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Nugent D, Apoola A, Coleman H, Gilmour C, Lawton MD, Nori A, D C Ross J, Whitlock G, Yeend-Curd-Trimble H. British association for sexual health and HIV national guideline for the management of anogenital warts in adults (2024). Int J STD AIDS 2024; 35:498-509. [PMID: 38456387 DOI: 10.1177/09564624241233338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of human papillomavirus (HPV)-related warts at anogenital sites including the external genitals, vagina, cervix, urethra, perianus and anal canal. The guideline is aimed primarily at patients aged 16 years or older presenting to healthcare professionals working in level 3 sexual health services in the United Kingdom. However, the principles of the recommendations may be applied in other care settings, including in primary care, using locally adapted care pathways where appropriate. The management of HPV-related anogenital dysplasia or warts at other extragenital sites is outside the scope of this guideline.
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Affiliation(s)
- Diarmuid Nugent
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | - Ade Apoola
- Derbyshire Community Health Services NHS Foundation Trust, Derby, UK
| | - Harry Coleman
- Central & North West London NHS Foundation Trust, London, UK
| | - Cindy Gilmour
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | | | - Achyuta Nori
- Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D C Ross
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Whitlock
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
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Rivera-Santiago T, Ramos-Cartagena JM, Amaya-Ardila C, Muñoz C, Guiot HM, Colón-López V, Matos M, Tirado-Gómez M, Patricia Ortiz A. Association of tobacco use and the presence of anal warts in people who attend the anal Neoplasia clinic in Puerto Rico. Prev Med Rep 2024; 37:102546. [PMID: 38186663 PMCID: PMC10767185 DOI: 10.1016/j.pmedr.2023.102546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Limited research exists regarding the association between smoking and anal warts. In this study, we evaluated this association among a clinic-based Hispanic population in Puerto Rico. Methods Cross-sectional study among eligible patients seen at the Anal Neoplasia Clinic of the University of Puerto Rico Comprehensive Cancer Center (2016-2023) (n = 920). Sociodemographic and clinical variables were collected from medical records. Patients underwent a high-resolution anoscopy (HRA) during the clinical visit; physicians assessed anal condylomas on HRA. Poisson regression models with robust standard errors were used to evaluate the association between smoking and anal warts. Demographic and clinical factors were also assessed. Results The mean age of participants was 45.8 ± 13.1 years, 66.4 % were men, and 21.6 % were current smokers. While 10.8 % self-reported a history of anogenital condylomas, 18.9 % had anal condylomas on clinical evaluation. A higher prevalence of anal condylomas was observed among current smokers (PR = 1.28, 95 % CI: 0.94-1.75) in comparison to non-smokers in adjusted analysis, but this was not statistically significant. However, a higher prevalence of anal condylomas was observed among younger individuals (PR = 0.96, 95 % CI: 0.96-0.98) and individuals with anal high-grade squamous intraepithelial lesions (HSIL) as compared to those with benign histology (PR = 1.74. 95 % CI: 1.09-2.77). Conclusions Although current smoking seemed to be positively associated with anal condylomas in this high-risk Hispanic population, this finding was not statistically significant as the power to detect an association was limited. However, younger age and HSIL diagnosis were associated with a higher prevalence of anal condylomas.
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Affiliation(s)
- Tanialy Rivera-Santiago
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus PO Box 365067, San Juan, Puerto Rico 00936, U.S
| | - Jeslie M. Ramos-Cartagena
- University of Puerto Rico Medical Sciences Campus/MD Anderson Cancer Center Partnership for Excellence in Cancer Research Program, PO Box 363067 San Juan, Puerto Rico 00936, U.S
| | | | - Cristina Muñoz
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027 San Juan, Puerto Rico 00936, U.S
| | - Humberto M. Guiot
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027 San Juan, Puerto Rico 00936, U.S
- Department of Medicine, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico, U.S
- Department of Microbiology and Medical Zoology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, U.S
| | - Vivian Colón-López
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027 San Juan, Puerto Rico 00936, U.S
| | - Miriam Matos
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, U.S
| | - Maribel Tirado-Gómez
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027 San Juan, Puerto Rico 00936, U.S
| | - Ana Patricia Ortiz
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus PO Box 365067, San Juan, Puerto Rico 00936, U.S
- University of Puerto Rico Comprehensive Cancer Center, PO Box 363027 San Juan, Puerto Rico 00936, U.S
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Gilson R, Nugent D, Werner RN, Ballesteros J, Ross J. 2019 IUSTI-Europe guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol 2021; 34:1644-1653. [PMID: 32735077 DOI: 10.1111/jdv.16522] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 04/01/2020] [Indexed: 12/31/2022]
Abstract
This guideline is an update of the 2011 European Guideline for the Management of Anogenital Warts. It is intended to support best practice in the care of patients with anogenital warts by including evidence-based recommendations on diagnosis, treatment, follow-up and advice to patients. It is intended for use by healthcare professionals in sexual healthcare or dermato-venereology clinics in Europe but may be adapted for use in other settings where the management of anogenital warts is undertaken. As a European guideline, recommendations should be adapted according to national circumstances and healthcare systems. Despite the availability of vaccine to prevent HPV types 6 and 11, the cause of >95% anogenital warts, they remain an important and frequent health problem. The previous systematic review of randomized controlled trials for anogenital warts was updated. The changes in the present guideline include the following: Updated background information on the prevalence, natural history and transmission of human papillomavirus (HPV) infection and anogenital warts. Key recommendations for diagnosis and treatment have been graded according to the strength of the recommendation and the quality of supporting evidence. 5-fluorouracil, local interferon and photodynamic therapy have been evaluated and included as potential second-line treatment options. Evidence of the impact of HPV vaccination on the incidence of anogenital warts has been updated.
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Affiliation(s)
- R Gilson
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - D Nugent
- Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK.,The Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK
| | - R N Werner
- Department of Dermatology, Venereology and Allergy, Division of Evidence-Based Medicine (dEBM), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | | | - J Ross
- University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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Mueller SM, Menzi S, Kind AB, Blaich A, Bayer M, Navarini A, Itin P, Brandt O. Sexually transmitted coinfections in patients with anogenital warts - a retrospective analysis of 196 patients. J Dtsch Dermatol Ges 2020; 18:325-332. [PMID: 32291912 DOI: 10.1111/ddg.14060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Anogenital warts (AGWs) are most commonly caused by low-risk human papillomavirus (HPV) types, and although they are the most frequent viral sexually transmitted infections (STIs), little is known about STI coinfections in affected patients. We therefore sought to assess STI coinfection rates in patients with AGW, specify STI coinfections and calculate the number needed to screen (NNS) for each STI. METHODS A retrospective cross-sectional study analyzing data sets from AGW patients treated in our clinic between 2008-2016. RESULTS 142/196 (72 %) patients had been variably screened for infections with HIV, HBV and HCV, Treponema pallidum, Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and HSV. The STI coinfection rate in all tested patients was 24.6 %, yielding an NNS of 4.1 to detect any STI. Of note, the coinfection rate did not differ significantly between heterosexual men, homosexual men and women, respectively. The NNS for syphilis was 8.4, for HIV 14.0, for HCV 28.5 and for HBV 39.0. The NNS for asymptomatic patients tested for HSV, Chlamydia trachomatis and Mycoplasma genitalium were 1.4, 5.3 and 12.0, respectively. CONCLUSION Due to the high prevalence of STI coinfections, AGW patients should be screened for other STIs.
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Affiliation(s)
- Simon M Mueller
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Sheryl Menzi
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - André B Kind
- Colposcopy Unit, Department of Gynecology, University Hospital Basel, Basel, Switzerland
| | - Annette Blaich
- Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Michael Bayer
- Department of Dermatology, University Hospital Basel, Basel, Switzerland.,Medici Aerztezentrum, Zell, Switzerland
| | - Alexander Navarini
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Oliver Brandt
- Department of Dermatology, University Hospital Basel, Basel, Switzerland
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Tyros G, Mastraftsi S, Gregoriou S, Nicolaidou E. Incidence of anogenital warts: epidemiological risk factors and real-life impact of human papillomavirus vaccination. Int J STD AIDS 2020; 32:4-13. [PMID: 33167803 DOI: 10.1177/0956462420958577] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Anogenital warts (AGWs) rank among the most frequent sexually transmitted infections in young adults. They are benign lesions, but they pose a significant economic cost to health care systems and a substantial psychological burden on patients, who need evidence-based counselling. Human papillomavirus (HPV) vaccination has shown very high protection rates against AGWs in clinical trials and real-world settings but vaccination coverage remains low in many countries. The aim of this review is to summarize the current evidence on the risk factors for AGW development and to present the available real-life data on the impact of HPV vaccination on AGW incidence. An increased number of lifetime sexual partners, a new sexual partner in the last 12 months, smoking, and immunosuppression have been associated with increased risk for AGWs. HPV vaccination has led to a dramatic decline in AGW incidence in populations that have achieved high vaccination rates. These conclusions can contribute to primary prevention of AGWs and evidence-based counselling of AGW patients.
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Affiliation(s)
- Georgios Tyros
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Styliani Mastraftsi
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Stamatis Gregoriou
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - Electra Nicolaidou
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
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Goddard SL, Templeton DJ, Petoumenos K, Jin F, Hillman RJ, Law C, Roberts JM, Fairley CK, Garland SM, Grulich AE, Poynten IM, Farnsworth A, Biro C, Richards A, Thurloe J, Ekman D, McDonald R, Adams M, Tabrizi S, Phillips S, Molano Luque M, Comben S, McCaffery K, Howard K, Kelly P, Seeds D, Carr A, Feeney L, Gluyas R, Prestage G, Law M, Acraman B, McGrath P, Mellor R, Pezzopane P, Varma R, Langton-Lockton J, Tong W. Prevalence and Association of Perianal and Intra-Anal Warts with Composite High-Grade Squamous Intraepithelial Lesions Among Gay and Bisexual Men: Baseline Data from the Study of the Prevention of Anal Cancer. AIDS Patient Care STDS 2020; 34:436-443. [PMID: 32955927 DOI: 10.1089/apc.2020.0067] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Human papillomavirus (HPV) causes anal warts and anal squamous cell carcinoma (SCC). A higher incidence of anal cancer has been found among individuals previously diagnosed with anogenital warts. We aimed to investigate the association between anal warts and the presumed anal SCC precursor high-grade squamous intraepithelial lesion (HSIL), among participants in the Study of the Prevention of Anal Cancer (SPANC). SPANC was a longitudinal study of anal HPV infections and related lesions among gay and bisexual men (GBM) age 35 years and older, in Sydney, Australia. Anal cytology and high-resolution anoscopy were performed. Logistic regression was used to investigate the association between clinically diagnosed anal warts and intra-anal composite-HSIL (cytology and/or histology) at the baseline visit. The prevalence of HSIL within biopsies from intra-anal warts was calculated. Laser capture microdissection (LCM) and HPV-genotyping was performed on HSIL lesions. Among 616 participants at study entry, 165 (26.8%) and 51 (8.3%) had intra-anal and perianal warts, respectively. Warts were associated with composite-HSIL, even after adjustment for HIV status, age, lifetime receptive anal intercourse partner number, and smoking (perianal: aOR 2.13, 95% CI 1.17-3.87, p = 0.013; intra-anal: aOR 1.69, 95% CI 1.16-2.46, p = 0.006). HSIL was detected in 24 (14.5%) of 165 biopsies from intra-anal warts. Of 17 HSIL lesions, 16 (94.1%) had high-risk HPV detected by LCM. Anal warts were common. Prevalent anal warts were associated with composite-HSIL. HSIL may be detected within biopsies of intra-anal warts. Anal warts may be a useful addition to risk stratification for HSIL among GBM.
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Affiliation(s)
- Sian L. Goddard
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Infection and Immunity, Barts Health NHS Trust, London, United Kingdom
| | - David J. Templeton
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
- Sexual Health Service, Sydney Local Health District, and Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kathy Petoumenos
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Richard J. Hillman
- Dysplasia and Anal Cancer Services, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Carmella Law
- Dysplasia and Anal Cancer Services, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Christopher K. Fairley
- Melbourne Sexual Health Center, and Central Clinical School Monash University, Melbourne, Victoria, Australia
| | - Suzanne M. Garland
- Center for Women's Infectious Diseases, Royal Women's Hospital, Melbourne, Victoria, Australia
- Infection Immunity, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Obstetrics and Gynecology, University of Melbourne, Parkville, Victoria, Australia
| | - Andrew E. Grulich
- The Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
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Mueller SM, Menzi S, Kind AB, Blaich A, Bayer M, Navarini A, Itin P, Brandt O. Sexuell übertragbare Koinfektionen bei Patienten mit anogenitalen Warzen – eine retrospektive Analyse von 196 Patienten. J Dtsch Dermatol Ges 2020; 18:325-333. [DOI: 10.1111/ddg.14060_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/23/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sheryl Menzi
- Dermatologische KlinikUniversitätsspital Basel Basel Schweiz
| | - André B. Kind
- Abteilung KolposkopieFrauenklinikUniversitätsspital Basel Basel Schweiz
| | - Annette Blaich
- Abteilung Klinische MikrobiologieUniversitätsspital Basel Basel Schweiz
| | - Michael Bayer
- Dermatologische KlinikUniversitätsspital Basel Basel Schweiz
- Medici Ärztezentrum Zell Schweiz
| | | | - Peter Itin
- Dermatologische KlinikUniversitätsspital Basel Basel Schweiz
| | - Oliver Brandt
- Dermatologische KlinikUniversitätsspital Basel Basel Schweiz
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Yorulmaz A, Tamer E, Kulcu Cakmak S. Smoking: Is it a Risk Factor for Common Warts? CURRENT HEALTH SCIENCES JOURNAL 2020; 46:5-10. [PMID: 32637159 PMCID: PMC7323726 DOI: 10.12865/chsj.46.01.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/02/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Common warts are one of the most prevalent infections affecting the skin. Common warts are caused by human papillomaviruses (HPV), which are ubiquitous in our environment. Most HPV infections are directly controlled and cleared by host immune system, although each case has the potential to persist and transform into a recalcitrant form. It is not exactly clear why certain populations are more susceptible to common warts. AIM To investigate factors affecting the occurence and outcome of common warts. MATERIAL AND METHODS A total of 188 consecutive patients with common warts (106 men, 82 women) and 188 controls were prospectively enrolled. Demographic and clinical characteristics were recorded. The Chi-square, Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis, with a significance threshold of p<0.05. RESULTS There were not any significant associations between cigarette smoking, alcohol consumption, accompanying diseases, medications, family history of warts and the duration of warts (p=0.102, p=0.317, p=0.535, p=0.535, p=0.535, respectively). There were not any significant associations between cigarette smoking, alcohol consumption, accompanying diseases, medications, family history of warts and the number of warts (p=0.232, p=0.762, p=0.389, p=0.389, p=0.824, respectively). CONCLUSIONS Our study has revealed that smoking is not a risk factor for common warts. However, we suspect the lack of statistical differences are likely due to small sample size of the study. Further studies with larger sample sizes are needed.
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Manyere NR, Dube Mandishora RS, Magwali T, Mtisi F, Mataruka K, Mtede B, Palefsky JM, Chirenje ZM. Human papillomavirus genotype distribution in genital warts among women in Harare-Zimbabwe. J OBSTET GYNAECOL 2019; 40:830-836. [PMID: 31790323 DOI: 10.1080/01443615.2019.1673710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study aimed to determine the prevalence of HPV genotypes in genital warts among women in Harare, Zimbabwe. Women aged 18-45 years attending gynaecology and genitourinary clinics with a clinical diagnosis of genital-warts were recruited. HPV-DNA was extracted from tissue biopsies. HPV-DNA testing and typing was done by Southern Dot Blot Hybridisation. A hundred samples from 100 women were analysed. Median age of participants was 30.3 years (range 18-45 years). Seventy-eight percent of participants were HIV infected. HPV prevalence was 98%. Low risk genotypes predominated at 86% prevalence. The most prevalent genotypes were 11 (47%), 6 (42%) and 16 (14%). This is the first study on HPV genotype distribution among women with genital warts in Zimbabwe. The high prevalence of HR-HPV 16 in clinically benign lesions shows that warts should have histological analysis to exclude pre-malignancy and malignancy.Impact statementWhat is already known on this subject? Genital warts (GWs), also known as condylomata acuminata (EAC), are a clinical manifestation of persistent infection with 'low risk' or non-oncogenic HPV genotypes. HPV 6 and 11 are examples of low risk genotypes, and both are associated with 90% of GWs. Data on HPV genotypes causing genital warts in the population under study are scarce.What do the results of this study add? A high prevalence (98%) of HPV DNA in genital warts, confirms that the biopsied lesions were HPV related. Over and above the high prevalence of low risk HPV 11 (47%) and HPV 6 (42%), the women had 14% prevalence of HPV 16, an oncogenic genotype, in genital warts. Seventy-eight percent of the participants were HIV infected. The HIV infected women had a 33.3% prevalence of HR-HPV as compared to the 15.8% prevalence in the HIV uninfected women.What are the implications of these findings for clinical practice and/or further research? The population under study will benefit more if an HPV vaccine that includes anti-HPV 6 and 11 is used. The high prevalence of the HR-HPV in apparently benign lesions shows that warts should have histological analysis to exclude vulvar cancer and vulvar intraepithelial neoplasia. All women presenting with genital warts should be offered an HIV test.
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Affiliation(s)
- N R Manyere
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - R S Dube Mandishora
- Department of Medical Microbiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - T Magwali
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - F Mtisi
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre (UZCHS-CTRC), University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - K Mataruka
- University of Zimbabwe College of Health Sciences Clinical Trials Research Centre (UZCHS-CTRC), University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - B Mtede
- Program Quality Improvement, Elizabeth Glaser Pediatric AIDS Foundation, Harare, Zimbabwe
| | - J M Palefsky
- Department of Medicine, UCSF School of Medicine, Med Sci San Francisco, CA, USA
| | - Z M Chirenje
- Department of Obstetrics and Gynaecology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.,University of Zimbabwe College of Health Sciences Clinical Trials Research Centre (UZCHS-CTRC), University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
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Sendagorta-Cudós E, Burgos-Cibrián J, Rodríguez-Iglesias M. Infecciones genitales por el virus del papiloma humano. Enferm Infecc Microbiol Clin 2019; 37:324-334. [DOI: 10.1016/j.eimc.2019.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/22/2022]
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Saniee S, Herizchi Qadim H, Ranjkesh M, Afshari N, Davarnia G, Nahchami E, Ahmadi Maleki D, Razaghi N, Ebrahimi S, Sadri A, Hatamnejad L, Mousavi MA. Human immunodeficiency virus, hepatitis B virus, hepatitis C virus, and syphilis co-infections among patients with anogenital warts in Tabriz, Iran. JOURNAL OF ANALYTICAL RESEARCH IN CLINICAL MEDICINE 2018. [DOI: 10.15171/jarcm.2018.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Genital infection with papilloma virus is the most common sexually-transmitted disease (STD). It is recommended that individuals who have a sexual risk factor, should be screened for syphilis, human immunodeficiency virus (HIV), and hepatitis B and C. However, this strategy is often not carried out in Iran. In the present study, patients with genital warts were screened for syphilis, HIV, and hepatitis B and C. Methods: We evaluated 311 patients with anogenital warts visiting dermatology clinics from June 2016 to June 2017. In addition, demographic data were collected using a pre-designed questionnaire. Patients who presented to Sina Hospital, Tabriz, Iran, were examined for HIV, syphilis, hepatitis B and C, urethral and vaginal discharge, and history of painful genital lesions, while patients presenting to Bahar Behavioral Disease Counseling Center of Tabriz were examined only for HIV. Data were analyzed using chi-square and Fisher’s exact tests via SPSS software. Results: Out of 263 cases with genital warts presenting to Sina Hospital, 1, 1, and 2 cases were positive for HIV, syphilis, and hepatitis B, respectively. At the same time, one of the patients presenting to Bahar Center showed HIV infection. Conclusion: We found two HIV-positive, two hepatitis B virus (HBV)-positive, and one syphilis cases in 311 patients with genital warts, so it is recommended to assess these tests routinely in high-risk individuals with genital warts, including multi-partner and addicted patients.
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Affiliation(s)
- Sara Saniee
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamideh Herizchi Qadim
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammadreza Ranjkesh
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Niloofar Afshari
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghazaleh Davarnia
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elham Nahchami
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davood Ahmadi Maleki
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Razaghi
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sahar Ebrahimi
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Asal Sadri
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Hatamnejad
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mir Ahad Mousavi
- Department of Dermatology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Cocchio S, Bertoncello C, Baldovin T, Buja A, Majori S, Baldo V. Self-reported genital warts among sexually-active university students: a cross-sectional study. BMC Infect Dis 2018; 18:41. [PMID: 29334908 PMCID: PMC5769424 DOI: 10.1186/s12879-018-2954-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/08/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Genital warts are one of the most common forms of sexually-transmitted disease, but their epidemiology has yet to be thoroughly elucidated. The present study was designed to shed light on the prevalence of clinically-confirmed, self-reported genital warts (GWs) in a representative sample of the university population. METHODS In 2015, a cross-sectional survey was conducted on 11,096 individuals approached at the Students Information Bureau where they came to enroll for a university degree course. Participants completed an anonymous, self-administered questionnaire providing information on their sociodemographic characteristics, sexual behavior, and any history of clinically-diagnosed genital warts. Multivariate logistic regression was then used to identify any factors associated with the disease. RESULTS Our analysis was conducted on 9259 questionnaires (83.4%). Participants were a mean 21.8 ± 4.8 years of age, and 59.6% were female. Overall, 124 individuals (1.3%, 95%CI: 1.0-1.6) reported having been diagnosed with genital warts: 48 men (1.3%, 95%CI: 0.9-1.6), and 76 women (1.4% 95%CI: 1.1-1.7). Overall, 22.5% of the sample were vaccinated (1.3% of the males and 36.8% of the females). The group of respondents aged 30 years or more had the highest incidence of genital warts (males: 5.6%, 95%CI: 2.5-8.6; females: 6.9%, 95%CI: 3.4-10.4). The independent risk factors associated with a history of disease were (for both genders) a history of other sexually-transmitted diseases, and ≥2 sex partners in the previous 24 months. A protective role emerged for routine condom use. Additional risk factors associated with genital warts in males concerned men who have sex with men, bisexuality vis-à-vis heterosexuality, and smoking. CONCLUSIONS The findings emerging from our study help to further clarify the epidemiology of genital warts in young people, and may be useful to public health decision-makers. This study showed that genital warts occur in men as well as women, and suggests that both genders should be monitored for this disease to ascertain the effects of the free HPV vaccination offered to all girls in the Veneto in their 12th year of life since 2008, and to all boys of the same age since 2015.
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Affiliation(s)
- Silvia Cocchio
- Department of Cardiac, Thoracic and Vascular Sciences, Public Health Unit, University of Padua, Padua, Italy
| | - Chiara Bertoncello
- Department of Cardiac, Thoracic and Vascular Sciences, Public Health Unit, University of Padua, Padua, Italy
| | - Tatjana Baldovin
- Department of Cardiac, Thoracic and Vascular Sciences, Public Health Unit, University of Padua, Padua, Italy
| | - Alessandra Buja
- Department of Cardiac, Thoracic and Vascular Sciences, Public Health Unit, University of Padua, Padua, Italy
| | - Silvia Majori
- Department of Public Health and Community Medicine, Hygiene and Environmental, Occupational and Preventive Medicine Division, University of Verona, Verona, Italy
| | - Vincenzo Baldo
- Department of Cardiac, Thoracic and Vascular Sciences, Public Health Unit, University of Padua, Padua, Italy.
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Tamer E, Çakmak SK, İlhan MN, Artüz F. Demographic characteristics and risk factors in Turkish patients with anogenital warts. J Infect Public Health 2016; 9:661-6. [PMID: 26776703 DOI: 10.1016/j.jiph.2015.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/09/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022] Open
Abstract
Anogenital warts (AGW) are one of the most common sexually transmitted diseases worldwide. The determination of groups vulnerable to contracting anogenital warts (AGW) leads to the development of policies for disease control and of prevention programs. The aim of our study was to investigate the demographical features and risk factors of Turkish patients with AGW. This study included 200 patients with AGW and 200 healthy individuals as a control group. The age, gender, education and marital status, age of first sexual intercourse, number of sexual partners, sexual orientation, and smoking status were recorded in both groups. In this study, 88% of the patients were male, and 12% were female. The mean age of the patients was 35.21±0.77 years, and the majority of patients were below 35 years old (63%). Furthermore, 46.0% of the patients were educated at the university level, and 33.5% had graduated high school. No significant differences were found based on sexual orientation or condoms between the patient and control groups. In the patient group, the mean age of first sexual intercourse was significantly earlier, and the number of single individuals and sexual partners were significantly higher. Also, 61% of the patients were current smokers, which was significantly higher than the control group. The duration of smoking and the duration of AGW were found to be correlated. All patients were tested for anti-HIV antibodies, and only one patient was found to be infected. AGW were more common in patients younger than 35 years old, among men, and among those who had graduated from high school or university. Early age of first sexual intercourse, a high number of sexual partners, being single, and smoking were also risk factors for the development of anogenital warts.
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Affiliation(s)
- Emine Tamer
- Ankara Numune Education and Research Hospital, Dermatology Clinic, Turkey.
| | - Seray K Çakmak
- Ankara Numune Education and Research Hospital, Dermatology Clinic, Turkey
| | - Mustafa N İlhan
- Gazi University Faculty of Medicine, Public Health & Occupational Health, Turkey.
| | - Ferda Artüz
- Ankara Numune Education and Research Hospital, Dermatology Clinic, Turkey.
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Gola M, Miyakoshi M, Sescousse G. Sex, Impulsivity, and Anxiety: Interplay between Ventral Striatum and Amygdala Reactivity in Sexual Behaviors. J Neurosci 2015; 35:15227-9. [PMID: 26586811 PMCID: PMC6605490 DOI: 10.1523/jneurosci.3273-15.2015] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mateusz Gola
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, La Jolla, California 92093-0559, Institute of Psychology, Polish Academy of Science, 00-378 Warsaw, Poland, and
| | - Makoto Miyakoshi
- Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, La Jolla, California 92093-0559
| | - Guillaume Sescousse
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University, 6525 EZ Nijmegen, The Netherlands
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Petráš M, Adámková V. Rates and predictors of genital warts burden in the Czech population. Int J Infect Dis 2015; 35:29-33. [PMID: 25869075 DOI: 10.1016/j.ijid.2015.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 03/30/2015] [Accepted: 04/03/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the burden and the predictors of genital warts (GWs) in Czech men and women. METHODS A population-based cross-sectional study was conducted of 32 974 randomly selected health clinic attendees from all 14 regions of the Czech Republic. Information on GWs and lifestyle behaviour was collected using a questionnaire. RESULTS Results revealed a 5.8% prevalence rate of self-reported GWs in the Czech population aged 16-55 years. There was an increase in the incidence of GWs in the years 2010-2013 when compared to lifetime incidence rates, from 205.4 (95% confidence interval (CI) 191.0-219.7) to 441.8 (95% CI 393.1-490.6) per 100 000 person-years. No significant differences were observed between genders. The strongest risk factors found for GWs were an infected sexual partner (adjusted odds ratio (OR) 114.3, 95% CI 78.9-165.4) and a high number of lifetime sexual partners (adjusted OR 3.36, 95% CI 2.72-4.17 for >14 partners vs. one partner). A novel finding was that 22.7% (95% CI 20.9-24.6%) of participants claimed that the pathology had disappeared spontaneously without medical assistance. CONCLUSIONS The results provide baseline information for the development and monitoring of prevention strategies against GWs in the Czech Republic.
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Affiliation(s)
- Marek Petráš
- Charles University in Prague, Second Faculty of Medicine, V Úvalu 84, 150 06 Prague 5, Czech Republic.
| | - Věra Adámková
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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16
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Criminal offending as part of an alternative reproductive strategy: investigating evolutionary hypotheses using Swedish total population data. EVOL HUM BEHAV 2014. [DOI: 10.1016/j.evolhumbehav.2014.06.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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McGraw SL, Ferrante JM. Update on prevention and screening of cervical cancer. World J Clin Oncol 2014; 5:744-752. [PMID: 25302174 PMCID: PMC4129537 DOI: 10.5306/wjco.v5.i4.744] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/11/2014] [Accepted: 05/14/2014] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer is the third most common cause of cancer in women in the world. During the past few decades tremendous strides have been made toward decreasing the incidence and mortality of cervical cancer with the implementation of various prevention and screening strategies. The causative agent linked to cervical cancer development and its precursors is the human papillomavirus (HPV). Prevention and screening measures for cervical cancer are paramount because the ability to identify and treat the illness at its premature stage often disrupts the process of neoplasia. Cervical carcinogenesis can be the result of infections from multiple high-risk HPV types that act synergistically. This imposes a level of complexity to identifying and vaccinating against the actual causative agent. Additionally, most HPV infections spontaneously clear. Therefore, screening strategies should optimally weigh the benefits and risks of screening to avoid the discovery and needless treatment of transient HPV infections. This article provides an update of the preventative and screening methods for cervical cancer, mainly HPV vaccination, screening with Pap smear cytology, and HPV testing. It also provides a discussion of the newest United States 2012 guidelines for cervical cancer screening, which changed the age to begin and end screening and lengthened the screening intervals.
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Abstract
Anogenital warts are the most common clinical manifestation of human papillomavirus (HPV) infections. Although easy to recognize, asymptomatic anogenital warts (condylomata acuminata) may be overlooked, leading to unaware transmission to the sexual partner. On the other hand awareness of this sexually transmitted disease (STD) is largely associated with a great psychological and social burden, in men as well as women. Spontaneous regression of genital warts has been observed mostly within 2-5 years; however, persisting condylomata may prove refractory to all current treatment options. Because removal of the warts does not totally eliminate the underlying viral infection, treatment of genital warts can often be of long duration, of varying effectiveness and with high recurrence rates. Without a doubt only the patient's own immune system is capable of clearing HPV infections. Therefore, the solution to one of mankind's oldest health problems will depend on the future acceptability of HPV vaccines.
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Affiliation(s)
- P Schneede
- Urologische Klinik, Klinikum Memmingen, Bismarckstraße 23, 87700, Memmingen, Deutschland,
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Kaderli R, Schnüriger B, Brügger LE. The impact of smoking on HPV infection and the development of anogenital warts. Int J Colorectal Dis 2014; 29:899-908. [PMID: 24935346 DOI: 10.1007/s00384-014-1922-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE The worldwide prevalence of human papillomavirus (HPV) infection is estimated at 9-13 %. Persistent infection can lead to the development of malignant and nonmalignant diseases. Low-risk HPV types are mostly associated with benign lesions such as anogenital warts. In the present systematic review, we examined the impact of smoking on HPV infection and the development of anogenital warts, respectively. METHODS A systematic literature search was performed using MEDLINE database for peer-reviewed articles published from January 01, 1985 to November 30, 2013. Pooled rates of HPV prevalence were compared using the χ (2) test. RESULTS In both genders, smoking is associated with higher incidence and prevalence rates for HPV infection, whereas the latter responds to a dose-effect relationship. The overall HPV prevalence for smoking patients was 48.2 versus 37. 5 % for nonsmoking patients (p < 0.001) (odds ratio (OR) = 1.5, 95 % confidence interval (CI) 1.4-1.7). Smoking does also increase persistence rates for high-risk HPV infection, while this correlation is debatable for low-risk HPV. The incidence and recurrence rates of anogenital warts are significantly increased in smokers. CONCLUSIONS Most current data demonstrate an association between smoking, increased anogenital HPV infection, and development of anogenital warts. These data add to the long list of reasons for making smoking cessation a keystone of patient health.
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Affiliation(s)
- Reto Kaderli
- Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010, Bern, Switzerland,
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Steben M, Garland SM. Genital warts. Best Pract Res Clin Obstet Gynaecol 2014; 28:1063-73. [PMID: 25155525 DOI: 10.1016/j.bpobgyn.2014.07.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 07/10/2014] [Indexed: 11/16/2022]
Abstract
Anogenital warts (AGWs) are a very common disease. They are caused mostly by low-risk human papillomaviruses (HPV) 6 and 11, particularly the former. Clinical presentation is mostly of growths in the areas of friction of the anogenital region. The treatment is classified as patient/home applied or administered by a professional. In cases with atypical presentations or resistance to recommended therapies, great care should be taken to establish a differential diagnosis taking into account normal anatomical variations, infectious etiologies, precancers and cancers, as well as benign dermatological growths. The prevention of AGWs can be achieved by the use of the quadrivalent prophylactic HPV vaccine administered prior to sexual debut, as well as the meticulous use of condoms. Where coverage of the quadrivalent vaccine has been high, marked reductions in AGWs are being seen in young women of vaccine-eligible age, as well as in young males (as herd immunity effect).
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Affiliation(s)
- Marc Steben
- STI Unit, Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Montréal, Québec, Canada; Université de Montréal, Montréal, Québec, Canada; Clinique A rue McGill, Montréal, Québec, Canada.
| | - Suzanne M Garland
- Royal Women's Hospital, Parkville, VIC, Australia; Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Parkville, VIC, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, VIC, Australia.
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Banura C, Mirembe FM, Orem J, Mbonye AK, Kasasa S, Mbidde EK. Prevalence, incidence and risk factors for anogenital warts in Sub Saharan Africa: a systematic review and meta analysis. Infect Agent Cancer 2013; 8:27. [PMID: 23842471 PMCID: PMC3712022 DOI: 10.1186/1750-9378-8-27] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 07/01/2013] [Indexed: 12/25/2022] Open
Abstract
Introduction The quadrivalent HPV vaccine is highly effective in primary prevention of anogenital warts (AGWs). However, there is lack of systematic review in the literature of the epidemiology of AGWs in Sub Saharan Africa (SSA). Objective To review the prevalence, incidence and risk factors for AGWs in SSA prior to the introduction of HPV vaccination programs. Methods PubMed/MEDLINE, Africa Index Medicus and HINARI websites were searched for peer reviewed English language published medical literature on AGWs from January 1, 1984 to June 30, 2012. Relevant additional references cited in published papers were also evaluated for inclusion. For inclusion, the article had to meet the following criteria (1) original studies with estimated prevalence and/or incidence rates among men and/or women (2) detailed description of the study population (3) clinical or self-reported diagnosis of AGWs (4) HPV genotyping of histologically confirmed AGWs. The final analysis included 40 studies. Data across different studies were synthesized using descriptive statistics for various subgroups of females and males by geographical area. A meta - analysis of relative risk was conducted for studies that had data reported by HIV status. Results The prevalence rates of clinical AGWs among sex workers and women with sexually transmitted diseases (STDs) or at high risk of sexually transmitted infection (STIs) range from 3.3% - 10.7% in East, 2.4% - 14.0% in Central and South, and 3.5% - 10.5% in West African regions. Among pregnant women, the prevalence rates range from 0.4% - 3.0% in East, 0.2% - 7.3% in Central and South and 2.9% in West African regions. Among men, the prevalence rates range from 3.5% - 4.5% in East, 4.8% - 6.0% in Central and South and 4.1% to 7.0% in West African regions. In all regions, the prevalence rates were significantly higher among HIV+ than HIV- women with an overall summary relative risk of 1.62 (95% CI: 143–1.82). The incidence rates range from 1.1 – 2.7 per 100 person-years among women and 1.4 per 100 person years among men. Incidence rate was higher among HIV+ (3.0 per 100 person years) and uncircumcised men (1.7 per 100 person-years) than circumcised men (1.3 per 100 person-years). HIV positivity was a risk factor for AGWs among both men and women. Other risk factors in women include presence of abnormal cervical cytology, co-infection with HPV 52, concurrent bacteria vaginoses and genital ulceration. Among men, other risk factors include cigarette smoking and lack of circumcision. Conclusions AGWs are common among selected populations particularly HIV infected men and women. However, there is need for population-based studies that will guide policies on effective prevention, treatment and control of AGWs.
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Affiliation(s)
- Cecily Banura
- Department of Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda.
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Pierce Campbell CM, Lin HY, Fulp W, Papenfuss MR, Salmerón JJ, Quiterio MM, Lazcano-Ponce E, Villa LL, Giuliano AR. Consistent condom use reduces the genital human papillomavirus burden among high-risk men: the HPV infection in men study. J Infect Dis 2013; 208:373-84. [PMID: 23644283 DOI: 10.1093/infdis/jit191] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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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23
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Nyitray AG, Lu B, Kreimer AR, Anic G, Stanberry LR, Giuliano AR. The Epidemiology and Control of Human Papillomavirus Infection and Clinical Disease. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.00013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Physical Barrier Methods. Sex Transm Dis 2013. [DOI: 10.1016/b978-0-12-391059-2.00008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Tobian AAR, Kigozi G, Gravitt PE, Xiao C, Serwadda D, Eaton KP, Kong X, Wawer MJ, Nalugoda F, Quinn TC, Gray RH. Human papillomavirus incidence and clearance among HIV-positive and HIV-negative men in sub-Saharan Africa. AIDS 2012; 26:1555-65. [PMID: 22441255 PMCID: PMC3442933 DOI: 10.1097/qad.0b013e328353b83c] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES High-risk human papillomavirus (HR-HPV) infection is the most common sexually transmitted infection. Penile and cervical cancer rates are highest in sub-Saharan Africa. However, little is known about the impact of HIV infection on HR-HPV acquisition and clearance among heterosexual men. DESIGN HR-HPV incidence and clearance were evaluated in 999 men (776 HIV-negative and 223 HIV-positive) aged 15-49 years who participated in male circumcision trials in Rakai, Uganda. METHODS Penile swabs were tested for HR-HPV by Roche HPV Linear Array. A Poisson multivariable model was used to estimate adjusted incidence rate ratios (adjIRRs) and clearance risk ratios (adjRRs). RESULTS HR-HPV incidence was 66.5/100 person-years in HIV-positive men and 32.9/100 person-years among HIV-negative men [IRR=2.02, 95% confidence interval (CI) 1.67-2.44]. Incidence was higher in the unmarried men (adjIRR=1.73, 95% CI 1.19-2.52), and decreased with age (adjIRR for men >35 years=0.64, 95% CI 0.43-0.94) and male circumcision (adjIRR=0.70, 95% CI 0.55-0.89). HR-HPV clearance was 114.7/100 person-years for HIV-positive men and 170.2/100 person-years for HIV-negative men (risk ratio=0.67, 95% CI 0.59-0.77). HR-HPV clearance in HIV-negative men increased with circumcision (adjRR=1.48, 95% CI 1.26-1.74), HSV-2 infection (adjRR=1.20, 95% CI 1.01-1.44), and symptoms of urethral discharge (adjRR=1.35, 95% CI 1.06-1.73). Clearance of HR-HPV was significantly lower for unmarried men (adjRR 0.76, 95% CI 0.59-0.98). CONCLUSION HR-HPV is common among heterosexual Ugandan men, particularly the HIV-infected. HIV infection increases HR-HPV acquisition and reduces HR-HPV clearance. Promotion of male circumcision and additional prevention measures, such as HPV vaccination, is critical in sub-Saharan Africa.
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Affiliation(s)
- Aaron A R Tobian
- Department of Pathology, School of Medicine, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21287, USA.
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Gormley RH, Kovarik CL. Human papillomavirus–related genital disease in the immunocompromised host. J Am Acad Dermatol 2012; 66:867.e1-14; quiz 881-2. [DOI: 10.1016/j.jaad.2010.12.050] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 12/17/2010] [Accepted: 12/19/2010] [Indexed: 11/30/2022]
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Lacey CJN, Woodhall SC, Wikstrom A, Ross J. 2012 European guideline for the management of anogenital warts. J Eur Acad Dermatol Venereol 2012; 27:e263-70. [PMID: 22409368 DOI: 10.1111/j.1468-3083.2012.04493.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although new HPV vaccines have been developed and are in the process of implementation, anogenital warts remain a very frequent problem in clinical practice. OBJECTIVE We wished to update previously published European guidelines for the management of anogenital warts. METHODS We performed a systematic review of randomized controlled trials for anogenital warts. The primary data were analyzed and collated, and the findings were formulated within the structure of a clinical guideline. The IUSTI Europe Editorial Board reviewed the draft guideline which was also posted on the web for comments which we incorporated into the final version of the guideline. RESULTS The data confirm that only surgical therapies have primary clearance rates approaching 100%. Recurrences, including new lesions at previously treated or new sites, occur after all therapies, and rates are often 20-30% or more. All therapies are associated with local skin reactions including itching, burning, erosions and pain. CONCLUSIONS Physicians treating patients with genital warts should develop their own treatment algorithms which include local practice and recommendations. Such patient level management protocols should incorporate medical review of cases at least every 4 weeks, with switching of treatments if an inadequate response is observed. First episode patients should be offered sexually transmitted disease screening. Management should include partner notification and health promotion.
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Affiliation(s)
- C J N Lacey
- Hull York Medical School, University of York, York, UK Department of Dermatovenereology, Karolinska Hospital, Stockholm, Sweden Whittall Street Clinic, Birmingham, UK
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Anic GM, Lee JH, Villa LL, Lazcano-Ponce E, Gage C, José C Silva R, Baggio ML, Quiterio M, Salmerón J, Papenfuss MR, Abrahamsen M, Stockwell H, Rollison DE, Wu Y, Giuliano AR. Risk factors for incident condyloma in a multinational cohort of men: the HIM study. J Infect Dis 2012; 205:789-93. [PMID: 22238467 DOI: 10.1093/infdis/jir851] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Identifying factors associated with condyloma are necessary for prevention efforts. Risk factors for incident condyloma were examined in a cohort of 2487 men from the United States, Brazil, and Mexico and were followed up every 6 months (median, 17.9 months). Factors strongly associated with condyloma were incident infection with human papillomavirus (HPV) types 6 and 11 (hazard ratio [HR], 12.42 [95% confidence interval {CI}, 3.78-40.77]), age (HR, 0.43 [95% CI, .26-.77]; 45-70 vs 18-30 years), high lifetime number of female partners (HR, 5.69 [95% CI, 1.80-17.97]; ≥21 vs 0 partners), and number of male partners (HR, 4.53 [95% CI, 1.68-12.20]; ≥3 vs 0 partners). The results suggest that HPV types 6 and 11 and recent sexual behavior are strongly associated with incident condyloma.
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Affiliation(s)
- Gabriella M Anic
- Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Abstract
Human papillomavirus (HPV) is highly prevalent in men and there is an interest in further understanding the relationship between HPV infection and disease in men, including the development of genital warts, penile intraepithelial neoplasia and invasive penile carcinomas. Genital warts are caused by HPV 6/11 and are the most common clinical manifestation of HPV in men. Though they are benign and not associated with mortality, they are a source of psychosocial distress and physical discomfort. HPV infection can also develop into invasive penile carcinoma which is associated with morbidity and mortality. Approximately 40% of invasive penile carcinomas are attributable to HPV with HPV 16, 18, and 6/11 being the genotypes most commonly detected in penile tumors. Penile carcinomas of the basaloid and warty histologic subtypes are most likely to test positive for HPV. In addition to HPV infection, the risk factors most strongly associated with penile cancer are lack of neonatal circumcision, phimosis (the inability of uncircumcised men to fully retract the foreskin), and anogenital warts. Male vaccination with the quadrivalent HPV vaccine that protects against HPV 6/11/16/18 has been shown to significantly reduce HPV-associated anogenital infection and disease in men. If the quadrivalent vaccine is successfully disseminated to large segments of the young male population, there is the potential for substantial reduction in genital HPV infection and related lesions in men.
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Affiliation(s)
- Gabriella M Anic
- Division of Population Sciences, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
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30
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Regan DG, Philp DJ, Waters EK. Unresolved questions concerning human papillomavirus infection and transmission: a modelling perspective. Sex Health 2010; 7:368-75. [PMID: 20719229 DOI: 10.1071/sh10006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Accepted: 06/03/2010] [Indexed: 01/02/2023]
Abstract
Mathematical transmission models are widely used to forecast the potential impact of interventions such as vaccination and to inform the development of health policy. Effective vaccines are now available for the prevention of cervical cancer and other diseases attributable to human papillomavirus (HPV). Considerable uncertainties remain regarding the characterisation of HPV infection and its sequelae, infectivity, and both vaccine-conferred and naturally-acquired immunity. In this review, we discuss the key knowledge gaps that impact on our ability to develop accurate models of HPV transmission and vaccination.
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Affiliation(s)
- David G Regan
- The National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales, Coogee, NSW 2034, Australia.
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31
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Minhas S, Manseck A, Watya S, Hegarty PK. Penile cancer--prevention and premalignant conditions. Urology 2010; 76:S24-35. [PMID: 20691883 DOI: 10.1016/j.urology.2010.04.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/09/2010] [Accepted: 04/09/2010] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Relatively little evidence is available in the published studies on the prevention of penile cancer and premalignant conditions of the penis. The present review examined the current evidence available in preventing penile cancer and pathologic subtypes of premalignant conditions and their treatment. The recommendations made in the present review formulate the basis of the recent 2009 International Consultation on Urologic Disease Consensus Publishing Group. METHODS The association of human papillomavirus subtypes and penile cancer is well-established, although the etiology, natural history, and treatment of premalignant lesions have mainly been reported in retrospective case series with short-term follow-up. The exact pathologic role of chronic inflammatory conditions, such as balanitis xerotica obliterans in the etiology of penile cancer remains largely unknown. RESULTS Some of the potential strategies for the prevention of penile cancer could include circumcision, reducing the risk of transmission of penile human papillomavirus infection with male vaccination, early treatment of phimosis, smoking cessation, and hygienic measures. Implementing some of these measures would require extensive cost/benefit analysis, with significant changes in the global health policy. CONCLUSIONS Owing to the current levels of evidence from published studies, firm guidelines cannot be formulated for the treatment of premalignant conditions, although preventative measures, such as reducing human papillomavirus transmission, could become strategic health targets.
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Affiliation(s)
- Suks Minhas
- Institute of Urology, Division of Surgical and Interventional Sciences, University College London, 25 Grafton Way, London, United Kingdom.
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32
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Ankerst DP, Diepolder H, Horster S. Topical treatment of anogenital human papillomavirus infection in male patients. Future Virol 2009. [DOI: 10.2217/fvl.09.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Human papillomavirus (HPV)-associated anogenital warts have a prevalence of up to 78% in sexually active men. Some HPV subtypes bear a considerable oncogenic potential. Materials & methods: Original papers on the treatment of external anogenital warts were included in a meta-analysis to assess the most effective topical treatment. Results: Clearance rates were 0–6.5% for placebo treatment, 76.6% for podophyllotoxin 0.15% cream administered for 4 weeks, 61.5% for podophyllotoxin 0.5% solution (2–6 weeks) and 53.7% for imiquimod 5% cream (12–16 weeks). For male patients, the intent-to-treat analysis demonstrated statistically significant superiority of podophyllotoxin preparations versus imiquimod (p < 0.0001 and p < 0.005, respectively). Clearance rates of locally ablative treatments, such as surgery, cryotherapy, electrocautery and carbon dioxide laser, differed widely without clear superiority of a specific ablative technique. In HIV-positive patients, all treatment options yielded lower clearance rates and higher recurrence rates. Conclusion: While preventive vaccines might reduce HPV-associated morbidity for future generations, those with active HPV disease still need to be treated with customary treatment options. In male patients, podophyllotoxin preparations yielded higher response rates than imiquimod.
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Affiliation(s)
- Donna P Ankerst
- Department of Mathematics, Technical University Munich, Boltzmannstr.3, 85747 Garching, Germany
| | - Helmut Diepolder
- Medizinische Klinik und Poliklinik II Klinikum Großhadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München, Germany
| | - Sophia Horster
- Medizinische Klinik und Poliklinik II Klinikum Großhadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München, Germany
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Twenty-Year Trends in the Incidence and Prevalence of Diagnosed Anogenital Warts in Canada. Sex Transm Dis 2009; 36:380-6. [DOI: 10.1097/olq.0b013e318198de8c] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smoking enhances risk for new external genital warts in men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2009; 6:1215-34. [PMID: 19440442 PMCID: PMC2672382 DOI: 10.3390/ijerph6031215] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 03/17/2009] [Indexed: 11/25/2022]
Abstract
Repeat episodes of HPV-related external genital warts reflect recurring or new infections. No study before has been sufficiently powered to delineate how tobacco use, prior history of EGWs and HIV infection affect the risk for new EGWs. Behavioral, laboratory and examination data for 2,835 Multicenter AIDS Cohort Study participants examined at 21,519 semi-annual visits were evaluated. Fourteen percent (391/2835) of men reported or were diagnosed with EGWs at 3% (675/21,519) of study visits. Multivariate analyses showed smoking, prior episodes of EGWs, HIV infection and CD4+ T-lymphocyte count among the infected, each differentially influenced the risk for new EGWs.
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35
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Mindel A, Sawleshwarkar S. Condoms for sexually transmissible infection prevention: politics versus science. Sex Health 2008; 5:1-8. [DOI: 10.1071/sh07054] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 11/09/2007] [Indexed: 11/23/2022]
Abstract
The present review assesses the protection that condoms offer against sexually transmissible infections (STI) and the impact that social, political and religious opinion in the USA has had in the past 8 years on promoting condoms for safer sex. Condoms offer protection against most STI. However, the degree of protection depends on correct and consistent use, the type of sexual activity and the biological characteristics of different infections. Cross-sectional and case-control studies and other observational data provide the majority of evidence for STI prevention. Condoms provide a high level of protection against those infections that are transmitted mainly via infected secretions, including HIV, gonorrhoea, chlamydia and trichomoniasis. Protection against those infections transmitted via skin and mucous membrane contact, including Herpes simplex virus infection and human papilloma virus, appears to be less. The Bush administration, driven by conservative political, social and religious elements in the USA, has mounted a concerted campaign to undermine the role of the condom in health-promotion activities in the USA and overseas by undervaluing and misrepresenting scientific data, and through a sustained and well-funded promotion of abstinence-only education. However, this has lead to considerable controversy and disillusionment with abstinence-only education, both at home and abroad, and there is now incontrovertible evidence that abstinence-only programs are ineffectual.
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36
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Nielson CM, Harris RB, Dunne EF, Abrahamsen M, Papenfuss MR, Flores R, Markowitz LE, Giuliano AR. Risk factors for anogenital human papillomavirus infection in men. J Infect Dis 2007; 196:1137-45. [PMID: 17955431 DOI: 10.1086/521632] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Accepted: 06/25/2007] [Indexed: 11/03/2022] Open
Abstract
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 > or =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 > or =21, 2.5 [95% CI, 1.3-4.6]), and factors significantly associated with oncogenic HPV were lifetime number of FSPs (OR for > or =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 > or =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.
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Affiliation(s)
- Carrie M Nielson
- Arizona Cancer Center and Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
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37
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Jin F, Prestage GP, Kippax SC, Pell CM, Donovan B, Templeton DJ, Kaldor JM, Grulich AE. Risk factors for genital and anal warts in a prospective cohort of HIV-negative homosexual men: the HIM study. Sex Transm Dis 2007; 34:488-93. [PMID: 17108849 DOI: 10.1097/01.olq.0000245960.52668.e5] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence, incidence, and risk factors for genital and anal warts in HIV-negative homosexual men in Sydney. STUDY DESIGN The authors conducted a prospective cohort study. Participants were asked whether they had had genital and anal warts at each interview. Details of lifetime sexual contacts and sexual behaviors in the last 6 months were collected. RESULTS Among 1,427 men recruited, 8.9% and 19.6% reported a history of genital and anal warts at baseline, respectively. Incidence rates for genital and anal warts were 0.94 and 1.92 per 100 person-years, respectively. In multivariate analysis, both incident genital and anal warts were associated with younger age. In addition, incident genital warts was associated with insertive fingering (P trend = 0.018), whereas incident anal warts was associated with insertive fingering (P trend = 0.007) and insertive fisting (P trend = 0.039). CONCLUSIONS Anal warts were twice as common as genital warts. Fingering and other manual sexual practices may be an important transmission route for both.
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Affiliation(s)
- Fengyi Jin
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Darlinghurst, New South Wales, Australia.
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Davies SL, DiClemente RJ, Wingood GM, Person SD, Dix ES, Harrington K, Crosby RA, Oh K. Predictors of inconsistent contraceptive use among adolescent girls: findings from a prospective study. J Adolesc Health 2006; 39:43-9. [PMID: 16781960 DOI: 10.1016/j.jadohealth.2005.10.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2005] [Revised: 09/13/2005] [Accepted: 10/26/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the independent effects of various behavioral and psychosocial antecedents on contraceptive use among a sample of low-income African-American adolescent females. METHODS Stepwise logistic regression was used to calculate odds ratios for baseline predictors of inconsistent contraceptive use six months later. Study participants include 375 nonpregnant African-American girls aged 14-18 years who reported sexual activity in the previous six months. Data were collected using a self-administered survey, individual interview and urine pregnancy test. RESULTS Adolescents who were inconsistent contraceptive users at follow-up were more likely to have reported a desire for pregnancy, previous inconsistent contraceptive use, less frequent communication with their partners about prevention issues, and an increased number of lifetime sexual partners at the baseline assessment. Of equal importance was the finding that a previous pregnancy or sexually transmitted infection did not influence future contraceptive behaviors. CONCLUSIONS Clinicians can play an important role in counseling adolescents about sexual health and dispelling misperceptions that hinder consistent contraceptive use. Findings from this research could have significant implications for the development of effective sexually transmitted infection (STI) and pregnancy prevention programs for adolescents and can help in guiding clinicians toward relevant treatment practices.
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Affiliation(s)
- Susan L Davies
- School of Public Health, Department of Health Behavior, University of Alabama at Birmingham, Birmingham, Alabama 35294-0022, USA.
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39
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Frazer IH, Cox JT, Mayeaux EJ, Franco EL, Moscicki AB, Palefsky JM, Ferris DG, Ferenczy AS, Villa LL. Advances in prevention of cervical cancer and other human papillomavirus-related diseases. Pediatr Infect Dis J 2006; 25:S65-81, quiz S82. [PMID: 16462611 DOI: 10.1097/01.inf.0000196485.86376.46] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ian H Frazer
- University of Queensland, Center for Immunology and Cancer Research, Brisbane, QLD 4072, Australia.
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40
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Partridge JM, Koutsky LA. Genital human papillomavirus infection in men. THE LANCET. INFECTIOUS DISEASES 2006; 6:21-31. [PMID: 16377531 DOI: 10.1016/s1473-3099(05)70323-6] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Genital human papillomavirus (HPV) infection, globally one of the most common sexually transmitted infections, is associated with cancers, genital warts, and other epithelial lesions. Although a consistent and coherent picture of the epidemiology and pathogenesis of genital HPV infections in women has developed over the past two decades, less is known about these infections in men. Available data suggest that, as with women, most genital HPV infections in men are symptomless and unapparent, and that HPV16 is probably the most frequently detected type. In populations of similar age, the prevalence of specific HPV types is usually lower in men than in women. Whether this observation relates to lower incidence or shorter duration of infection in men than in women has not yet been determined. Seroprevalence of specific anti-HPV antibodies also seems to be lower in men than in women of similar age, a difference that might be due to lower viral load, lower incidence or duration of infection or lower antibody responses, or both, in men compared with women. Differences in sexual behaviour may also be important predictors of genital HPV infection. With the anticipated availability of prophylactic HPV vaccines in the near future, it becomes increasingly important to understand the incidence and duration of HPV infections in men to develop cost-effective approaches to prevention through a combination of immunisation and promotion of risk-reduction strategies.
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Affiliation(s)
- Jeffrey M Partridge
- Department of Epidemiology, University of Washington HPV Research Group, University of Washington, Seattle, WA 98103, USA
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41
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Bleeker MCG, Snijders PFJ, Voorhorst FJ, Meijer CJLM. Flat penile lesions: The infectious “invisible” link in the transmission of human papillomavirus. Int J Cancer 2006; 119:2505-12. [PMID: 16988942 DOI: 10.1002/ijc.22209] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Although it has been widely accepted that high-risk human papillomavirus (hrHPV) is sexually transmitted, limited insight is available about the clinical manifestations of hrHPV infection in men and their contribution in the viral spread. Here, we reviewed the literature on the relationship between hrHPV and the presence of penile lesions. Flat penile lesions have similar predilection sites as HPV, often contain hrHPV as identified by DNA in situ hybridization in biopsy specimens, show a high association with hrHPV as identified by PCR in penile scrapes of lesional sites and are associated with high viral copy numbers. Absence of flat lesions is generally associated with very low HPV copy numbers or absence of HPV. Therefore, we argue that these lesions form the reservoir of hrHPV in men and contribute to the viral spread. Their bare visibility with the naked eye and their high degree of spontaneous healing explain why flat penile lesions have slipped the attention of the clinician. Combining an HPV DNA test with a visual inspection after acetic acid application offers a more reliable interpretation of a positive HPV test in men, as it helps to distinguish positivity that is very likely to reflect a productive HPV infection from potentially HPV infections with very low copy numbers or HPV contamination by the sex partner. Future trials of HPV vaccines in men should take into account not only the presence of penile HPV but also the presence of flat penile lesions as an outcome measure for the efficacy of a vaccine.
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Affiliation(s)
- Maaike C G Bleeker
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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42
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Epstein RJ. Primary prevention of human papillomavirus-dependent neoplasia: No condom, no sex. Eur J Cancer 2005; 41:2595-600. [PMID: 16223580 DOI: 10.1016/j.ejca.2005.06.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 06/23/2005] [Indexed: 11/17/2022]
Abstract
Cervix cancer is one of several neoplastic disorders that arise following transfer of human papillomavirus (HPV) during unprotected sexual intercourse, and like most other sexually transmitted diseases (STDs), is largely preventable by consistent condom use. This primary prevention strategy has received little support, however, when compared with massive secondary prevention initiatives involving cervical screening. The reasons for this anomalous situation are complex, and include: (i) the asymptomatic nature of most primary HPV infections; (ii) widespread ignorance concerning the venereal aetiology of HPV-related cancers; (iii) the common but incorrect belief that condom use does not reduce HPV transmission; (iv) the perceived irrelevance of safe sex campaigns based on reducing transmission of human immunodeficiency virus (HIV) in high-HPV but low-HIV countries such as the Philippines; (v) the promotion of oral contraception by the medical and pharmaceutical sectors as the sexual prophylaxis of choice; and (vi) the assumption that HPV vaccines will solve the problem. Here it is proposed that the high prevalence of non-HIV STDs, including distressing disorders such as genital warts and herpes simplex, can be exploited with greater efficacy as a public health deterrent to unsafe sex and HPV transmission. Targeting a "mutually assured infection" campaign at vulnerable subgroups such as teenagers and oral contraceptive users could help reverse the global expansion of HPV-related cancers.
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Affiliation(s)
- Richard J Epstein
- Division of Haematology and Medical Oncology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Room 404, Professorial Block, Pokfulam Road, Hong Kong
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43
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Bleeker MCG, Berkhof J, Hogewoning CJA, Voorhorst FJ, van den Brule AJC, Starink TM, Snijders PJF, Meijer CJLM. HPV type concordance in sexual couples determines the effect of condoms on regression of flat penile lesions. Br J Cancer 2005; 92:1388-92. [PMID: 15812547 PMCID: PMC2361997 DOI: 10.1038/sj.bjc.6602524] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Revised: 02/21/2005] [Accepted: 02/21/2005] [Indexed: 01/14/2023] Open
Abstract
We earlier demonstrated, in a randomised clinical trial, that the regression time of flat penile lesions in male sexual partners of women with cervical intraepithelial neoplasia (CIN) was shorter in men who used condoms compared to those who did not. To further evaluate this finding, we examined whether the effect of condom use on the regression of flat penile lesions depends on the presence of human papillomavirus (HPV) type concordance in sexual couples, as determined in cervical and penile scrapes by GP5+/6+ PCR testing. A Cox model with time-dependent covariates showed a beneficial effect of condoms on regression of flat penile lesions in concordant couples (hazard ratio 2.63, 95% CI 1.07-6.48) but not in those who were nonconcordant. When both partners harboured different HPV types, no effect of condoms was found (hazard ratio 0.90, 95% CI 0.27-2.96). Delayed regression of flat penile lesions was associated with either stable lesions or with new penile lesions developing at sites surrounding pre-existing lesions suggesting reinfection of the penile epithelium. We conclude that condom use blocks sexual HPV transmission by preventing reinfection and development of new penile lesions in men who are susceptible to the same type as present in the female partner.
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Affiliation(s)
- M C G Bleeker
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - J Berkhof
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - C J A Hogewoning
- Department of Gynaecology and Obstetrics, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - F J Voorhorst
- Department of Clinical Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - A J C van den Brule
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - T M Starink
- Department of Dermatology, VU University Medical Center, Amsterdam, the Netherlands
| | - P J F Snijders
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
| | - C J L M Meijer
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
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Abstract
Five percent of all ambulatory visits by men 18 years of age or older include genitourinary symptoms as a reason for the visit. In this article, using typical, unusual, or otherwise instructive cases, the authors review a select group of genitourinary issues in the college-age male. Warts (human papilloma virus), is the most common sexually transmitted infection, and it may mimic other disease. Testicular cancer is one of the most serious diseases to confront health care providers. Varicoceles are the most common scrotal mass. Urethritis is a common presentation of sexually transmitted infection in the young adult male. Acute prostatitis is an unusual condition in the young adult, but it is easily treatable. Sexual dysfunction causes great distress in the young adult, but a systematic approach usually leads to a treatable psychological or environmental cause. With understanding of these medical conditions, the practitioner should feel comfortable addressing the most challenging genitourinary health needs of this population.
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Affiliation(s)
- William P Adelman
- Department of Pediatrics and Adolescent Medicine, National Naval Medical Center, Uniformed Services University of the Health Sciences, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA
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45
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Gross G, Pfister H. Role of human papillomavirus in penile cancer, penile intraepithelial squamous cell neoplasias and in genital warts. Med Microbiol Immunol 2004; 193:35-44. [PMID: 12838415 DOI: 10.1007/s00430-003-0181-2] [Citation(s) in RCA: 133] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2003] [Indexed: 02/04/2023]
Abstract
Using PCR, the overall prevalence of human papillomavirus (HPV) DNA in penile carcinoma is about 40-45%, which is similar to the detection rate of HPV-DNA in vulvar carcinoma (50%). In analogy to vulvar cancer two different pathways of penile carcinogenesis seem to exist. In contrast to basaloid and warty penile cancers which are regularly HPV-associated (about 80-100%), only a part of keratinizing and verrucous penile carcinomas appear to be related with HPV (33-35%). Penile intraepithelial neoplasias comprising Bowen's disease, erythroplasia of Queyrat and bowenoid papulosis are precursor lesions of basaloid and warty carcinomas of the penis. Precursors of keratinizing carcinomas and verrucous carcinomas are not established. Whether lichen sclerosus and squamous-cell hyperplasia precede penile keratinizing carcinoma is a matter of discussion. Giant condylomata acuminata may precede the development of verrucous carcinomas in some cases. Since high risk HPVs are more frequently found in verrucous carcinomas than in giant condylomas, HPV typing may be a helpful diagnostic step to differentiate giant condyloma from verrucous carcinoma.
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Affiliation(s)
- G Gross
- Department of Dermatology and Venereology, Faculty of Medicine, University of Rostock, Augustenstrasse 80-84, 18055 Rostock, Germany.
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47
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Bleeker MCG, Hogewoning CJA, Voorhorst FJ, van den Brule AJC, Snijders PJF, Starink TM, Berkhof J, Meijer CJLM. Condom use promotes regression of human papillomavirus-associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia. Int J Cancer 2003; 107:804-10. [PMID: 14566831 DOI: 10.1002/ijc.11473] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Penile HPV-associated lesions are frequently seen in male sexual partners of women with CIN. The natural course and clinical significance of these lesions are unclear. Women with CIN and their male sexual partners were randomized for condom use (condom group n = 68, noncondom group n = 68). Males were screened for the presence of penile lesions, i.e., flat lesions, papular lesions and condylomata acuminata, and of HPV in their penile swabs by PCR testing. Median follow-up time was 13.1 months (range 2.9-57.4). The outcome of our study was clinical regression of penile lesions defined as disappearance of lesions at penoscopy. Potentially prognostic factors, i.e., HPV status, lesion type and age, were studied as well. Outcomes were assessed in 57 men of the condom group and in 43 men of the noncondom group. Condom use shortened the median time to regression of flat penile lesions (7.4 months condom group vs. 13.9 months noncondom group; HR = 2.1, 95% CI 1.2-3.7). This effect was not found for papular lesions (HR = 0.5, 95% CI 0.1-2.8). HPV-negative men showed a significantly shorter median time to regression of flat lesions (3.8 months) compared to men with either HPV-positive status (8.5 months; HR = 0.4, 95% CI 0.2-0.9) or inconsistent HPV status (13.1 months; HR = 0.2, 95% CI 0.1-0.6). Regression of flat penile lesions is HPV-dependent and accelerated by condom use. This effect is probably the result of blocking viral transmission between sexual partners.
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Affiliation(s)
- Maaike C G Bleeker
- Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands
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48
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Laukkanen P, Koskela P, Pukkala E, Dillner J, Läärä E, Knekt P, Lehtinen M. Time trends in incidence and prevalence of human papillomavirus type 6, 11 and 16 infections in Finland. J Gen Virol 2003; 84:2105-2109. [PMID: 12867641 DOI: 10.1099/vir.0.18995-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Human papillomavirus (HPV) type 16 is the major cause of cervical carcinoma, the incidence of which is decreasing in western countries. In Finland the incidence is, however, increasing in women aged <40 years, but possible underlying changes in HPV-16 epidemiology are unknown. To assess incidence trends of HPV infections, paired sera from a random sample of 8000 women with two pregnancies/sera within 5 years, taken from the serum bank of the Finnish Maternity Cohort (1983-98), were analysed for HPV-6, -11 and -16 antibodies. For 23-31-year-old women, HPV-16 incidence increased over the period 1983-97. HPV-16 seroprevalence increased from 17% in 1983-85 to 24% in 1995-97, but HPV-6 and HPV-11 prevalence was stable at 9-12% throughout the study period. Epidemic spread of the oncogenic HPV-16, but not the non-oncogenic HPV-types, throughout the 1980s and 1990s preceded an increase in the incidence of cervical carcinoma in fertile-aged Finnish women.
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Affiliation(s)
- Päivi Laukkanen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- National Public Health Institute, Helsinki and Oulu, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Pentti Koskela
- National Public Health Institute, Helsinki and Oulu, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | | | | | - Paul Knekt
- National Public Health Institute, Helsinki and Oulu, Mannerheimintie 166, 00300 Helsinki, Finland
| | - Matti Lehtinen
- National Public Health Institute, Helsinki and Oulu, Mannerheimintie 166, 00300 Helsinki, Finland
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49
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Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis 2002; 29:725-35. [PMID: 12438912 DOI: 10.1097/00007435-200211000-00018] [Citation(s) in RCA: 207] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although condoms most likely prevent HIV infection, evidence of their effectiveness against other sexually transmitted diseases is mixed. GOAL The goal of the study was to determine whether condom use prevents genital human papillomavirus (HPV) infection and HPV-related conditions. STUDY DESIGN We conducted a literature review and meta-analysis of the effect of condom use on the prevention of genital warts, subclinical HPV infection, cervical intraepithelial neoplasia (CIN), and invasive cervical cancer (ICC). RESULTS Among 27 estimates from 20 studies, there was no consistent evidence that condom use reduces the risk of becoming HPV DNA-positive. However, risk for genital warts, CIN of grade II or III (CIN II or III), and ICC was somewhat reduced. CONCLUSIONS Available data are too inconsistent to provide precise estimates. However, they suggest that while condoms may not prevent HPV infection, they may protect against genital warts, CIN II or III, and ICC.
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Affiliation(s)
- Lisa E Manhart
- Department of Medicine, University of Washington, Seattle, Washington, USA
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50
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Wiley DJ, Douglas J, Beutner K, Cox T, Fife K, Moscicki AB, Fukumoto L. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis 2002; 35:S210-24. [PMID: 12353208 DOI: 10.1086/342109] [Citation(s) in RCA: 201] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
External genital warts (EGWs) are visible warts that occur in the perigenital and perianal regions. They are due primarily to non-oncogenic human papillomavirus (HPV) types, usually types 6 and 11. Physical examination assisted by bright light and magnification is the recommended approach for primary diagnosis. Biopsy is indicated when EGWs are fixed to underlying structures or discolored or when standard therapies are not effective. Recurrences are common, and there is no single treatment that is superior to others. Among women with atypical squamous cells, molecular HPV testing may be useful in determining who should be referred for colposcopy. Condoms may provide some protection against HPV-related diseases and thus are recommended in new sexual relationships and when partnerships are not mutually monogamous. Because the efficacy of cesarean section in preventing vertical transmission of HPV infection from women with EGWs to their progeny has not been proved, it is not recommended.
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Affiliation(s)
- D J Wiley
- Division of Primary Care, School of Nursing, University of California at Los Angeles, Los Angeles, CA 90095-6919, USA.
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