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Shapiro SB, Laurie C, El-Zein M, Franco EL. Association between male circumcision and human papillomavirus infection in males and females: a systematic review, meta-analysis, and meta-regression. Clin Microbiol Infect 2023:S1198-743X(23)00149-0. [PMID: 37011808 DOI: 10.1016/j.cmi.2023.03.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/05/2023] [Accepted: 03/25/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Previous studies have suggested a protective effect of male circumcision on human papillomavirus (HPV) infections in males, and that this protection may be conferred to their female sexual partners. OBJECTIVES To synthesize the available evidence on the association between male circumcision and HPV infections in males and females. DATA SOURCES We searched MEDLINE, Embase, Scopus, Cochrane, LILACS, and ProQuest Dissertations & Theses Global for records published up to 22 June 2022. STUDY ELIGIBILITY We considered observational and experimental studies that assessed male circumcision status and HPV prevalence, incidence, or clearance in males or females for inclusion. PARTICIPANTS Males and their female sexual partners who were tested for genital HPV infection. INTERVENTIONS Male circumcision compared to no circumcision. RISK OF BIAS ASSESSMENT The Newcastle-Ottawa scale was used for observational studies and the Cochrane risk-of-bias tool was used for randomized trials. DATA SYNTHESIS We estimated summary measures of effect and 95% confidence intervals (CI) for the prevalence, incidence, and clearance of HPV infections in males and females using random-effects meta-analysis. We assessed effect modification of circumcision on HPV prevalence by penile site in males using random-effects meta-regression. RESULTS Across 32 studies, male circumcision was associated with decreased odds of prevalent HPV infections (OR 0.45, CI 0.34-0.61), a reduced incidence rate of HPV infections (IRR 0.69, CI 0.57-0.83), and an increased risk of clearing HPV infections (RR 1.44, CI 1.28-1.61) at the glans penis among male subjects. Circumcision conferred greater protection against infection at the glans than shaft (OR 0.68, 95% CI 0.48-0.98). Females with circumcised partners were protected from all outcomes. CONCLUSIONS Male circumcision may protect against various HPV infection outcomes, suggesting its prophylactic potential. Understanding site-specific effects of circumcision on HPV infection prevalence has important implications for studies of HPV transmission.
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Shapiro SB, Wissing MD, Khosrow-Khavar F, El-Zein M, Burchell AN, Tellier PP, Coutlée F, Franco EL. Male Circumcision and Genital Human Papillomavirus (HPV) Infection in Males and Their Female Sexual Partners: Findings From the HPV Infection and Transmission Among Couples Through Heterosexual Activity (HITCH) Cohort Study. J Infect Dis 2022; 226:1184-1194. [PMID: 35429378 PMCID: PMC10233487 DOI: 10.1093/infdis/jiac147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/13/2022] [Indexed: 02/11/2024] Open
Abstract
BACKGROUND Previous studies examining the association between male circumcision (MC) and human papillomavirus (HPV) infections have reported inconsistent results. We used data from the HPV Infection and Transmission Among Couples Through Heterosexual Activity (HITCH) cohort study to examine the association between MC and HPV infections in males and their female sexual partners. METHODS We enrolled monogamous couples in a longitudinal study between 2005 and 2011 in Montreal, Canada. We used logistic and Poisson regression models with propensity score adjustment to estimate odds ratios (ORs) and rate ratios for the association between MC and the prevalence, transmission, and clearance of HPV infections. RESULTS Four hundred thirteen couples were included in our study. The prevalence OR for the association between MC and baseline infections was 0.81 (95% confidence interval [CI], .56-1.16) in males and 1.05 (95% CI, .75-1.46) in females. The incidence rate ratio for infection transmission was 0.59 (95% CI, .16-2.20) for male-to-female transmission and 0.77 (95% CI, .37-1.60) for female-to-male transmission. The clearance rate ratio for clearance of infections was 0.81 (95% CI, .52-1.24). CONCLUSIONS We found little evidence of an association between MC and HPV infection prevalence, transmission, or clearance in males and females. Further longitudinal couple-based studies are required to investigate this association.
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Affiliation(s)
- Samantha B Shapiro
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
| | - Michel D Wissing
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
| | - Farzin Khosrow-Khavar
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
| | - Mariam El-Zein
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
| | - Ann N Burchell
- Department of Family and Community Medicine and MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - François Coutlée
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
- Laboratoire de virologie moléculaire, Centre de recherche du Centre hospitalier de l’Université de Montréal, et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Quebec, Canada
| | - Eduardo L Franco
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montréal, Quebec, Canada
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Hebnes JB, Munk C, Frederiksen K, Joergensen HO, Iftner T, Kjaer SK. The role of circumcision, tobacco, and alcohol use in genital human papillomavirus infection among men from Denmark. Int J STD AIDS 2021; 32:1028-1035. [PMID: 33978528 DOI: 10.1177/09564624211014727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is crucial to understand the natural history of genital human papillomavirus (HPV) infection in men to prevent the increasing male HPV-related disease burden. We evaluated the associations between HPV infection and circumcision, smoking, and alcohol use after accounting for sexual behavior. The study included 2331 male personnel from Danish barracks. Penile swabs were tested for HPV DNA with a polymerase chain reaction assay, INNO-LiPA. All men completed a self-administered questionnaire providing data on potential risk factors for HPV such as lifestyle and sexual habits. Using multivariable logistic regression, associations between potential risk factors and HPV infection were estimated and expressed as odds ratios (ORs) with 95% confidence intervals (CI). Current cigarette smoking was associated with increased odds of HPV detection (OR = 1.2; 95% CI: 1.0-1.4), but we found no association with alcohol use in the analysis adjusted for sexual behavior. Circumcision reduced the odds of a prevalent HPV infection (OR = 0.7; 95% CI: 0.5-1.0) although not statistically significantly. Strong associations with lifetime and recent number of female sex partners were observed, but in contrast to uncircumcised men, increasing number of sex partners was not associated with higher HPV prevalence in circumcised men. In conclusion, smoking was associated with increased odds of penile HPV in men from the general population in Denmark, whereas circumcision seemed to reduce the risk. Moreover, our results indicated that there might be differences in the viral susceptibility between circumcised and uncircumcised men.
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Affiliation(s)
- Julie B Hebnes
- Unit of Virus, Lifestyle and Genes, 165143Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Christian Munk
- Unit of Virus, Lifestyle and Genes, 165143Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Kirsten Frederiksen
- Unit of Statistics and Pharmacoepidemiology, 165143Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | - Thomas Iftner
- Medical Virology, Section of Experimental Virology, University Hospital of Tübingen, Tübingen, Germany
| | - Susanne K Kjaer
- Unit of Virus, Lifestyle and Genes, 165143Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Vieira CB, Feitoza L, Pinho J, Teixeira-Júnior A, Lages J, Calixto J, Coelho R, Nogueira L, Cunha I, Soares F, Silva GEB. Profile of patients with penile cancer in the region with the highest worldwide incidence. Sci Rep 2020; 10:2965. [PMID: 32076037 PMCID: PMC7031540 DOI: 10.1038/s41598-020-59831-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 01/31/2020] [Indexed: 11/16/2022] Open
Abstract
To determine the epidemiological, histopathological, and clinical characteristics of patients diagnosed with penile cancer in the Brazilian state of Maranhão, the region with the highest incidence worldwide. One hundred and sixteen penile cancer patients were interviewed from July 2016 to October 2018. The majority of patients lived in a rural area (57%), worked in farming (58%), had a low level of schooling or no schooling (90%), and were married or in a stable relationship (74%). The mean age was 60.4 ± 16.51 years (range, 23–93 years). Phimosis (66%), poor/moderate genital hygiene (73%), history of sexually transmitted infections (55%), and zoophilia (60%) were found in the majority of patients. Most patients had their first sexual encounter at 16.2 ± 2.8 years (range, 10–25 years), and 75% had >6 sexual partners. The most common initial symptom was pruritus (37%), and most patients waited to seek treatment (average time to treatment, 18.9 months; range, 2–84 months). Human papillomavirus (HPV)-related histologies were observed in 62% of patients. Most patients had histological grades II or III (87%), stage ≥T2 disease (84%), and lymphadenopathy at admission (42%). Penectomy was performed in 96% of patients. The population with penile cancer in the region of highest incidence in the world is marked by low socioeconomic status, high prevalence of HPV infection, and phimosis. The delay in seeking treatment is related to a very high rate of advanced cancer and aggressive surgical treatment. The high prevalence of young patients was also a striking feature.
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Affiliation(s)
- Ciro Bezerra Vieira
- University Hospital of Federal University of Maranhão (UFMA), Barão de Itapari Street, Centro, São Luís, Brazil
| | - Laisson Feitoza
- Department of Radiology, University Clinic Hospital of Estadual University of Campinas, Campinas, Brazil
| | - Jaqueline Pinho
- Laboratory of Immunofluorescence and Electron Microscopy (LIME), Presidente Dutra University Hospital (HUUFMA), São Luís, MA, Brazil
| | - Antonio Teixeira-Júnior
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão (UFMA), São Luis, MA, Brazil
| | - Joyce Lages
- Department of Public Health, Presidente Dutra University Hospital (HUUFMA), São Luís, MA, Brazil
| | - José Calixto
- Department of Medicine II, Federal University of Maranhão (UFMA), São Luís, MA, Brazil
| | - Ronald Coelho
- Doctor, Oncologist at the Aldenora Bello Cancer Hospital (HCAB), São Luís, MA, Brazil
| | - Leudivan Nogueira
- Doctor, Urologist at the Aldenora Bello Cancer Hospital (HCAB), São Luís, MA, Brazil
| | - Isabela Cunha
- Doctor at the Antônio Prudente Foundation, São Paulo, Brazil
| | - Fernando Soares
- Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Gyl Eanes Barros Silva
- Laboratory of Immunofluorescence and Electron Microscopy (LIME), Presidente Dutra University Hospital (HUUFMA), São Luís, MA, Brazil. .,Department of Pathology, Ribeirão Preto Medical of School, University of São Paulo (USP), Ribeirão Preto, Brazil.
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Sichero L, Giuliano AR, Villa LL. Human Papillomavirus and Genital Disease in Men: What We Have Learned from the HIM Study. Acta Cytol 2019; 63:109-117. [PMID: 30799416 DOI: 10.1159/000493737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 01/01/2023]
Abstract
It is currently recognized that in addition to the major impact of human papillomavirus (HPV) infection in females, HPV causes considerable disease in men at the genitals, anal canal, and oropharynx. Specifically, genital HPV infections may progress to genital warts and penile carcinoma. Although studies concerning the natural history of HPV infections and associated neoplasias have mainly focused on women, during the last 2 decades considerable attention has been given in further understanding these infections in men. The HIM (HPV infection in men) Study, the only prospective multicenter study of male HPV natural history, consisted of a large prospective international cohort study in which men from Brazil, the United States, and Mexico were enrolled. The design and protocols of this study allowed unraveling crucial information regarding the relationship between HPV infection and clinical consequences in men, and associated risk factors at each of the anatomic sites where HPV is known to cause cancer in men.
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Affiliation(s)
- Laura Sichero
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, and the Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Luisa Lina Villa
- Center for Translational Research in Oncology, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil,
- Department of Radiology and Oncology, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil,
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Dave S, Afshar K, Braga LH, Anderson P. Canadian Urological Association guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants (full version). Can Urol Assoc J 2018; 12:E76-E99. [PMID: 29381458 PMCID: PMC5937400 DOI: 10.5489/cuaj.5033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Sumit Dave
- Department of Surgery (Urology), Western University, London, ON; Canada
| | - Kourosh Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Luis H. Braga
- Department of Surgery (Urology), McMaster University, Hamilton, ON; Canada
| | - Peter Anderson
- Department of Urology, Dalhousie University, Halifax, NS; Canada
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Kidd LC, Chaing S, Chipollini J, Giuliano AR, Spiess PE, Sharma P. Relationship between human papillomavirus and penile cancer-implications for prevention and treatment. Transl Androl Urol 2017; 6:791-802. [PMID: 29184775 PMCID: PMC5673821 DOI: 10.21037/tau.2017.06.27] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 06/22/2017] [Indexed: 11/06/2022] Open
Abstract
Penile cancer is a rare disease in the United States, but rates are increasing, causing concern. Several risk factors have been associated with the disease, including human papillomavirus (HPV) infection. Knowledge of HPV pathogenesis has led to the development of a vaccine, which has proven instrumental in reducing the incidence of female HPV-related cancers, but results in men have yet to be elucidated. Fortunately, rates of vaccination are up-trending in both males and females in the past several years. In addition, targeted therapies are the focus of several ongoing research efforts. Some of these therapeutics are currently in use, while several are in trials. With continued patient education and research, both treatment and prevention of HPV-related pre-malignant lesions and penile cancer will likely diminish.
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Affiliation(s)
- Laura C. Kidd
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sharon Chaing
- Department of Urology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Juan Chipollini
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Anna R. Giuliano
- Center for Infection Research in Cancer (CIRC), Moffitt Cancer Center, Tampa, FL, USA
| | - Philippe E. Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Pranav Sharma
- Department of Urology, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Lifestyle factors and oncogenic papillomavirus infection in a high-risk male population. PLoS One 2017; 12:e0184492. [PMID: 28898279 PMCID: PMC5595320 DOI: 10.1371/journal.pone.0184492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 08/24/2017] [Indexed: 01/27/2023] Open
Abstract
Background High risk human papillomavirus (HR-HPV) infection in males is a health issue with implications for HPV-related lesions in their partners. The identification of risk factors for male infection may improve our understanding of HR-HPV transmission and prevention. The aim of this study was to evaluate the relationships between lifestyle, genital warts and HR-HPV infection. The study was focused on men with an increased risk of HR-HPV infection: male sexual partners of women diagnosed with high-grade squamous intraepithelial cervical lesions. Methods Men were enrolled and prospectively recruited within the first six months after diagnosis of cervical lesions in their female partners (n = 175, 2013–2016). Epidemiological and sexual behaviour data were obtained. The presence of genital warts was established by visual inspection. Detection and genotyping of HR-HPV infection in genital samples were performed with a Linear Array HPV Genotyping Test. All HR-HPV positive men were offered a follow-up exam at 12 months. SPSS version 19 was used for statistical analysis. Results and discussion The prevalence of HR-HPV infection in men was 45.1% (79/175). Genital warts were observed in 10.3% (18/175) of the subjects. Detection of genital warts (OR 3.5, p = 0.015), smoking habits (OR 2.3, p = 0.006) and sexual debut before 16 years old (OR 2, p = 0.035) were associated with an increased risk for HR-HPV infection (univariate analysis). This association was also observed for genital warts and smoking status in a multivariate analysis. The same genotype was found after one year in 71.4% (20/28) of subjects. Conclusions The presence of genital warts and smoking habits seem to be associated with a higher risk of HR-HPV infection in males. Earlier sexual debut may increase this risk. Extensive knowledge of the natural history of HR-HPV infection in males is an absolute requirement for the design and implementation of prevention strategies for the general population as well as for specific populations such as couples after treatment for high-grade cervical lesions.
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Lu CW, Hong HS, Lu CF, Ko YS. Human papillomavirus-70 infection as a possible pathogenesis of eruptive scrotal calcinosis. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2017.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Spiess PE, Dhillon J, Baumgarten AS, Johnstone PA, Giuliano AR. Pathophysiological basis of human papillomavirus in penile cancer: Key to prevention and delivery of more effective therapies. CA Cancer J Clin 2016; 66:481-495. [PMID: 27314890 DOI: 10.3322/caac.21354] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Answer questions and earn CME/CNE Squamous cell carcinoma (SCC) of the penis is a rare malignancy in the United States, with a significantly higher incidence-up to 20 to 30 times greater-in areas of Africa and South America. This can be explained in part by the significantly greater prevalence of sexually transmitted diseases among high-risk males often having unprotected sex with multiple sexual partners. Human papillomavirus (HPV) has been implicated as the infectious pathway by which several these penile neoplasms originate from precursor lesions. In this regard, a fundamental understanding of HPV in penile carcinogenesis can have meaningful implications in understanding 1) the diagnosis of HPV-related precursor penile lesions, 2) targeting HPV-specific molecular pathways, and 3) cancer prevention. Using vaccination programs not only may improve patient outcomes but also may minimize the need for highly aggressive and often debilitating surgical resection. CA Cancer J Clin 2016;66:481-495. © 2016 American Cancer Society.
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Affiliation(s)
- Philippe E Spiess
- Associate Member, Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Jasreman Dhillon
- Assistant Member, Department of Anatomical Pathology, Moffitt Cancer Center, Tampa, FL
| | - Adam S Baumgarten
- Urology Resident Physician, Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL
| | - Peter A Johnstone
- Senior Member, Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL
| | - Anna R Giuliano
- Senior Member, Department of Infection and Cancer, Moffitt Cancer Center, Tampa, FL
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Tsikopoulos G, Asimakidou M, Smaropoulos E, Farmakis K, Klokkaris A. Circumcision - A new approach for a different cosmetic result. Hippokratia 2014; 18:116-119. [PMID: 25336872 PMCID: PMC4201395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To assess the difference in aesthetic result after a non-religious circumcision with classic Johnston's technique and a new proposed technique. MATERIALS AND METHODS A total of 76 children were circumcised (not for religious purposes) in a period of 6 years using the classic Johnston's technique (50 patients) and a new proposed technique (26 patients). Parents of circumcised children were interviewed three months after the operation. The aesthetic result was scored by both the parents and the patients as bad, acceptable, good or very good. Scores between the two groups were compared. RESULTS No major complications were encountered. The aesthetic result score between the two groups had a statistically significant difference (Mann Whitney U Test, p<0.0005). Children being circumcised with the new technique and their parents were more satisfied with the aesthetic result three months after the operation. CONCLUSIONS In communities in which religious circumcisions are being performed relatively rare, the aesthetic result of a classic method may seem awkward to the patient and his family. Therefore, circumcision being performed for non religious reasons necessitates an acceptable aesthetic result. Our technique fulfills this prerequisite. Hippokratia 2014; 18 (2):116-119.
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Affiliation(s)
- G Tsikopoulos
- Paediatric Surgery Department, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - M Asimakidou
- Paediatric Surgery Department, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - E Smaropoulos
- Paediatric Surgery Department, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - K Farmakis
- Paediatric Surgery Department, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - A Klokkaris
- Paediatric Surgery Department, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
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Albero G, Castellsagué X, Lin HY, Fulp W, Villa LL, Lazcano-Ponce E, Papenfuss M, Abrahamsen M, Salmerón J, Quiterio M, Nyitray AG, Lu B, Bosch FX, Giuliano AR. Male circumcision and the incidence and clearance of genital human papillomavirus (HPV) infection in men: the HPV Infection in men (HIM) cohort study. BMC Infect Dis 2014; 14:75. [PMID: 24517172 PMCID: PMC3925013 DOI: 10.1186/1471-2334-14-75] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/05/2014] [Indexed: 12/05/2022] Open
Abstract
Background Reported associations of male circumcision (MC) with human papillomavirus (HPV) infection in men have been inconsistent. Methods 4,033 healthy men were examined every six months for a median of 17.5 months. In each study visit, exfoliated cell specimens from the coronal sulcus/glans penis, penile shaft, and scrotum were collected and combined into one sample per person for HPV DNA detection. Samples were tested for 37 HPV types. Cox proportional hazards models were used to evaluate the association between MC and the incidence and clearance of HPV infections and specific genotypes. Results The overall incidence of new HPV infections did not differ by MC status (for any HPV, adjusted hazard ratio (aHR) 1.08, 95% confidence interval (CI) 0.91-1.27). However, incidence was significantly lower among circumcised versus uncircumcised men for HPV types 58 (p = 0.01), 68 (p < 0.001), 42 (p = 0.01), 61 (p < 0.001), 71 (p < 0.001), 81 (p = 0.04), and IS39 (p = 0.01), and higher for HPV types 39 (p = 0.01) and 51 (p = 0.02). Despite the lack of an overall association in the risk of HPV clearance by MC (for any HPV, aHR 0.95, 95% CI 0.88-1.02), median times to clearance were significantly shorter among circumcised than uncircumcised men for HPV types 33 (p = 0.02) and 64 (p = 0.04), and longer for HPV types 6 (p < 0.001), 16 (p < 0.001), and 51 (p = 0.02). Conclusions MC is not associated with the incidence and clearance of genital HPV detection, except for certain HPV types. The use of a single combined sample from the penis and scrotum for HPV DNA detection likely limited our ability to identify a true effect of MC at the distal penis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Anna R Giuliano
- H, Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA.
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Schabath MB, Villa LL, Lin HY, Fulp WJ, Lazcano-Ponce E, Salmerón J, Abrahamsen ME, Papenfuss MR, Quiterio M, Giuliano AR. A prospective analysis of smoking and human papillomavirus infection among men in the HPV in Men Study. Int J Cancer 2013; 134:2448-57. [PMID: 24222514 DOI: 10.1002/ijc.28567] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/06/2013] [Accepted: 10/16/2013] [Indexed: 11/07/2022]
Abstract
At present it is unknown whether the higher prevalence of human papillomavirus (HPV) infection among smokers in men is attributed to a higher probability of acquiring an infection or because of longer infection persistence. Thus, we investigated the role of smoking on the incidence (acquisition) and clearance (persistence) of genital HPV infections among 4,026 men in the HPV in Men (HIM) Study, a multinational prospective study of the natural history of genital HPV infection in men. Genital HPV infections were grouped by any, oncogenic and nononcogenic HPV infections and smoking status was categorized as current, former and never smokers. The incidence of any, oncogenic and nononcogenic HPV infections was significantly higher among current smokers compared to former and never smokers (p < 0.01). In multivariable analyses adjusting for sexual behavior and potential confounders, when compared to never smokers, current smokers exhibited significantly higher probability of acquiring any [hazard ratio (HR) = 1.23; 95% confidence interval (CI) 1.02-1.50] and nononcogenic (HR = 1.21; 95% CI 1.00-1.45) infections and a borderline significant probability for oncogenic infections (HR = 1.18; 95% CI 0.98-1.41). Although the median duration of HPV infection was generally longer among current smokers, we found no statistically significant associations in the multivariable analyses. Overall, these results demonstrated that current smoking exhibited the highest incidence and highest probability of acquiring genital HPV infections.
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Affiliation(s)
- Matthew B Schabath
- Division of Population Sciences, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
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Barriers to Human Papillomavirus Vaccine Acceptability in Israel. Vaccine 2013; 31 Suppl 8:I53-7. [DOI: 10.1016/j.vaccine.2013.06.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/06/2012] [Accepted: 06/18/2013] [Indexed: 11/20/2022]
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