Summary Background 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. Methods 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. Findings 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). Interpretation The data from this study are useful for the development of realistic cost-effectiveness models for male HPV vaccination internationally. Funding National Cancer Institute.
Summary Background Oral human papillomavirus (HPV) infection causes a subset of oropharyngeal cancers. These cancers disproportionately affect men, are increasing in incidence, and have no proven ...prevention methods. We aimed to establish the natural history of oral HPV infection in men. Methods To estimate incidence and clearance of HPV infections, men residing in Brazil, Mexico, and the USA who were HIV negative and reported no history of anogenital cancer were recruited into the HPV Infection in Men (HIM) cohort study. A subset of the cohort who provided two or more oral rinse-and-gargle samples with valid HPV results and who completed a minimum of 2 weeks of follow-up were included in this analysis. Oral rinse-and-gargle samples and questionnaire data were obtained every 6 months for up to 4 years. Samples were analysed for the presence of oncogenic and non-oncogenic HPV infections by the linear array method. Findings 1626 men aged 18–73 years and with a median follow-up of 12·7 months (IQR 12·1–14·7) were included in the analysis. During the first 12 months of follow-up, 4·4% (95% CI 3·5–5·6; n=115 incident infections) of men acquired an incident oral HPV infection, 1·7% (1·2–2·5; n=53 incident infections) an oral oncogenic HPV infection, and 0·6% (0·3–1·1; n=18 incident infections) an oral HPV 16 infection. Acquisition of oral oncogenic HPV was significantly associated with smoking and not being married or cohabiting, but was similar across countries, age groups, and reported sexual behaviours. Median duration of infection was 6·9 months (95 % CI 6·2–9·3; n=45 cleared infections) for any HPV, 6·3 months (6·0–9·9; n=18 cleared infections) for oncogenic HPV, and 7·3 months (6·0–not estimable; n=5 cleared infections) for HPV 16. Eight of the 18 incident oral HPV 16 infections persisted for two or more study visits. Interpretation Newly acquired oral oncogenic HPV infections in healthy men were rare and most were cleared within 1 year. Additional studies into the natural history of HPV are needed to inform development of infection-related prevention efforts. Funding US National Cancer Institute, Merck Sharp & Dohme.
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.
Male sexual behavior influences the rates of cervical dysplasia and invasive cervical cancer, as well as male human papillomavirus
(HPV) infection and disease. Unfortunately, little is known ...regarding male HPV type distribution by age and across countries.
In samples combined from the coronal sulcus, glans penis, shaft, and scrotum of 1,160 men from Brazil, Mexico, and the United
States, overall HPV prevalence was 65.2%, with 12.0% oncogenic types only, 20.7% nononcogenic types only, 17.8% both oncogenic
and nononcogenic, and 14.7% unclassified infections. Multiple HPV types were detected in 25.7% of study participants. HPV
prevalence was higher in Brazil (72.3%) than in the United States (61.3%) and Mexico (61.9%). HPV16 (6.5%), HPV51 (5.3%),
and HPV59 (5.3%) were the most commonly detected oncogenic infections, and HPV84 (7.7%), HPV62 (7.3%), and HPV6 (6.6%) were
the most commonly detected nononcogenic infections. Overall HPV prevalence was not associated with age. However, significant
associations with age were observed when specific categories of HPV, nononcogenic, and unclassified HPV infections were considered.
Studies of HPV type distribution among a broad age range of men from multiple countries is needed to fill the information
gap internationally with respect to our knowledge of HPV infection in men. (Cancer Epidemiol Biomarkers Prev 2008;17(8):2036–43)
The natural history of type-specific human papillomavirus (HPV) infections was examined in a cohort of 331 women aged 18–35 years who self-referred for routine gynecological care. Participants ...underwent a gynecological examination at baseline and at ∼4 and ∼10 months after baseline. Cervical samples were collected for HPV testing and genotyping at each visit, as was information on reproductive, sexual, and medical histories. The rate of new HPV infections was 2.9% per month; the highest rates were observed for HPV types 16, 39, 84, and 51. Among women who tested negative for HPV at baseline, the cumulative probability of acquiring an oncogenic HPV strain during a 12-month follow-up period was 0.32, compared with 0.18 for nononcogenic strains. Women who had had ⩾1 new male sex partner in the recent past were significantly more likely to acquire a new HPV infection (relative hazard, 2.39; 95% confidence interval, 1.20–4.76). The median time to clearance of infection was significantly longer for oncogenic strains (9.8 months) than for nononcogenic strains (4.3 months)
Background. Human papillomavirus (HPV) infections cause disease in men and women, and male-to-female HPV transmission influences the risk of cancer in females. The purpose of the present study was to ...describe the overall and age-specific incidence and clearance of HPV infections in men. Methods. In a prospective cohort study of 290 men aged 18–44 years, participants were examined at baseline and every 6 months, with a mean duration of follow-up of 15.5 months. Results. The period prevalence was 52.8% for any, 31.7% for oncogenic, and 30.0% for nononcogenic HPV infection. The 12-month cumulative risk of acquiring a new HPV infection was 29.2%. Incidences of HPV types 6, 11, 16, and 18 were 2.8, 0.5, 4.8, and 0.8 per 1000 person-months, respectively. The median time to clearance of any HPV infection was 5.9 months (95% confidence interval, 5.7–6.1 months), with comparable times to clearance for oncogenic and nononcogenic infections. Approximately 75% of men tested negative for any HPV 12 months after initial HPV detection. Age was not significantly associated with HPV incidence or duration of infection in men. Conclusion. HPV infection in men was common, with relatively rapid rates of acquisition and clearance.
Background.Human papillomavirus (HPV) is strongly associated with cervical and other anogenital cancers. Identification of risk factors for HPV infection in men may improve our understanding of HPV ...transmission and prevention. Methods.HPV testing for 37 types was conducted in 463 men 18–40 years old recruited from 2 US cities. The entire anogenital region and semen were sampled. A self-administered questionnaire was completed. Multivariate logistic regression aided the identification of independent risk factors for any HPV type, oncogenic HPV types, and nononcogenic HPV types. Results.Prevalence was 65.4% for any HPV, 29.2% for oncogenic HPV, and 36.3% for nononcogenic HPV. Factors significantly associated with any HPV were smoking ⩾10 cigarettes per day (odds ratio OR, 2.3 95% confidence interval {CI}, 1.0–5.3) and lifetime number of female sex partners (FSPs) (OR for ⩾21, 2.5 95% CI, 1.3–4.6), and factors significantly associated with oncogenic HPV were lifetime number of FSPs (OR for ⩾21, 7.4 95% CI, 3.4–16.3) and condom use during the past 3 months (OR for more than half the time, 0.5 95% CI, 0.3–0.8). For nononcogenic HPV, a significant association was found for number of FSPs during the past 3 months (OR for ⩾2, 2.9 95% CI, 1.4–6.3). Conclusions.Lifetime and recent number of FSPs, condom use, and smoking were modifiable risk factors associated with HPV infection in men.
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. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1107–14)
Human papillomavirus (HPV) causes cervical cancer and is strongly associated with other anogenital cancers. Multiple-type
HPV infection has been associated with lengthier infection and precancerous ...lesions. Little is known about multiple-type HPV
prevalence and associated factors in men. We examined the prevalence of and risk factors for multiple-type HPV in primarily
asymptomatic men. Detection of 37 HPV types in male anogenital epithelium and semen was completed in 463 men in two U.S. cities.
The proportions of men with multiple HPV of any type and with multiple oncogenic or nononcogenic types were calculated. Factors
associated with multiple HPV were evaluated using multinomial logistic regression. Overall, 22.9% of men had multiple-HPV,
8.6% of men had multiple oncogenic types, and 13.4% had multiple nononcogenic types. Greater proportions of samples at the
shaft, glans/corona, and scrotum had multiple HPV types (18.7%, 12.8%, and 7.3%, respectively) than did other anogenital sites
(all ≤2.8%). Factors independently associated with multiple-type HPV were Hispanic ethnicity adjusted odds ratio (AOR), 2.45;
95% confidence interval (95% CI), 1.05-5.67, concurrent detection of genital warts (AOR, 10.40; 95% CI, 1.12-96.6), smoking
≥10 cigarettes/d (AOR, 3.00; 95% CI, 1.07-8.43), greater lifetime number of female sexual partners (AOR, 13.73 for ≥21 versus
1-5; 95% CI, 5.34-35.3), and condom use less than half the time (AOR, 2.03; 95% CI, 1.07-3.84). Detection of multiple HPV
types in this study of primarily asymptomatic men was common, particularly at external genital sites. Lifetime number of female
sex partners, condom use, and smoking were modifiable factors associated with multiple HPV. (Cancer Epidemiol Biomarkers Prev
2009;18(4):1077–83)
Background. Data supporting the efficacy of condoms against human papillomavirus (HPV) infection in males are limited. Therefore, we examined the effect of consistent condom use on genital HPV ...acquisition and duration of infection. Methods. A prospective analysis was conducted within the HPV Infection in Men Study, a multinational HPV cohort study. Men who were recently sexually active (n = 3323) were stratified on the basis of sexual risk behaviors and partnerships. Using Cox proportional hazards regression, type-specific incidence of HPV infection and clearance were modeled for each risk group to assess independent associations with condom use. Results. The risk of HPV acquisition was 2-fold lower among men with no steady sex partner who always used condoms, compared with those who never used condoms (hazard ratio, 0.54), after adjustment for country, age, race, education duration, smoking, alcohol, and number of recent sex partners. The probability of clearing an oncogenic HPV infection was 30% higher among nonmonogamous men who always used condoms with nonsteady sex partners, compared with men who never used condoms (hazard ratio, 1.29), after adjustment for country, age, race, education duration, marital status, smoking, alcohol, and number of recent sex partners. No protective effects of condom use were observed among monogamous men. Conclusions. Condoms should be promoted in combination with HPV vaccination to prevent HPV infection in men.
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