechanisms underlying impairment of sperm motility apparatus need further evaluations. A greater attention should be applied to assess HPV sperm infection, particularly in men undergoing assisted reproduction techniques cycle for male infertility or sperm banking. It would be useful to perform HPV test and fluorescent in situ hybridization analysis for HPV in semen from these patients both at first admission, to define the possible presence and localization of semen infection, and after 6 months, to assess the possible virus clearance retrieval on normal sperm parameters.

Prevalence of human papillomaviruses in semen: a systematic review and meta-analysis

STUDY QUESTION

What is the prevalence of human papillomavirus (HPV) in semen?

SUMMARY ANSWER

HPV is present in the semen of asymptomatic men, with a pooled prevalence in a random effects meta-analysis of populations seeking fertility evaluation/treatment of 16%, versus 10% in other populations.

WHAT IS KNOWN ALREADY

The main risk of donor insemination (DI) is known to be contamination with an infectious agent. HPV is the necessary cause of cervical cancer, and plays an etiologic role in other anogenital cancers. Although it is known to be prevalent and sexually transmitted, donor semen specimens are not tested for the presence of HPV.

STUDY DESIGN, SIZE, DURATION

A systematic review and meta-analysis of studies published between January 1980 and June 2013 were performed. Variables collected included characteristics of study populations, method of semen preparation, HPV DNA detection and genotyping, HPV types targeted and proportion of HPV positivity.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Two investigators independently assessed the studies for inclusion in the review and abstracted the data, while others reviewed the extracted data in detail. Studies were included if they provided data on HPV DNA prevalence in semen and PCR-based methods were used. For the meta-analysis, reports were separated according to the study populations, creating two distinct subgroups: populations seeking fertility evaluation/treatments, and other populations. Data were analysed using a random effects model for each subpopulation.

MAIN RESULTS AND THE ROLE OF CHANCE

The literature search identified 285 studies, and in the 27 studies that were included the HPV DNA prevalence in 4029 semen samples varied from 0 to 100%. The three studies focusing on sperm donors identified HPV DNA in 26.3, 7.5 and 16.0% of semen samples. HPV-16 was the most common type overall. The pooled prevalence in a random effects meta-analysis of seven studies focusing on infertile populations was 16% [95% confidence interval (CI): 10-23%] versus 10% (95% CI: 7-14%) in 11 reports focusing on other populations.

LIMITATIONS, REASONS FOR CAUTION

First, despite defining clinically relevant subgroups, substantial heterogeneity remained. Secondly, although we retrieved data from reports in English or French only, after reviewing the five reports in other languages only two more could have been added and, as their prevalence estimates were similar to those of studies included in our review, we do not believe that exclusion of these reports biased our results or conclusions.

WIDER IMPLICATIONS OF THE FINDINGS

HPV DNA can be found in donor semen and preliminary studies confirm genome activity. For this reason, and although the exact consequences of insemination with HPV-infected semen (cervical infections/lesions, impact on success rate of DI) remain to be clarified, we believe that HPV-infected sperm should be considered a health risk unless well-designed studies prove otherwise. The development and validation of adequate sperm washing techniques before DI appears to be a promising option.

STUDY FUNDING/COMPETING INTEREST(S)

C.L. and P.M. have no conflicts of interests relevant to the submitted work. H.T. has served as a consultant and on advisory boards and has received speaker fees and travel assistance from Merck-Frosst Canada, Glaxo SmithKline Pharmaceuticals, Belgium and Gilead Sciences. F.C. has received grants through his institution from Merck and Roche, as well as honoraria from Merck and Roche for lectures on HPV. M.-H.M. has received grants though her institution from Merck and Qiagen and lecture honoraria from Merck and GSK for conferences on HPV and best practices in cervical cancer prevention.

TRIAL REGISTRATION NUMBER

N/A.

Oral and genital HPV genotypic concordance between sexual partners

OBJECTIVES

The aim of this study was to verify human papillomavirus (HPV) transmission and genotype concordance among heterosexual couples.

MATERIALS AND METHODS

Thirty-one married couples were evaluated. All male subjects presented with clinically diagnosed HPV-related malignant or potentially malignant lesions and underwent peniscopy and penile swab. Their female counterparts underwent swabs of the uterine cervix and oral mucosa. HPV-DNA detection was performed by polymerase chain reaction and restriction fragment length polymorphism.

RESULTS

HPV-DNA was detected in the penis, vagina/cervix, and oral cavity of 16 couples (51.61%). Of these, HPV-DNA concordance was observed in 14 couples (87.5%). HPV-DNA was amplified in penile and oral sites of 14 couples. Of these, 13 couples reported fellatio (92.85%), most of them (10 couples, 76.9%) without condom use. HPV-DNA concordance was observed in 7/10 of these couples (70%). The three couples (100%) who reported use of condom during fellatio were HPV-DNA discordant (p = 0.025).

CONCLUSIONS

Lifetime number of female sexual partners and detection of HPV-DNA in the penile mucosa are surrogate markers of exposure to HPV during marriage. Consistent use of condoms may reduce the risk of HPV transmission.

CLINICAL RELEVANCE

Oral acquisition of HPV from oro-genital contact is influenced by lack of condom use and previous sexual behavior of the male partner. In addition, oral transmission of the virus due to fellatio is as common as genital transmission.

Genital human papillomavirus (HPV) concordance in heterosexual couples

BACKGROUND

Few studies have assessed genital human papillomavirus (HPV) concordance and factors associated with concordance among asymptomatic heterosexual couples.

METHODS

Genotyping for HPV was conducted with male and female sex partners aged 18-70 years from Tampa, Florida. Eligibility included no history of HPV-associated disease. Type-specific positive concordance (partners with ≥ 1 genotype in common) and negative concordance (neither partner had HPV) were assessed for 88 couples. Factors associated with concordance were assessed with Fisher exact tests and tests for trend.

RESULTS

Couples reported engaging in sexual intercourse for a median of 1.7 years (range, 0.1-49 years), and 75% reported being in the same monogamous relationship for the past 6 months. Almost 1 in 4 couples had type-specific positive concordance, and 35% had negative concordance for all types tested, for a total concordance of 59%. Concordance was not associated with monogamy. Type-specific positive concordance was associated with an increasing difference in partners' lifetime number of sex partners and inversely associated with an increasing difference in age. Negative concordance was inversely associated with both the couple's sum of lifetime number of sex partners and the difference in the partners' lifetime number of sex partners.

CONCLUSIONS

Genital HPV concordance was common. Viral infectiousness and number of sex partners may help explain concordance among heterosexual partners.

Human papillomavirus type distribution among heterosexual couples

OBJECTIVE

To gain a better understanding of human papillomavirus (HPV) transmission dynamics between sexual partners, HPV-type-specific concordance was investigated.

METHODS

Twenty-nine couples were enrolled in this cross-sectional study. Mean age was 30.5 years (range = 19.1-42.6 y) for men and 28.2 years (range = 19.4-44.5 y) for women. Samples were collected at the glans penis, penile shaft, and scrotum in men and at the endo/ectocervix and labia/vulva, and perineum in women. Samples were analyzed for the presence of HPV DNA first by polymerase chain reaction and then genotyped using the reverse-line blot method.

RESULTS

Human papillomavirus prevalence for any HPV type was 75.9% among men and 86.2% among women. Eleven men and 10 women were infected with multiple HPV types. At least partial type-specific concordance was observed in 66% of the couples. Forty-one percent of the couples had perfect concordance. In 11 couples (37.9%), complete discordance was observed.

CONCLUSIONS

These results provide valuable information about HPV-type-specific concordance and demonstrate the complexity of transmission dynamics in heterosexual couples.

Identification of multiple HPV types on spermatozoa from human sperm donors

Human papillomaviruses (HPV) may cause sexually transmitted disease. High-risk types of HPV are involved in the development of cervical cell dysplasia, whereas low-risk types may cause genital condyloma. Despite the association between HPV and cancer, donor sperm need not be tested for HPV according to European regulations. Consequently, the potential health risk of HPV transmission by donor bank sperm has not been elucidated, nor is it known how HPV is associated with sperm. The presence of 35 types of HPV was examined on DNA from semen samples of 188 Danish sperm donors using a sensitive HPV array. To examine whether HPV was associated with the sperm, in situ hybridization were performed with HPV-6, HPV-16 and -18, and HPV-31-specific probes. The prevalence of HPV-positive sperm donors was 16.0% and in 66.7% of these individuals high-risk types of HPV were detected. In 5.3% of sperm donors, two or more HPV types were detected. Among all identified HPV types, 61.9% were high-risk types. In situ hybridization experiments identified HPV genomes particularly protruding from the equatorial segment and the tail of the sperm. Semen samples from more than one in seven healthy Danish donors contain HPV, most of them of high-risk types binding to the equatorial segment of the sperm cell. Most HPV-positive sperm showed decreased staining with DAPI, indicative of reduced content of DNA. Our data demonstrate that oncogenic HPV types are frequent in men.

The combined influence of oral contraceptives and human papillomavirus virus on cutaneous squamous cell carcinoma

The vast majority of cutaneous squamous cell carcinoma (CSCC) will occur in those with fair complexion, tendency to burn, and high ultraviolet radiation (UVR) exposure. Organ transplant recipients also are an important population at great risk for CSCC. An association has been reported between oral contraceptive (OC) use, human papillomavirus virus (HPV) and cervical cancer, and there could be a similar association for CSCC. The cutaneous HPV β-E6 protein, a close cousin of the transformative E6 protein underlying anogenital cancers, has been shown to inhibit apoptosis in response to UVR damage and stimulate morphologic transformation in rodent fibroblast cell lines. Furthermore, OC use has been shown to enhance HPV transcription and may contribute to CSCC risk through this pathway.

Meta-analysis of human papillomavirus infection concordance

BACKGROUND

Estimates of human papillomavirus (HPV) concordance among sexual partners are important for various public health activities, from counseling individual patients to predicting the effect of HPV vaccination.

METHODS

We systematically searched the PubMed and EMBASE databases for studies of HPV concordance among heterosexual couples published through 2008 in English. Two coders independently abstracted data using standardized forms. We integrated concordance data using random-effects meta-analysis.

RESULTS

Thirty studies (33 study populations) that met inclusion criteria reported concordance data for 2,972 couples. Most studies were cross-sectional cohort studies conducted in Europe or Asia that used DNA hybridization to test for HPV, sometimes in conjunction with PCR. Overall, 25.5% (95% confidence interval, 17.2-36.1%) of couples were infected with 1 or more of the same HPV types. Among couples with both members HPV-positive, 63.2% (95% confidence interval, 49.1-75.3%) were infected with 1 or more of the same viral types. Positive concordance was higher for female partners of men with HPV infections than for male partners of women with HPV infections. Positive concordance was also higher for studies using PCR and for the few studies that recruited men with HPV-related disease.

CONCLUSIONS

Sexual partners of HPV-infected individuals had high rates of HPV infection, suggesting a need for increased attention to this group.

IMPACT

Our refined estimates of HPV concordance can inform clinical encounters and public health planning. Future HPV concordance studies should use more rigorous research designs, characterize their participants in greater detail, and study more meaningful populations.

Prevalence, concordance and determinants of human papillomavirus infection among heterosexual partners in a rural region in central Mexico

Background

Although human papillomavirus (HPV) infection in heterosexual couples has been sparsely studied, it is relevant to understand disease burden and transmission mechanisms. The present study determined the prevalence and concordance of type-specific HPV infection as well as the determinants of infection in heterosexual couples in a rural area of Mexico.

Methods

A cross-sectional study was conducted in 504 clinically healthy heterosexual couples from four municipalities in the State of Mexico, Mexico. HPV testing was performed using biotinylated L1 consensus primers and reverse line blot in cervical samples from women and in genital samples from men. Thirty-seven HPV types were detected, including high-risk oncogenic types and low-risk types. Multivariate logistic regression models were utilized to evaluate factors associated with HPV.

Results

The prevalence of HPV infection was 20.5% in external male genitals and 13.7% in cervical samples. In 504 sexual couples participating in the study, concordance of HPV status was 79%; 34 partners (6.7%) were concurrently infected, and 21 out of 34 partners where both were HPV positive (61.8%) showed concordance for one or more HPV types. The principal risk factor associated with HPV DNA detection in men as well as women was the presence of HPV DNA in the respective regular sexual partner (OR = 5.15, 95%CI 3.01-8.82). In men, having a history of 10 or more sexual partners over their lifetime (OR 2.5, 95%CI 1.3 - 4.8) and having had sexual relations with prostitutes (OR 1.7, 95%CI 1.01 - 2.8) increased the likelihood of detecting HPV DNA.

Conclusions

In heterosexual couples in rural regions in Mexico, the prevalence of HPV infection and type-specific concordance is high. High-risk sexual behaviors are strong determinants of HPV infection in men.

[How did I contract human Papillomavirus (HPV)?]

More than 120 genotypes have been identified among the Papillomavirus (HPV) family. These viruses are ubiquitary with skin or mucous membrane tropism and cause various pathologies from wart to neoplasia. HPV family is classified according to their tropism. Genital HPV infection is considered as the most frequent sexually transmitted disease in the world. Seventy-five percent of women will be in contact with HPV at least one time in their life. HPV is usually transmitted through direct skin-to-skin contact, more often during penetrative genital contact. Other types of genital contact in the absence of penetration can lead to HPV infection, but those routes of transmission are much less common than sexual intercourse. However, virgins (<2 % of cases) and young children can present HPV infection, suggesting other routes of transmission than sexual intercourse. HPV infection could occur during delivery; vaginal deliveries appear to promote this transmission in comparison with cesarean section. But cesarean section do not completely protect against contamination risk. In utero, vertical transmission has been suggested by different studies but with lack of evidence. HPV infection can be detected on inanimate objects, such as clothing or environmental surfaces. However, transmission is not known to occur by this route. More detailed knowledges of the transmission route of HPV infection will enable to get prevention more effective.

Epidemiology and pathology of HPV disease in males

It is currently recognized that besides the significant impact of human papillomavirus (HPV) infection in females, HPV causes substantial disease in men as well. Genital warts are a common manifestation of male infection with HPV. Genital warts are highly infectious and approximately 65% of people who have sex with an infected partner will develop warts themselves. More than 90% of genital warts are caused by non-oncogenic HPV types 6 and 11. In addition, recurrent respiratory papillomatosis is a rare disease most often associated with HPV types 6 and 11. Several cancers of the anogenital tract and upper aero-digestive tract, and their precursor lesions in men are now understood to be caused by infection with sexually transmitted HPV. For example, there is increasing incidence of anal cancer in western countries; however, there are limited data on its primary cause, anal canal HPV infection. Genital HPV infection is very common in men with an ongoing international study estimating a prevalence of 65.2% in asymptomatic males aged 18-70 years. Lifetime number of sexual partners was the most significant risk factor for the acquisition of HPV infection (P<0.05), and circumcision has been associated with reduced detection of HPV infection in men. HPV infections may be less likely to persist in men than in women. In men, the median time to clearance of any HPV infection was 5.9 months, with 75% of infections clearing within 12 months. More data are needed to better understand the natural history of HPV infection. Although the quadrivalent HPV vaccine has been shown to be effective and safe in men, low awareness of HPV in males may be a barrier to its use for the prevention of HPV infection.

Human papillomavirus infections among couples in new sexual relationships

BACKGROUND

No studies have examined human papillomavirus (HPV) infections among couples early in their sexual relationships when transmission is most likely. Our objective was to describe the distribution of HPV infections among recently formed couples, using the partnership as the unit of analysis.

METHODS

Women aged 18-24 years attending a university or junior college in Montreal enrolled in a longitudinal study with their new male partners. Self-collected vaginal swabs and clinician-collected swabs from the penis and scrotum were tested for 36 HPV genotypes. Participants self-reported sexual behavior in computerized questionnaires. We analyzed patterns of genital HPV infection in 263 couples using data obtained at enrollment.

RESULTS

Couples had engaged in vaginal sex for a median of 3.9 months. HPV was detected in 64% (169/263) of couples. In 41% (109/263), both partners harbored the same HPV type-nearly 4 times more than expected if HPV status of partners were uncorrelated. There were 583 type-specific HPV infections among 169 couples for whom at least one partner was infected. Of these, 42% were of the same type for both partners (95% confidence interval = 36%-47%). This rose from 25% among those engaging in vaginal sex for less than 2 months to 68% among those at 5 to 6 months.

CONCLUSIONS

Although HPV is common, detection of the same type in persons initiating a sex relationship would be rare given type-specific prevalence rates. The high degree of concordance we found suggests a high probability of transmission.

Cell-mediated immune responses to human papillomavirus 16 E6 and E7 antigens as measured by interferon gamma enzyme-linked immunospot in women with cleared or persistent human papillomavirus infection

Cell-mediated immune responses have been thought to be important in the control of human papillomavirus (HPV) infections. We examined cell-mediated immune responses to HPV-16 E6 and E7 in the peripheral blood using interferon gamma (IFN-gamma) enzyme-linked immunospot assay (Cellular Technology Ltd, Cleveland, Ohio) in women with HPV-16 infection who showed clearance and compared these women to women with HPV-16 persistence. Women participating in a longitudinal study of cervical HPV were recruited once cervical HPV-16 infection was detected by polymerase chain reaction. Four groups of women were examined: (1) persistent, (2) intermittent, (3) transient, and (4) cleared. Ninety-six samples from 55 women were compared. Comparing IFN-gamma enzyme-linked immunospot to the HPV-16 clearance of 10 women with recent persistence, none had response to either E6 or E7; of 24 women with recent clearance, 14 had E6 and 8 had E7 response. Women with intermittent persistence behaved similarly to the clearance group than recent persistors: 50% were positive to E6 and 20% to E7. In summary, anti-E6 responses seem critical in the immediate control of HPV, and in some women, an immune tolerance eventually develops if HPV is not eliminated soon after infection.

Age-specific prevalence of infection with human papillomavirus in females: a global review

PURPOSE

Global data on age-specific prevalence of human papillomavirus (HPV) infection overall, and for high-risk HPV types 16 and 18, are essential for the future implementation of HPV prophylactic vaccines for cervical cancer prevention.

METHODS

A systematic review of peer-reviewed publications was conducted to summarize worldwide data on genital HPV-DNA prevalence in women. Studies with clear descriptions of polymerase chain reaction or hybrid capture detection assays were included.

RESULTS

A total of 346,160 women were included in 375 studies. Of 134 studies with age-stratified HPV prevalence data (116 low sexual risk populations, 18 high sexual risk populations), over 50% were from Europe and the Middle East (38%) and North America (19%), with smaller proportions from Asia and Australia (21%), Central and South America (11%), and Africa (10%). Across all geographical regions, data on HPV prevalence were generally limited to women over 18 years of age. Consistently across studies, HPV infection prevalence decreased with increasing age from a peak prevalence in younger women (< or =25 years of age). In middle-aged women (35-50 years), maximum HPV prevalence differed across geographical regions: Africa (approximately 20%), Asia/Australia (approximately 15%), Central and South America (approximately 20%), North America (approximately 20%), Southern Europe/Middle East (approximately 15%), and Northern Europe (approximately 15%). Inconsistent trends in HPV prevalence by age were noted in older women, with a decrease or plateau of HPV prevalence in older ages in most studies, whereas others showed an increase of HPV prevalence in older ages. Similar trends of HPV 16 and/or 18 prevalence by age were noted among 12 populations with available data.

DISCUSSION

Genital HPV infection in women is predominantly acquired in adolescence, and peak prevalence in middle-aged women appears to differ across geographical regions. Worldwide variations in HPV prevalence across age appear to largely reflect differences in sexual behavior across geographical regions. Further studies of HPV prevalence in adolescents are needed for all geographic regions.

Epidemiology of human papillomavirus infection in men, cancers other than cervical and benign conditions

Human papillomavirus (HPV) infection is commonly found in the genital tract of men and women with or without any clinical lesion. The association of HPV DNA with several different ano-genital cancers other than cervical has been reported for the vulva, vagina, anus and penis. HPV DNA has also been identified in head and neck cancers in the oral cavity, the oropharynx and the larynx in both sexes. In men, 80-85% of anal cancers and close to 50% of penile cancers are associated with HPV infection. In women, HPV DNA is prevalent in 36-40% vulvar cancer cases and close to 90% of vaginal cancers. There is limited data available on the natural history and HPV-related diseases in the genital tract in men, although studies are ongoing. Efficacy of HPV vaccines in the prevention of HPV infection and disease among men also remains unknown. Among HPV DNA positive ano-genital cancer cases, HPV-16 is the most frequently found followed distantly by HPV-18. In benign HPV-related diseases such as genital warts or recurrent respiratory papillomatosis HPV-6 and 11, the two most frequent non-oncogenic types, are the predominant types detected. Oncogenic types are rarely detected. In this article we summarize and review studies describing the natural history of HPV infections among men and its impact on HPV related disease in women. We summarize the evidence linking HPV in the epidemiology and etiology of cancers of the vulva, vagina, anus and oropharynx and present recent estimates of the burden of and HPV type distribution in genital warts and in cases of HPV infection of the airways.

Transmission of human papillomavirus in heterosexual couples

We examined the transmission of human papillomavirus (HPV) in 25 heterosexual, monogamous couples (25 men, 25 women), followed up over an average of 7.5 months. A total of 53 heterosexual transmission events were observed among 16 couples (14 male-to-female and 39 female-to male). Sexual transmission involved 13 different oncogenic and nononcogenic HPV types; 8% were vaccine-covered types transmitted between partners. The overall rate of HPV transmission from the penis to the cervix was 4.9/100 person-months, which was substantially lower than that from the cervix to the penis (17.4/100 person-months). Transmission between the hands and genitals, as well as apparent self-inoculation events (primarily in men), were also observed. Couples who transmitted HPV were more sexually active and used condoms less frequently. These results have implications for HPV prevention and control strategies, including the targeting of prophylactic vaccines.

Transmission of human papillomavirus in heterosexual couples

We examined the transmission of human papillomavirus (HPV) in 25 heterosexual, monogamous couples (25 men, 25 women), followed up over an average of 7.5 months. A total of 53 heterosexual transmission events were observed among 16 couples (14 male-to-female and 39 female-to male). Sexual transmission involved 13 different oncogenic and nononcogenic HPV types; 8% were vaccine-covered types transmitted between partners. The overall rate of HPV transmission from the penis to the cervix was 4.9/100 person-months, which was substantially lower than that from the cervix to the penis (17.4/100 person-months). Transmission between the hands and genitals, as well as apparent self-inoculation events (primarily in men), were also observed. Couples who transmitted HPV were more sexually active and used condoms less frequently. These results have implications for HPV prevention and control strategies, including the targeting of prophylactic vaccines.

The optimal anatomic sites for sampling heterosexual men for human papillomavirus (HPV) detection: the HPV detection in men study

Background. Human papillomavirus (HPV) infection in men contributes to infection and cervical disease in women as well as to disease in men. This study aimed to determine the optimal anatomic site(s) for HPV detection in heterosexual men.Methods. A cross-sectional study of HPV infection was conducted in 463 men from 2003 to 2006. Urethral, glans penis/coronal sulcus, penile shaft/prepuce, scrotal, perianal, anal canal, semen, and urine samples were obtained. Samples were analyzed for sample adequacy and HPV DNA by polymerase chain reaction and genotyping. To determine the optimal sites for estimating HPV prevalence, site-specific prevalences were calculated and compared with the overall prevalence. Sites and combinations of sites were excluded until a recalculated prevalence was reduced by <5% from the overall prevalence.Results. The overall prevalence of HPV was 65.4%. HPV detection was highest at the penile shaft (49.9% for the full cohort and 47.9% for the subcohort of men with complete sampling), followed by the glans penis/coronal sulcus (35.8% and 32.8%) and scrotum (34.2% and 32.8%). Detection was lowest in urethra (10.1% and 10.2%) and semen (5.3% and 4.8%) samples. Exclusion of urethra, semen, and either perianal, scrotal, or anal samples resulted in a <5% reduction in prevalence.Conclusions. At a minimum, the penile shaft and the glans penis/coronal sulcus should be sampled in heterosexual men. A scrotal, perianal, or anal sample should also be included for optimal HPV detection.

Human Papillomavirus Prevalence and Type Distribution in Male Anogenital Sites and Semen

BACKGROUND

Human papillomavirus (HPV) is sexually transmitted and causes cervical cancer. Although HPV can infect men and women, little is known about infection in men. Specifically, the prevalence of type-specific HPV infection and the distribution of infections by anogenital anatomic site in men are incompletely characterized.

METHODS

We tested 463 men ages 18 to 40 years for HPV at the glans/corona, penile shaft, scrotum, urethra, perianal area, anal canal, and in a semen sample. Eligible men acknowledged no history of genital warts and had sexual intercourse with a woman within the past year. HPV testing by PCR and reverse line blot genotyping for 37 types was conducted on each of the specimens from the seven sampling sites.

RESULTS

When HPV results from any sampling site were considered, 237 (51.2%) men were positive for at least one oncogenic or nononcogenic HPV type, and another 66 (14.3%) men were positive for an unclassified HPV type. The types with the highest prevalence were HPV-16 (11.4%) and 84 (10.6%). External genital samples (glans/corona, shaft, and scrotum) were more likely than anal samples to contain oncogenic HPV (25.1% versus 5.0%). HPV-positive penile shaft and glans/corona samples were also more likely to be infected with multiple HPV types than other sites.

CONCLUSIONS

More complete anogenital sampling and sensitive detection for 37 HPV types resulted in a higher HPV prevalence in primarily asymptomatic men than reported previously. The penile shaft was the site most likely to be HPV positive and harbored the greatest proportion of multiple type and oncogenic infections. These results have implications for research of HPV among men and transmission between partners.

HPV seminal shedding among men seeking fertility evaluation in Abidjan, Ivory Coast

BACKGROUND

Little is known about the semen shedding of human papillomaviruses (HPV) in African men.

OBJECTIVES

To detect and identify HPV types in semen samples from men seeking fertility evaluation in Abidjan, Ivory Cost.

STUDY DESIGN

Sixty-three semen samples were tested by PCR using consensus primers and HPV types were determined by PCR product sequencing or by line probe assay (LiPA) when sequencing was inconclusive.

RESULTS

A total of 19 HPV isolates belonging to 11 HPV types were identified in semen samples from 18 (28.6%) men. Ten (55.5%) of the HPV-positive men shed oncogenic HPV types. An association of borderline significance (P=0.06) was observed between HPV semen shedding and a lower sperm count.

CONCLUSION

HPV shedding in semen is common in African men. The relationship between HPV semen shedding and sperm quality merits to be further investigated.

Prevalence of sexually transmissible pathogens in semen from asymptomatic male infertility patients with and without leukocytospermia

OBJECTIVE

To determine the prevalence of pathogens that cause sexually transmitted infections (STIs) in semen from asymptomatic male infertility patients with and without leukocytospermia (LCS), and associations between STIs, inflammatory markers, and other semen variables.

DESIGN

Retrospective, controlled study.

SETTING

Academic Medical Center.

PATIENT(S)

Two hundred and forty-one male infertility patients undergoing routine semen analysis: 132 with LCS, and 109 without LCS.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

The DNA from STI pathogens (human papillomavirus [HPV], cytomegalovirus [CMV], herpes simplex virus [HSV], human herpesvirus type 6 [HHV-6], Epstein-Barr virus [EBV], hepatitis B virus [HBV], and Chlamydia trachomatis [CT]), routine semen parameters, and markers of accessory gland and epididymal function and inflammation.

RESULT(S)

The DNA from STI pathogens was detected in 45/241 (18.7%) of the samples (CMV, 8.7%; HPV, 4.5%; HHV-6, 3.7%; HSV, 3.7%; CT, 2.5%; EBV, 0.4%; and HBV, 0%), with no difference in prevalence between the LCS and non-LCS groups. The DNA of STI pathogens in semen was associated with a decrease in sperm concentration, motile sperm concentration, total sperm count, and neutral alpha-glucosidase concentration, whereas LCS was associated with a decrease in total sperm count, percent normal forms, and fructose concentration.

CONCLUSION(S)

The DNA of STI pathogens was detected in semen from a high percentage of asymptomatic male infertility patients, and was associated with poor semen quality. Efforts to diagnose and treat subclinical genital-tract infections should be intensified.

Penile, urethral, and seminal sampling for diagnosis of human papillomavirus infection in men

Methods that used specimens from three genital sites (penile brushing [PB], urethral brushing [UB], and the retrieval of semen [SE]) from 50 men were examined for human papillomavirus (HPV) DNA detection. The rates of detection by PB, UB, SE, PB and UB, and PB and SE were 88.9%, 50.0%, 33.3%, 100%, and 97.2%, respectively. The use of PB and UB appears to be the most accurate method; as an alternative to UB, the use of SE with PB could be used to improve the rate of HPV DNA detection in men.

Frequency of antibodies against E4 and E7 from human papillomavirus type 16 in Mexican soldiers

The high prevalence of HPV in men's genitalia and the low frequency of virus-associated lesions gave rise to questions on the influence of infection-site on the HPV antibody profile. In a cross-sectional study, HPV infection in penis and urethra, and serum antibodies against HPV-16 E4 and E7 proteins were evaluated in 288 Mexican soldiers. The results showed that HPV prevalence was 31% (51% in penis, 11% in urethra and 38% in both sites), while 47% were multiple infections. Overall, seroprevalence was 13% for anti-E4 antibodies and 6% for anti-E7. However, the highest prevalence of anti-E4 antibodies was observed in men with HPV infection in urethra (30%), while for E7 antibodies, the highest prevalence (10%) was found in men who tested positive for HPV in penis. The prevalence of IgG and IgA anti-E4 was related to HPV-16 urethral infection, while detection of HPV-16 in penis was related to IgG anti-E7 prevalence. In conclusion, the high-risk sexual behavior observed in this population might be responsible for high HPV prevalence and multiple infections. However, the seroprevalence of E4 and E7 was similar to that observed in healthy Mexican women. These results suggest that the humoral immune response against HPV infection in men differs, depending on the site of infection.

Chapter 6: Epidemiology and transmission dynamics of genital HPV infection

This chapter provides an overview of the epidemiology of human papillomavirus (HPV) infection, with a focus on the dynamics of sexual transmission. We explore concepts related to the spread of sexually transmitted infections, including population prevalence, duration of infectivity, patterns of sexual contacts, and transmissibility, including modifiers of susceptibility and infectivity. HPV prevalence and incidence are high in most studies, particularly amongst young women. There is strong evidence that transmission occurs primarily via sexual activity, most commonly vaginal and anal intercourse. Although the duration of infectivity may be short, current evidence suggests that HPV is highly transmissible. The implications of transmission dynamics for the success of future HPV vaccines are discussed.

Genital human papillomavirus infection in men

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.

Flat penile lesions: The infectious “invisible” link in the transmission of human papillomavirus

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.

Infección por Papillomavirus en el hombre. Estado actual

The Virus of the Human Papiloma (HPV), classically he/she has been related with infections of sexual transmission and processes wicked oncologists of the feminine genital apparatus and with less frequency of the masculine one. The new technical diagnostics, based on molecular biology (by means of polymerase chain reaction), they help to a better epidemic approach, an improvement in the I diagnose viral, and a correct therapeutic focus. The object of this work is to revise the current state of the HPV from the points of view etiopathogenics, epidemic, clinical, diagnosis, therapeutic and preservative.

Risk factors related to the development and mortality from invasive cervical cancer clinical utility and impact on prevention

The focus of this article is to explore the various risk factors related to cervical cancer and the practical context in which they can be applied. The ability to link dinical outcomes (disease presence, persistence, progression, and recurrence) with antecedent risk factors is strengthened by a new understanding of the molecular mechanisms that are responsible for malignant transformation.

Prevalence and determinants of human papillomavirus genital infection in men

Four-hundred-forty-five husbands of women with invasive cervical carcinoma, 165 of women with in situ cervical cancer, and 717 of control women (age range 19-82 years) were interviewed and a sample of exfoliated cells from the penis obtained in seven case-control studies conducted by the International Agency for Research on Cancer. The characteristics of human papillomavirus-positive and human papillomavirus-negative husbands were compared using odds ratios and 95% confidence intervals. Thirteen per cent of the husbands of control women, 18% of the husbands of women with invasive cervical carcinoma, and 21% of the husbands of in situ cervical carcinoma women were positive for penile human papillomavirus DNA. Human papillomavirus 16 was detected in 45 husbands, human papillomavirus 18, 31 or 33 in 19, and human papillomavirus 6/11 in 6, but the majority of human papillomavirus infection (158) was with other or unspecified human papillomavirus types. The same human papillomavirus type was seldom identified in both husband and wife. The strongest variation in penile human papillomavirus infection was by country, with percentages among the husbands of control women ranging between 3% in Spain and 39% in Brazil. Having had over 50 lifetime sexual partners, compared with only one, was associated with an odds ratio of 2.3.

Viruses in the mammalian male genital tract and their effects on the reproductive system

This review describes the various viruses identified in the semen and reproductive tracts of mammals (including humans), their distribution in tissues and fluids, their possible cell targets, and the functional consequences of their infectivity on the reproductive and endocrine systems. The consequences of these viral infections on the reproductive tract and semen can be extremely serious in terms of organ integrity, development of pathological and cancerous processes, and transmission of diseases. Furthermore, of essential importance is the fact that viral infection of the testicular cells may result not only in changes in testicular function, a serious risk for the fertility and general health of the individual (such as a fall in testosteronemia leading to cachexia), but also in the possible transmission of virus-induced mutations to subsequent generations. In addition to providing an exhaustive account of the data available in these domains, this review focuses attention on the fact that the interface between endocrinology and virology has so far been poorly explored, particularly when major health, social and economical problems are posed. Our conclusions highlight the research strategies that need to be developed. Progress in all these domains is essential for the development of new treatment strategies to eradicate viruses and to correct the virus-induced dysfunction of the endocrine system.

Fluorescence urethroscopy following instillation of 5-aminolevulinic acid: a new procedure for detecting clinical and subclinical HPV lesions of the urethra

OBJECTIVE

To report early clinical experience with intraurethral instillation of 5-aminolevulinic acid (ALA) for the detection of clinical lesions (condyloma acuminata) and subclinical human papillomavirus (HPV) lesions of the urethra, not visible by conventional endoscopy.

SUBJECTS AND SETTING

Eighty-four men with clinical diagnosis of condyloma acuminata were examined for urethral HPV lesions at the Department of Urology, Ludwig Maximilian University, Munich, Germany.

METHODS

The anogenital areas of the patients were thoroughly examined using a magnifying glass before and after application of 5% acetic acid. Conventional as well as fluorescence urethroscopy were performed 1 h after topical application of 0.1% ALA for 15 min. A sensitive colour charge-coupled device camera for fluorescence video inspection was used with spectral analysis. Biopsies were taken for histological examination and HPV detection by polymerase chain reaction (PCR).

RESULTS

Forty-three of 84 men attending our clinic for condyloma acuminata had clinical HPV lesions of the urethra. Condylomas of the proximal urethra were found by conventional endoscopy in eight patients. Fluorescence urethroscopy detected additional subclinical lesions in 13 men. All lesions were HPV infections of the urethra confirmed histologically or by PCR. In nine of these subclinical urethra lesions low-risk HPV types (HPV6, 11, 34) were found. Four lesions were associated with high-risk types (HPV18, 31,52,58).

CONCLUSIONS

Fluorescence urethroscopy is a promising diagnostic procedure for detecting subtle clinical and subclinical HPV lesions of the urethra, that are normally not visualized by conventional endoscopy. Generally, urethroscopy is recommended in all cases of externally visible condylomas of the urethra after therapy.

Effect of human seminal fluid on production of messenger ribonucleic acid for metalloproteinase 2 and metalloproteinase 9 in cervical epithelial carcinoma cells

OBJECTIVES

The risk for cervical cancer is related to sexual intercourse. One factor associated with tumor invasion and metastases is the production of matrix metalloproteinases, which degrade the extracellular matrix. The ability of human semen to influence production of messenger ribonucleic acid for 2 matrix metalloproteinases associated with cervical cancer, MMP-2 and MMP-9, was examined.

STUDY DESIGN

Seminal fluids from 16 men were diluted 1:50 and incubated with the cervical carcinoma cell line HeLa for 18 hours. Cells were harvested, ribonucleic acid was isolated and reverse transcribed into complementary deoxyribonucleic acid, and deoxyribonucleic acid sequences coding for regions of the genes for MMP-2 and MMP-9 were generated by polymerase chain reaction and detected by enzyme-linked immunosorbent assay.

RESULTS

All 16 semen samples inhibited production of MMP-2 messenger ribonucleic acid. The MMP-2 messenger ribonucleic acid synthesis in the presence of semen was a mean of 39.5% of the control value. In contrast, MMP-9 messenger ribonucleic acid synthesis was stimulated (mean stimulation, 68.3%) by semen in 10 of the 15 samples tested. Synthesis of beta-actin was comparable in each culture, and cell viability was unaffected by the diluted semen.

CONCLUSION

The capacity of semen to influence transcription of the genes for matrix metalloproteinases may be one mechanism whereby sexual activity influences cervical cancer progression.

Clearance of cervical human papillomavirus infection by treatment for cervical dysplasia

OBJECTIVES

The aim of this study was to investigate the prevalence of human papillomavirus (HPV) after treatment for cervical dysplasia.

STUDY DESIGN

The presence of HPV was investigated in cervical scrapes of 91 patients, before and after treatment, using consensus primers in the polymerase chain reaction.

RESULTS

Before treatment for cervical dysplasia, 89 of 91 patients (98%) were HPV-positive compared with 28 of 91 patients (31%) after treatment. The HPV type present before treatment was found in the scrapes of only 9 of 89 patients (10%). Detection of HPV after treatment was associated with human immunodeficiency virus infection and incomplete conization.

CONCLUSION

The HPV type present before treatment was frequently cleared by treatment for cervical dysplasia.

Human papillomavirus infection and risk determinants for squamous intraepithelial lesion and cervical cancer in Japan

A case control design was used to investigate human papillomavirus (HPV) prevalence and risk factors associated with development of cervical squamous intraepithelial lesion (SIL) and cervical cancer (CC) in Japan. One hundred and twenty-three women with histologically confirmed SIL or CC were compared to a control group of 778 cytologically normal women. With the use of a polymerase chain reaction (PCR)-based method for detection of low-risk (types 6 and 11) and high-risk (types 16, 18, 31, 33, 35, 52 and 58) HPVs, a high prevalence of HPV infection was observed in smokers among the controls. Logistic regression analysis demonstrated that high-risk HPV infection was the most significant risk determinant for LSIL (OR=9.4, 95% CI=4.5-19), HSIL (OR=77, 95% CI=28-217) and CC (OR=97, 95% CI=35-269). It also showed that unmarried women, women married for 5 to 19 years and smokers represented high risk groups for SIL, while smokers and women with a history of many pregnancies/parities had increased risk for CC. Smoking was the only HPV infection-independent factor for CC, suggesting that smoking may have a carcinogenic effect on the cervix. Since neither history of other cancer nor family cancer history was associated with SIL or CC, genetic factors appear to play little role in cervical carcinogenesis. The risk for cervical neoplasia due to HPV infection increased after marriage in Japan, suggesting a role for husbands as carriers of HPV transmission. Protection from high-risk HPV infection may be of greatest importance for prevention of cervical cancer.

Kaposi's sarcoma-associated herpesvirus DNA sequences in prostate tissue and human semen

BACKGROUND

Sequences of novel herpesvirus, Kaposi's sarcoma-associated herpesvirus (KSHV), have been indentified in Kaposi's sarcoma tissue, but it is not known whether the virus is transmitted by sexual contact.

METHODS

Using the polymerase chain reaction (PCR), we searched for KSHV DNA sequences in ejaculates from 43 healthy men and tissue from the urogenital tract or prostate of 100 immunocompetent adults.

RESULTS

In an unblinded analysis, we identified KSHV DNA sequences in 2 of 20 tissue specimens from the urinary tract (10 percent; 15 men and 5 women), 3 of 46 specimens from the female genital tract (6.5 percent), 4 of 18 specimens from the glans or foreskin (22 percent), 7 of 16 specimens from the prostate (44 percent), and 30 or 33 ejaculates (91 percent). By contrast, such sequences were present in 1 of 18 samples of normal skin (5.5 percent) and 1 of 14 samples of peripheral-blood mononuclear cells (PBMCs; 7.1 percent). Ejaculates and PBMC samples from each of 10 study subjects were analyzed in a blinded, coded fashion, along with PBMCs and biopsy specimens of normal skin from 4 and 8 other patients, respectively. This analysis confirmed the presence of KSHV DNA sequences in semen. Viral DNA was not found in the sperm heads but was present in the fraction of the ejaculates that contained urothelial and other types of cells. Point mutations were found in PCR products amplified from both prostate tissue and sperm samples.

CONCLUSIONS

KSHV infects a large proportion of healthy adults and is probably transmitted by sexual contact.

Genotyping human papillomavirus type 16 isolates from persistently infected promiscuous individuals and cervical neoplasia patients

Nucleotide sequence variation in the noncoding region of the genome of human papillomavirus type 16 (HPV16) was determined by direct sequencing and single-strand conformation polymorphism analysis of DNA fragments amplified by PCR. Individuals of diverse sexual promiscuity and/or cervicopathology were studied. In a group of 14 healthy, monogamous HPV16-positive females, only two HPV16 sequence variants could be documented. Among 17 females and 3 males with multiple sex partners and living in the same geographical region, nine sequence variants were found, whereas among 7 patients with cervical neoplasia from another region, five variants were detected. Although numbers are limited, in the group of individuals at high risk of acquiring a sexually transmitted disease or with cervical neoplasia, a larger number of HPV16 sequence variants was encountered (two types among 14 individuals versus nine types among 20; Fisher's exact test, P = 0.07). Seven of the individuals were sampled repeatedly over time. For these persistently infected women, no differences in HPV16 sequences were detected, irrespective of promiscuity, and persistence of a single viral variant, spread over multiple anatomic sites, for more than 2 years could be demonstrated. This indicates that viral persistence may be a common feature and that successful superinfection with a new variant may be rare, despite a potentially high frequency of viral reinoculation.