Sexual transmission of human papillomaviruses in heterosexual and male homosexual couples, studied by DNA hybridisation

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.

HPV prevalence and concordance in the cervix and oral cavity of pregnant women

OBJECTIVES

This investigation examined human papillomavirus (HPV) in pregnant women in order to characterize viral prevalence, types and concordance between infection in the cervix and in the oral cavity.

METHODS

A total of 577 pregnant women seeking routine obstetric care were evaluated for HPV infection in their cervix during gestation and immediately before delivery, and in the oral cavity during gestation. Male partners present during the gestational clinic visit also provided a specimen from their oral cavity. HPV assessment was performed by PCR, dot blot hybridization and DNA sequencing. A sexual and health questionnaire was completed by the pregnant women.

RESULTS

HPV prevalence in women was 29% in the cervix and 2.4% in the oral cavity. Among those with both gestational and delivery specimens, 35% were infected at least once and 20% had infection at both intervals. At delivery, 68% of infected women had an oncogenic HPV type in the cervix. There was no type-specific HPV concordance between the two cervical specimens, nor cervical and oral results in women, nor with cervical and oral findings between partners.

CONCLUSION

The lack of association in HPV positivity and types between the cervix and oral cavity in these women suggests that self-inoculation is uncommon. This source of infection does not appear to be from oral contact with a current male partner, since there also was no concordance between partners. These results suggest either other modes of HPV transmission or differences in susceptibility to HPV infection or its clearance in the oral cavity and genital mucosa.

Anogenital warts and condom use--a survey of information giving

OBJECTIVE

To examine information giving by genitourinary medicine (GUM) consultants about the use of condoms for patients with anogenital warts (AGW).

METHOD

228 GUM consultants in the UK and Ireland were sent a questionnaire concerning the information about condom use which they usually discuss with patients with AGW. The survey was carried out in 1994.

RESULTS

There was a 46% response rate. Most consultants indicated giving information specifically with regard to the prevention of transmission of human papilloma virus (HPV), and not only in the context of safe sex. With regard to current AGW, consultants were more likely to discuss, than not to discuss, use of condoms with patients with regular sexual partners in terms of benefit, uncertain benefit, or no benefit. However, no significant difference in the likelihood of discussing, or not discussing, these issues was found for current AGW for patients without regular partners. For both groups, benefit of using condoms for current AGW was more likely to be discussed than no benefit. The majority of consultants indicated that they would discuss condom use after disappearance of AGW as being of uncertain benefit. However, many consultants also indicated discussing use of condoms for a specific period or an indefinite period of time, including many of those who specific discussing uncertain beneficial use of condoms after disappearance of AGW. The most common duration of condom use chosen for discussion was until 3 months after disappearance of AGW.

CONCLUSION

GUM consultants vary in the information they give about condom use specifically to prevent transmission of HPV. This survey suggests a need for evaluation by GUM physicians of management guidelines relating to information given about condom use for AGW, including utilising the available scientific evidence as well as dealing with issues of uncertainty.

Changes in HPV infection in patients with anogenital warts and their partners

OBJECTIVES--To investigate the relationship between clinical findings and the detection of human papillomavirus (HPV) DNA in a range of anatomical sites in patients with and without anogenital warts. SUBJECTS--Men and women with a clinical diagnosis of anogenital warts, or a current partner with anogenital warts. SETTING--A department of genitourinary medicine in central London. METHODS--The anogenital areas of the patients were thoroughly examined using a colposcope before and after application of acetic acid. Different types of specimens were taken from a variety of anatomical sites. Superficial skin sampling was performed by the application of slides covered with "Superglue" (SG) to clinically normal and abnormal areas of anogenital skin. The presence of human cells in the SG samples was confirmed by detection of the beta-globin gene using the polymerase chain reaction (PCR). HPV DNA was extracted from the specimens and amplified by using consensus primers with the PCR. HPV types 6, 11, 16, 18, 31 and 33 were identified by Southern blotting followed by hybridisation. RESULTS--In women, HPV DNA was detected in 83% of wart biopsies, 29% of cervical biopsies, 36% of cervical scrapes, 25% of urethral loop specimens, 37% of vaginal washes and 33% of rectal swab specimens. In men, HPV DNA was detected in 67% of wart biopsies, 37% of urethral loop specimens and 12% of rectal swab specimens. Of the SG samples containing the beta-globin gene, 49% from women and 50% from men contained HPV DNA. HPV DNA was not detected in buccal scrapes and serum samples from women or men. Of all specimens with detectable HPV DNA, there was evidence of a single HPV type in 41%, multiple types in 48% and undetermined types in 11%. Samples taken from different sites of a patient tended to have HPV types in common. Sexual partners, however, did not consistently have HPV types in common. CONCLUSIONS--HPV DNA was distributed widely in the anogenital area, in warts, acetowhite areas and clinically normal skin. The SG technique was well tolerated by patients and produced results consistent with other findings. Sampling from a single site of the genitalia on one occasion may significantly underestimate the infection rate with HPV. Multifocal infection of the anogenital area with HPV should be taken into consideration when interpreting epidemiological studies and management strategies.

Dual genitotropic human papillomavirus infections in genital warts

BACKGROUND AND METHODS

We have carried out a prospective study of dual genitotropic human papillomavirus (HPV) infections by means of two different DNA detection methods in biopsy specimens obtained from patients who were examined for genital warts at the STD clinic of the School of Medicine in Seville, between January 1990 and December 1991.

RESULTS

100 patients with a clinical diagnosis of condilomata acuminata were seen during the study period. DNA of the genitotropic HPV 6/11, 16/18 and 31/33/35 was detected by an in situ hybridisation method in 75 (77%) of the 98 evaluable samples; one of the genotypes tested in 59 (61%) samples, and two or more genotypes tested in the remaining 16 (15%) samples. In 21 (98%) of the 23 negative samples by in situ hybridisation, we were able to detect DNA of genital HPV using a polymerase chain reaction amplification method (PCR). Among the 34 samples where PCR was applied we confirmed the presence of two different HPV genotypes in eight samples.

CONCLUSIONS

The frequency of dual infections with human genitotropic papillomavirus in genital warts was 8%, although we believe that this rate should be higher as we have not used the PCR method in all of the samples.

Detection of human papillomavirus DNA by PCR in semen from patients with and without penile warts

OBJECTIVES

To determine the prevalence of urethral HPV infection, as indicated by the presence of HPV DNA in semen, in males with and without penile warts.

DESIGN

Prevalence study of HPV types 6/11 and 16 DNA using PCR and Southern blot hybridisation analysis of semen.

SETTING

Department of Genitourinary Medicine, Blundell Street Clinic, Leeds General Infirmary and the Assisted Conception Unit (ACU) Kings' College, London.

SUBJECTS

Patients attending the Genitourinary Clinic for treatment of sexually transmitted diseases including penile warts and males attending Kings' ACU for investigations of infertility.

MAIN OUTCOME MEASURES

HPV DNA detected by polymerase chain reaction (PCR) and/or Southern blot hybridisation in semen.

RESULTS

HPV DNA was detected by PCR in 23 of 27 (85%) specimens from patients attending the GUM clinic for treatment of genital warts and in one of two specimens from patients attending the clinic for other conditions. By Southern blot, nine (33%) of the 29 specimens from GUM clinic patients were HPV DNA-positive. HPV DNA was detected by PCR in 43 of 104 (41%) of specimens from males attending the ACU, whilst 70 of these tested by Southern blot hybridisation were all negative for HPV DNA.

CONCLUSIONS

The data suggest that urethral HPV infections, as indicated by the presence of HPV DNA in semen, are prevalent in males with and without genital warts.