Incidence and clearance of genital human papillomavirus infection in men (HIM): A cohort study

H Lee Moffitt Cancer Center, Tampa, FL, USA. anna.giuliano@moffi
The Lancet (Impact Factor: 45.22). 02/2011; 377(9769):932-40. DOI: 10.1016/S0140-6736(10)62342-2
Source: PubMed


Human papillomaviruses (HPVs) cause genital warts and cancers in men. The natural history of HPV infection in men is largely unknown, and that information is needed to inform prevention strategies. The goal in this study was to estimate incidence and clearance of type-specific genital HPV infection in men, and to assess the associated factors.
Men (aged 18-70 years), residing in Brazil, Mexico, and the USA, who were HIV negative and reported no history of cancer were recruited from the general population, universities, and organised health-care systems. They were assessed every 6 months for a median follow-up of 27·5 months (18·0-31·2). Specimens from the coronal sulcus, glans penis, shaft, and scrotum were obtained for the assessment of the status of HPV genotypes.
In 1159 men, the incidence of a new genital HPV infection was 38·4 per 1000 person months (95% CI 34·3-43·0). Oncogenic HPV infection was significantly associated with having a high number of lifetime female sexual partners (hazard ratio 2·40, 1·38-4·18, for at least 50 partners vs not more than one partner), and number of male anal-sexual partners (2·57, 1·46-4·49, for at least three male partners vs no recent partners). Median duration of HPV infection was 7·52 months (6·80-8·61) for any HPV and 12·19 months (7·16-18·17) for HPV 16. Clearance of oncogenic HPV infection decreased in men with a high number of lifetime female partners (0·49, 0·31-0·76, for at least 50 female partners vs not more than one partner), and in men in Brazil (0·71, 0·56-0·91) and Mexico (0·73, 0·57-0·94) compared with the USA. Clearance of oncogenic HPV was more rapid with increasing age (1·02, 1·01-1·03).
The data from this study are useful for the development of realistic cost-effectiveness models for male HPV vaccination internationally.
National Cancer Institute.

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    • "Participants at study entry were a median (25%–75% quartile range (QR)) age of 22 years (19–31 years), had none to 3 sexual partners within 6 weeks before sampling (Table S1), were HIV-1 negative, and received no HPV vaccines before or during the course of the study. Genital sampling and DNA extraction have been described previously[35,38]. In brief, saline-wetted Dacron applicators (Digene, Gaithersburg, MD, USA) were used to swab three sites of the external genitalia (glans penis/coronal sulcus, penile shaft, and scrotum), and combined into one sample in 450 µL of specimen transport medium (Digene Corporation, Gaithersburg, MD). "
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    ABSTRACT: Multiple-type human papillomaviruses (HPV) infection presents a greater risk for persistence in asymptomatic individuals and may accelerate cancer development. To extend the scope of HPV types defined by probe-based assays, multiplexing deep sequencing of HPV L1, coupled with an HPV-QUEST genotyping server and a bioinformatic pipeline, was established and applied to survey the diversity of HPV genotypes among a subset of healthy men from the HPV in Men (HIM) Multinational Study. Twenty-one HPV genotypes (12 high-risk and 9 low-risk) were detected in the genital area from 18 asymptomatic individuals. A single HPV type, either HPV16, HPV6b or HPV83, was detected in 7 individuals, while coinfection by 2 to 5 high-risk and/or low-risk genotypes was identified in the other 11 participants. In two individuals studied for over one year, HPV16 persisted, while fluctuations of coinfecting genotypes occurred. HPV L1 regions were generally identical between query and reference sequences, although nonsynonymous and synonymous nucleotide polymorphisms of HPV16, 18, 31, 35h, 59, 70, 73, cand85, 6b, 62, 81, 83, cand89 or JEB2 L1 genotypes, mostly unidentified by linear array, were evident. Deep sequencing coupled with HPV-QUEST provides efficient and unambiguous classification of HPV genotypes in multiple-type HPV infection in host ecosystems.
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    • "A high prevalence of HPV (44.8%) is found in U.S. women 20 to 24 years old (30% low and 28% high-risk subtypes), compared with 24.5% for U.S. women over the broader age range of 14 to 49 (Dunne et al., 2007). Risk might be even greater for men: 50% prevalence was reported among men 18 to 70 years old (38% low risk and 30% high risk subtypes; Giuliano et al., 2011). There is no treatment for the virus, and although most precancerous cells normalize on their own, some do not and can cause anogenital warts and cervical, vulvar, vaginal, penile, anal, or oropharangeal cancer (CDC, 2013b), as well as psychological and sexual consequences (e.g., anger, anxiety, stigma, lower sexual desire) for the individual and relationship partner(s) (Chaturvedi, 2010). "
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    • "The mean duration of infertility in couples of participants in our study was almost two years, supposing that the duration of their stable sexual relationships was even longer. Taking into account the clearance time of HPV infection, which is generally shorter than two years in men, we expected much lower HPV prevalence [42]. "
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