Comment

Male circumcision and HPV transmission to female partners

The causative role of human papillomavirus (HPV) in cervical carcinogenesis is well established; however, prospective studies examining high-risk(HR)-HPV acquisition among adult women in HIV-prevalent settings are limited.

We conducted a prospective study among women (25–60 years) attending cervical cancer screening in Tanzania. Cervical specimens obtained at enrolment and follow-up were tested for HPV. Participants were interviewed on lifestyle and tested for HIV.

Among 3805 eligible women, 3074 (80.8%) attended follow-up (median time between the 2 examinations, 17.3 months); 307 had missing HPV results at enrolment or follow-up, leaving 2767 study participants. Among 2253 women initially HR-HPV negative, 184 acquired HR-HPV—incidence: 54.5 per 1000 person-years (95% CI:47.1–62.9); among HIV-positive women 75.2 per 1000 person-years (95% CI:54.5–103.7), HIV-negative 50.9 per 1000 person-years (95% CI:43.3–60.0). HPV52 and HPV16 were the most frequently acquired types. In multivariable regression analysis, HIV positivity, low CD4 count, younger age, and multiple sexual partners were associated with increased odds of HPV acquisition.

HPV acquisition was higher among HIV-positive than HIV-negative women, especially women with low CD4 counts. Improvement of immune status among HIV-positives may decrease HPV acquisition. Nonavalent HPV vaccination should be considered given the pattern of HR-HPV types acquired.

Male human papillomavirus (HPV) infection significantly contributes to infection and subsequent cervical disease in women. Case-control studies of women with cervical cancer and their husbands have demonstrated that men’s sexual behavior affects women’s risk of cervical neoplasia, even when controlling for female sexual activity. In areas with a high incidence of cervical cancer, men’s sexual behavior is in itself a risk factor for cervical neoplasia. Among men with a history of multiple sexual partners, male circumcision was associated with a reduced risk of penile HPV infection and a reduced risk of cervical cancer in their current female partners.

Little is known about the characteristics of high-risk papillomavirus (HR-HPV) infection in men. The aims of this cross-sectional study were: (a) to investigate HR-HPV prevalence and genotype distribution in men, sexual partners of women presenting with high-grade cervical intraepithelial neoplasia (HG-CIN), according to epidemiological characteristics, and (b) to assess type-specific concordance between partners.

A total of 125 men were recruited within the first 6 months after HG-CIN diagnosis of their partner. Samples from the coronal sulcus, glans penis shaft, and scrotum were tested with linear array HPV genotyping assay (Roche Diagnostics, Mannheim, Germany). Type-specific concordance within 120 couples was studied. Epidemiological factors were evaluated by multivariate logistic regression analysis. SPSS 19 (IBM, Chicago, USA).

The prevalence of HR-HPV infection in males was 50.4% (63/125). HPV16/53/52/51/66/31 were the most frequent genotypes (24/10.4/9.6/8.8/8/7.2%, respectively). Current smoking was associated with an increased risk for HR-HPV infection in men (38.2% (21/55) vs 60% (42/70), OR 2.4, p = 0.025). Among 60 infected couples, 62% shared at least one genotype: 41.7% couples were concordantly HPV16 positive and 18.3% were HPV16 negative (kappa value: 0.21). The proportion of women with the same genotype as their male partner was higher than the proportion of men sharing the same genotype as their female partner: 58.7% (37/63) vs 30.8% (37/120), p < 0.0001.

Sexual partners of women with HG-CIN are a significant reservoir and vector of HPV infection, a fact that could contribute to making viral clearance more difficult to achieve in their partners after treatment of their HG-CIN lesions.

Las características de la infección por papilomavirus de alto riesgo (VPH-AR) en el varón apenas se conocen. Los objetivos de este estudio transversal fueron: (a) investigar la prevalencia de VPH-AR y la distribución de genotipos en varón pareja sexual de mujer con neoplasia intraepitelial cervical de alto grado (CIN-AG) y su epidemiología, y (b) evaluar la concordancia tipo-específica entre parejas.

Se seleccionaron hombres (n = 125) en los primeros 6 meses tras el diagnóstico de CIN-AG de su pareja. Se genotiparon muestras del surco coronario, base del glande y escroto (Linear Array, Roche Diagnostics, Mannheim, Alemania). Se estudió la concordancia tipo-específica entre parejas (n = 120). Los factores epidemiológicos se evaluaron mediante regresión logística multivariante, SPSS 19 (IBM, Chicago, USA).

La prevalencia de VPH-AR en el hombre fue del 50,4% (63/125). VPH16/53/52/51/66/31 fueron los genotipos más frecuentes (24/10,4/9,6/8,8/8/7,2%, respectivamente). El tabaquismo se asoció con un mayor riesgo de infección por VPH-AR en el hombre (38,2% [21/55] vs 60% [42/70], OR 2,4, p = 0,025). Entre 60 parejas infectadas, el 62% compartieron al menos un genotipo: el 41,7% fueron concordantes VPH16 positivas y el 18,3% VPH16 negativas (valor kappa: 0,21). La proporción de mujeres con el mismo genotipo que su pareja fue mayor que la de hombres con el mismo genotipo que su pareja: 58,7% (37/63) vs 30,8% (37/120), p < 0,0001.

Las parejas sexuales de mujeres con CIN-AG constituyen un importante reservorio y vector de infección por VPH; esto podría contribuir a que el aclaramiento viral de sus parejas tras el tratamiento de CIN-AG fuese más difícil de alcanzar.