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PDF - 65K, Hazard ratios for incidence and clearance of HPV infection by race and stratified by number of lifetime female partners.

Background: This analysis assessed the acquisition (incidence) and persistence (clearance) of human papilloma virus (HPV) infection by self-reported race among men in The HPV in Men (HIM) Study, a multinational prospective study of the natural history of genital HPV infections.Methods: Self-reported race was categorized as White, Black, Asian/Pacific Islander (PI), or multiple and mixed race. Genital samples were combined for HPV DNA testing and categorized by any, oncogenic, and non-oncogenic HPV infections.Results: Asian/PI race had significantly the lowest incidence of any, oncogenic, and non-oncogenic HPV infection (P < 0.001). In multivariable analyses, Asian/PI race was associated with a lower probability of acquiring any [HR = 0.63; 95% confidence interval (CI), 0.42–0.95] and non-oncogenic HPV infection (HR = 0.61; 95% CI, 0.40–0.93) when compared to Whites. No significant associations were evident for Asian/PI race for clearance. Multiple and mixed race was significantly associated with lower probability of acquiring non-oncogenic HPV infection (HR = 0.83; 95% CI, 0.69–0.99) and borderline significant associations were observed for any HPV (HR = 0.91) and oncogenic infections (HR = 0.92). Multiple and mixed race was associated with a lower probability of clearing any (HR = 0.92; 95% CI, 0.84–1.00) and oncogenic HPV infections (HR = 0.85; 95% CI, 0.75–0.95).Conclusion: Asian/PI race had the lowest incidence of HPV and exhibited a lower probability of acquiring new HPV infections. Multiple and mixed race had the second lowest incidence of infection and was associated with a lower probability of acquiring and clearing an HPV infection.Impact: Race-specific differences in HPV infection could be due to behavior, innate genetic differences, or circulating intratypic HPV variants. Cancer Epidemiol Biomarkers Prev; 22(10); 1762–70. ©2013 AACR.

Background Accumulated evidence from epidemiological studies and more recently from randomized controlled trials suggests that male circumcision (MC) may substantially protect against genital HPV infection in men. The purpose of this study was to assess the association between MC and genital HPV infection in men in a large multinational study. Methods A total of 4072 healthy men ages 18–70 years were enrolled in a study conducted in Brazil, Mexico, and the United States. Enrollment samples combining exfoliated cells from the coronal sulcus, glans penis, shaft, and scrotum were analyzed for the presence and genotyping of HPV DNA by PCR and linear array methods. Prevalence ratios (PR) were used to estimate associations between MC and HPV detection adjusting for potential confounders. Results MC was not associated with overall prevalence of any HPV, oncogenic HPV types or unclassified HPV types. However, MC was negatively associated with non-oncogenic HPV infections (PR 0.85, 95% confident interval: 0.76-0.95), in particular for HPV types 11, 40, 61, 71, and 81. HPV 16, 51, 62, and 84 were the most frequently identified genotypes regardless of MC status. Conclusions This study shows no overall association between MC and genital HPV infections in men, except for certain non-oncogenic HPV types for which a weak association was found. However, the lack of association with MC might be due to the lack of anatomic site specific HPV data, for example the glans penis, the area expected to be most likely protected by MC.

The incidence of genital warts has been increasing in many western countries since the 1970s [1]. Sexually transmitted human papillomavirus (HPV) infection, usually with types 6 or 11, causes these condylomas, which incur significant morbid effects and substantial economic costs [2, 3]. In addition, genital HPV-16 infection is a major cause of penile squamous cell carcinoma, which, though rare, has either a declining, stable, or increasing incidence in recent decades, depending on country [4–6]. Like cervical cancer, the incidence of penile carcinoma is higher in developing than in developed countries [7]. The burden of some HPV-associated anogenital diseases, but not all, is higher among men having sex with men (MSM) than among men having sex with women (MSW). For example, the incidence of anal cancer, almost all of which is caused by HPV, is many times higher in MSM than in MSW [8]. On the other hand, genital condylomas may have a similar prevalence among these populations [9]. Although anogenital HPV infection is thought to be the most common sexually transmitted infection (STI), there are few published data comparing genital HPV infection among human immunodeficiency virus (HIV)–negative MSM and MSW [10, 11]; however, there is a substantial amount of data from the US STI surveillance system indicating that MSM are more likely than MSW to report a prior diagnosis of certain STIs, such as HIV, syphilis, gonorrhea, human herpesvirus, and hepatitis B [12]. The prevalence of HPV infection in the anal canal is much higher in MSM than in MSW [13], but studies of genital HPV prevalence comparing MSM and MSW have found little difference or even a higher prevalence of genital HPV among MSW than among MSM [10, 14]. Among HIV-infected men, the prevalence of genital HPV is also higher in MSW than in MSM [15]. To our knowledge, however, no prospective studies have examined the incidence and clearance of genital HPV among HIV-negative MSW and MSM. Our objective was to estimate and compare the incidence of genital HPV infections and the duration of incident infections among HIV-negative MSM and MSW. We also examined the incidence of HPV in MSM stratified into men having sex only with men (MSOM) and men having sex with both women and men (MSWM).

Objectives Moderate alcohol consumption can impair host defence against viral infections. The objective of this cross-sectional analysis was to assess the association between alcohol intake and prevalent human papillomavirus (HPV) infection among US men enrolled in the HPV in Men ( HIM ) study using quantitative alcohol intake measured from a Food Frequency Questionnaire. Methods The HIM study is a prospective, multinational study of the natural history of HPV infection. For this report, we restricted our analyses to men from the US cohort (N =1313). Samples from the corona of glans penis, penile shaft and scrotum were combined for HPV DNA testing. Self-reported alcohol intake was quantified by grams of alcohol intake per day. Multivariable prevalence ratios (mPRs) were used to assess the association between alcohol intake and HPV infections. Results Prevalent infections were significantly higher among men in the highest quartile of alcohol intake and multivariable models revealed that the highest quartile of alcohol intake was associated with significantly increased risks for any (mPR=1.13; 95% CI 1.00 to 1.27) HPV types and oncogenic (mPR=1.35; 95% CI 1.08 to 1.68) HPV types. The fourth quartile of alcohol intake was associated with elevated risks for prevalent HPV infection across all strata of number of sexual partners and among never-smokers and current smokers, but not among former smokers. Conclusions These results demonstrate that high intake of alcohol is associated with an increased risk for prevalent HPV infections among men. The biological role that alcohol plays in genital HPV infection remains understudied and limited epidemiological data exist, especially among men.

Background: This analysis assessed the acquisition (incidence) and persistence (clearance) of human papilloma virus (HPV) infection by self-reported race among men in The HPV in Men (HIM) Study, a multinational prospective study of the natural history of genital HPV infections. Methods: Self-reported race was categorized as White, Black, Asian/Pacific Islander (PI), or multiple and mixed race. Genital samples were combined for HPV DNA testing and categorized by any, oncogenic, and non-oncogenic HPV infections. Results: Asian/PI race had significantly the lowest incidence of any, oncogenic, and non-oncogenic HPV infection (P < 0.001). In multivariable analyses, Asian/PI race was associated with a lower probability of acquiring any [HR = 0.63; 95% confidence interval (CI), 0.42–0.95] and non-oncogenic HPV infection (HR = 0.61; 95% CI, 0.40–0.93) when compared to Whites. No significant associations were evident for Asian/PI race for clearance. Multiple and mixed race was significantly associated with lower probability of acquiring non-oncogenic HPV infection (HR = 0.83; 95% CI, 0.69–0.99) and borderline significant associations were observed for any HPV (HR = 0.91) and oncogenic infections (HR = 0.92). Multiple and mixed race was associated with a lower probability of clearing any (HR = 0.92; 95% CI, 0.84–1.00) and oncogenic HPV infections (HR = 0.85; 95% CI, 0.75–0.95). Conclusion: Asian/PI race had the lowest incidence of HPV and exhibited a lower probability of acquiring new HPV infections. Multiple and mixed race had the second lowest incidence of infection and was associated with a lower probability of acquiring and clearing an HPV infection. Impact: Race-specific differences in HPV infection could be due to behavior, innate genetic differences, or circulating intratypic HPV variants. Cancer Epidemiol Biomarkers Prev; 22(10); 1762–70. ©2013 AACR.

Summary Background Oral human papillomavirus (HPV) infection causes a subset of oropharyngeal cancers. These cancers disproportionately affect men, are increasing in incidence, and have no proven prevention methods. We aimed to establish the natural history of oral HPV infection in men. Methods To estimate incidence and clearance of HPV infections, men residing in Brazil, Mexico, and the USA who were HIV negative and reported no history of anogenital cancer were recruited into the HPV Infection in Men (HIM) cohort study. A subset of the cohort who provided two or more oral rinse-and-gargle samples with valid HPV results and who completed a minimum of 2 weeks of follow-up were included in this analysis. Oral rinse-and-gargle samples and questionnaire data were obtained every 6 months for up to 4 years. Samples were analysed for the presence of oncogenic and non-oncogenic HPV infections by the linear array method. Findings 1626 men aged 18–73 years and with a median follow-up of 12·7 months (IQR 12·1–14·7) were included in the analysis. During the first 12 months of follow-up, 4·4% (95% CI 3·5–5·6; n=115 incident infections) of men acquired an incident oral HPV infection, 1·7% (1·2–2·5; n=53 incident infections) an oral oncogenic HPV infection, and 0·6% (0·3–1·1; n=18 incident infections) an oral HPV 16 infection. Acquisition of oral oncogenic HPV was significantly associated with smoking and not being married or cohabiting, but was similar across countries, age groups, and reported sexual behaviours. Median duration of infection was 6·9 months (95 % CI 6·2–9·3; n=45 cleared infections) for any HPV, 6·3 months (6·0–9·9; n=18 cleared infections) for oncogenic HPV, and 7·3 months (6·0–not estimable; n=5 cleared infections) for HPV 16. Eight of the 18 incident oral HPV 16 infections persisted for two or more study visits. Interpretation Newly acquired oral oncogenic HPV infections in healthy men were rare and most were cleared within 1 year. Additional studies into the natural history of HPV are needed to inform development of infection-related prevention efforts. Funding US National Cancer Institute, Merck Sharp & Dohme.

Background: Studies in women indicate that some sexually transmitted infections promote human papillomavirus (HPV) persistence and carcinogenesis. Little is known about this association in men; therefore, we assessed whether Chlamydia trachomatis (CT) infection and herpes simplex virus type 2 (HSV-2) serostatus are associated with genital HPV prevalence, an early event in HPV-related pathogenesis. Methods: Genital exfoliated cells, first-void urine, and blood from 3971 men recruited in the United States, Mexico, and Brazil were tested for HPV, CT, and HSV-2 antibodies, respectively. Multivariable logistic regression was used to assess the association of CT infection and HSV-2 serostatus with 4 HPV outcomes (any, oncogenic, nononcogenic only, and multiple infections). Results: A total of 64 (1.6%) men were CT positive, and 811 (20.4%) men were HSV-2 seropositive. After adjustment for potential confounders, CT was associated with any HPV (adjusted odds ratio [aOR], 2.19; 95% confidence interval [CI], 1.13-4.24), oncogenic HPV (aOR, 3.10; 95% CI, 1.53-6.28), and multiple HPV (aOR, 3.43; 95% CI, 1.69-6.95) prevalence. Herpes simplex virus type 2 serostatus was associated with any HPV (aOR, 1.25; 95% CI, 1.02-1.52), nononcogenic HPV only (aOR, 1.38; 95% CI, 1.08-1.75), and multiple HPV (aOR, 1.33; 95% CI, 1.06-1.68) prevalence. In analyses stratified by sexual behavior, CT infection was significantly associated with HPV detection among men reporting 2 or more recent sexual partners, whereas HSV-2 serostatus was significantly associated with HPV detection in men reporting 0 to 5 lifetime sexual partners. Conclusion: In this population, CT infection and HSV-2 serostatus were associated with prevalent genital HPV infection. Future prospective studies should investigate whether these infections influence HPV acquisition and/or persistence

Background. Data on the natural history of human papillomavirus (HPV)–related genital warts (GWs) in men are sparse. We described the distribution of HPV types in incident GWs and estimated GW incidence and time from type-specific incident HPV infections to GW detection in a multinational cohort of men aged 18–70 years. Methods. Participants included 2487 men examined for GWs and tested for HPV every 6 months and followed up for a median of 17.9 months. Samples were taken from 112 men with incident GWs to test for HPV DNA by polymerase chain reaction. Results. Incidence of GWs was 2.35 cases per 1000 person-years, with highest incidence among men aged 18–30 years (3.43 cases per 1000 person-years). HPV 6 (43.8%), HPV 11 (10.7%), and HPV 16 (9.8%) were the genotypes most commonly detected in GWs. The 24-month cumulative incidence of GWs among men with incident HPV 6/11 infections was 14.6% (95% confidence interval [CI], 7.5%–21.1%). Median time to GW detection was 17.1 months (95% CI, 12.4–19.3 months), with shortest time to detection among men with incident infections with HPV 6/11 only (6.2 months; 95% CI, 5.6–24.2 months). Conclusions. HPV 6/11 plays an important role in GW development, with the highest incidence and shortest time to detection among men with incident HPV 6/11 infection.

Anal cancer is the result of infection with an oncogenic human papillomavirus (HPV) type, followed by the development of high-grade anal intraepithelial neoplasia and then invasive cancer. A likely crucial step in anal cancer carcinogenesis is the establishment of a persistent oncogenic HPV infection in anal canal epithelium [1]. Although the annual incidence of anal cancer is rare among men in general (∼1 in 100 000) [2], it is considerably higher among men who have sex with men (MSM), among whom incidence was estimated to be as high as 36 per 100 000 before the human immunodeficiency virus (HIV) epidemic [3, 4]; however, the difference in prevalence of anal canal HPV among MSM and men who have sex with women (MSW) is modest. For example, our cross-sectional studies among HIV-negative men indicate that anal HPV infection is common among MSW: among 1305 MSW, approximately 12% harbored HPV in the anal canal compared with 47% of MSM (including bisexual men) [5]. Thus, whereas prevalence of anal HPV is approximately 4 times higher among MSM, anal cancer incidence among HIV-negative MSM may be approximately 35 times greater. No literature has explained this considerable difference in anal cancer incidence in the context of these populations’ relatively modest difference in anal HPV prevalence. Likewise, there are no published data on behavioral factors associated with anal HPV persistence among HIV-negative MSM and MSW. The identification of modifiable risk factors for anal HPV persistence may be important for anal cancer interventions. Our primary objective was to estimate and compare the incidence and persistence of anal HPV among MSM and MSW. We hypothesized that anal HPV infection was transient among MSW and more persistent among MSM. Our second objective was to assess factors associated with anal HPV persistence.

Background: Few human papillomavirus (HPV) serology studies have evaluated type-specific seroprevalence of vaccine HPV types in men. This study investigates seroprevalence of HPV 6, 11, 16, and 18, and associated risk factors in men residing in three countries (United States, Mexico, and Brazil). Methods: Data from 1,477 men aged 18 to 70 enrolled in the HPV Infection in Men Study (HIM Study) were analyzed. Serum antibody testing was performed with virus-like particle-based ELISA. Potential risk factors were assessed for individual HPV types by the use of logistic regression. Results: Overall, HPV-6, 11, 16, and 18 seroprevalence was 14.8%, 17.3%, 11.2%, and 5.8%, respectively. Thirty-four percent of men were seropositive to one or more HPV types. When examined by sexual practice, 31.2% of men who had sex with women, 65.6% of men who had sex with men (MSM), and 59.4% of men who had sex with both men and women (MSMW) were seropositive to one or more HPV types. Seroprevalence increased with age among young-to-middle-aged men with significant upward age trends observed for HPV 11, 16, and 18. Men with multiple lifetime male anal sex partners were 2 to 4 times more likely to be HPV 6 or 11 seropositive and 3 to 11 times more likely to be HPV 16 or 18 seropositive. Conclusion: Our data indicate that exposures to vaccine HPV types were common in men and highly prevalent among MSM and MSMW. Impact: Our study provides strong evidence that the practice of same-sex anal intercourse is an independent risk factor for seroprevalence of individual vaccine HPV types. Examination of antibody responses to HPV infections at various anatomic sites in future studies is needed to elaborate on the mechanism. Cancer Epidemiol Biomarkers Prev; 20(5); 990–1002. ©2011 AACR.

We examined factors associated with HPV vaccine intentions by racial/ethnic group among men participating in a HPV natural history study. HPV knowledge, vaccine intentions and perceived barriers were assessed among non-Hispanic White, non-Hispanic Black and Hispanic men. Men were tested for HPV every 6 months. After receiving test results from their previous visit, participants (N=477) reported their intentions for HPV vaccination in a computer-assisted survey instrument (CASI). Vaccine intentions were high among all respondents, although differences were found between racial and ethnic groups in awareness and knowledge of HPV and, vaccine intentions and perceived access and barriers to receiving the HPV vaccine. In order to effectively disseminate the vaccine among men, factors that may promote or inhibit vaccine acceptability need to be identified. Identifying these factors related to vaccine intentions among minority and majority men offers an opportunity for addressing barriers to health equity and, in turn, reductions in HPV-related disparities.

An increasing incidence of anal cancer among men suggests a need to better understand anal canal human papillomavirus (HPV) infection among human immunodeficiency virus-negative men.Genotyping for HPV was conducted on cells from the anal canal among men who have sex with women (MSW) and men who have sex with men (MSM), aged 18-70 years, from Brazil, Mexico, and the United States. Factors associated with anal HPV infection were assessed using multivariable logistic regression.The prevalence of any HPV type and oncogenic HPV types did not differ by city. Anal canal HPV prevalence was 12.2% among 1305 MSW and 47.2% among 176 MSM. Among MSW, reporting a lifetime number of ≥ 10 female sex partners, a primary sexual relationship1 year in duration, and a prior hepatitis B diagnosis were independently associated with detection of any anal HPV in multivariable analysis. Among MSM, a younger age, reporting ≥ 2 male anal sex partners in the past 3 months, and never using a condom for anal sex in the past 6 months were independently associated with detection of any anal HPV in multivariable analysis.Number of sex partners was associated with anal HPV infection in both MSW and MSM. Anal HPV infection in men may be mediated by age, duration of sexual relationship, and condom use.

There is growing interest in understanding human papillomavirus (HPV) infection and related disease among men. To date there have been numerous studies reporting HPV DNA prevalence among men from several different countries, however, few have incorporated multivariable analyses to determine factors independently associated with male HPV detection. The purpose of this study was to assess the factors independently associated with HPV detection in men ages 18-70 years residing in Brazil (n = 343), Mexico (n = 312), and the United States (US) (n = 333). In samples combined from the coronal sulcus, glans penis, shaft, and scrotum, we evaluated factors associated with any, oncogenic, and nononcogenic HPV infections. In multivariable analyses, detection of any HPV infection was significantly associated with reported race of Asian/Pacific Islander, lifetime and recent number of sexual partners, and having sex in the past 3 months. Oncogenic HPV detection was independently associated with lifetime and recent number of sexual partners, and having sex in the past 3 months. NonOncogenic HPV infection was independently associated with lifetime number of sexual partners. Circumcision, assessed by clinical examination, was associated with reduced risk of HPV detection across all categories of HPV evaluated. HPV detection in men in the current study was strongly related to sexual behavior and circumcision status. Interventions such as circumcision may provide a low-cost method to reduce HPV infection.

Male sexual behavior influences the rates of cervical dysplasia and invasive cervical cancer, as well as male human papillomavirus (HPV) infection and disease. Unfortunately, little is known regarding male HPV type distribution by age and across countries. In samples combined from the coronal sulcus, glans penis, shaft, and scrotum of 1,160 men from Brazil, Mexico, and the United States, overall HPV prevalence was 65.2%, with 12.0% oncogenic types only, 20.7% nononcogenic types only, 17.8% both oncogenic and nononcogenic, and 14.7% unclassified infections. Multiple HPV types were detected in 25.7% of study participants. HPV prevalence was higher in Brazil (72.3%) than in the United States (61.3%) and Mexico (61.9%). HPV16 (6.5%), HPV51 (5.3%), and HPV59 (5.3%) were the most commonly detected oncogenic infections, and HPV84 (7.7%), HPV62 (7.3%), and HPV6 (6.6%) were the most commonly detected nononcogenic infections. Overall HPV prevalence was not associated with age. However, significant associations with age were observed when specific categories of HPV, nononcogenic, and unclassified HPV infections were considered. Studies of HPV type distribution among a broad age range of men from multiple countries is needed to fill the information gap internationally with respect to our knowledge of HPV infection in men. (Cancer Epidemiol Biomarkers Prev 2008;17(8):2036–43)

Human papillomavirus (HPV) infection is the necessary etiologic agent for cervical carcinogenesis, with HPV infection in men significantly contributing to infection and subsequent cervical disease in women as well as to disease in men [1–4]. Case-control studies of women with cervical cancer and their husbands have demonstrated that men’s sexual behavior affects women’s risk of cervical neoplasia, even when controlling for female sexual activity. In areas with a high incidence of cervical cancer, men’s sexual behavior is a risk factor for cervical neoplasia [5]. Available information regarding penile HPV infection is primarily derived from 3 sources: (1) studies of husbands of women with cervical cancer [6–9]; (2) cross-sectional studies of select populations, such as patients with sexually transmitted diseases (STDs) and military recruits [10, 11]; and (3) small prospective studies [12, 13] (see [14] for a recent review of the literature). The reported prevalence of HPV infection in men varies widely. Early studies used acetowhitening of the penis as a diagnostic marker for HPV infection and examined men for epithelial lesions [15]. Although HPV is significantly associated with acetowhite penile lesions [16], many other genital conditions are also associated with these lesions [17, 18], resulting in poor specificity for HPV detection. To accurately assess HPV infection in men, molecular techniques must be used. Recent studies using polymerase chain reaction (PCR), a method sensitive enough to detect 10–100 copies of viral DNA, have found HPV detection in men to be as high as in their female counterparts [19]. Most studies of HPV infection in men have sampled penile skin—specifically, the coronal sulcus and glans penis—and the urethra [6–9, 11–13, 20–23]. Many studies combined specimens from the skin and urethra to report HPV DNA prevalence. In 2 studies, urine was collected [21, 24]; however, neither reported HPV DNA results. There is some consensus that sampling the coronal sulcus and glans penis is necessary for assessing HPV status in men because of direct contact with the cervix [14]. There is less consensus regarding urethral sampling, particularly among asymptomatic men. In addition to potentially not yielding informative data, urethral sampling may decrease study participation, particularly in prospective studies that require repetitive sampling of anatomic sites. Several studies have evaluated the scrotum and semen for the presence of HPV DNA [25–38]; however, the majority did not also evaluate the presence of HPV at other anatomic sites [25, 27, 29–31, 34, 36]. As a result, it is unclear whether sampling the scrotum and semen contribute meaningful information to the estimation of HPV prevalence. Twelve studies have attempted to evaluate HPV sampling at multiple anatomic sites [12, 21, 26, 28, 33, 37, 39–44]. The purpose of the present study was to determine the optimal anatomic site(s) for the detection of HPV infection among heterosexual men by assessing HPV DNA in urethral, glans penis/coronal sulcus, penile shaft/prepuce, scrotal, perianal, anal canal, semen, and urine samples.

Between July and December 1993, the Hopi Department of Health Services, in collaboration with the Arizona Cancer Center (AZCC), conducted a population-based study of cervical cancer risk factors, screening practices, and predictors of Pap test utilization among American Indian women age 18 years and older living on the Hopi reservation in northern Arizona. This survey, entitled the Healthy Hopi Women's Study, involved a stratified random sample of households from each of the 11 Hopi villages. The final study sample was 559 completed face-to-face interviews. This article reports on unpublished findings of the survey and discusses how the Hopi utilized the study's findings to develop a Centers for Disease Control and Prevention (CDC)-funded breast and cervical cancer program.

Background Given high rates of anal disease, we investigated the natural history of high-risk anal human papillomavirus (HPV) among a multinational group of men who have sex with men (MSM) aged 18-64 years. Methods Anal specimens from human immunodeficiency virus-negative men from Brazil, Mexico, and the United States were genotyped. Over 2 years, 406 MSM provided evaluable specimens every 6 months for ≥2 visits. These men were stratified into men who have sex only with men (MSOM, n = 70) and men who have sex with women and men (MSWM, n = 336). Persistence was defined as ≥12 months' type-specific duration and could begin with either a prevalent or incident infection. Prevalence ratios and 95% confidence intervals were calculated by Poisson regression. Results Median follow-up time was 2.1 years. Retention was 82%. Annual cumulative incidence of 9-valent vaccine types was 19% and 8% among MSOM and MSWM, respectively (log-rank P = .02). Duration of anal HPV did not differ for MSOM and MSWM and was a median of 6.9 months for HPV-16 after combining men from the 2 groups. Among men with prevalent high-risk infection (n = 106), a total of 36.8%, retained the infection for at least 24 months. For those with prevalent HPV-16 (n = 27), 29.6% were persistent for at least 24 months. Persistence of high-risk HPV was associated with number of male anal sex partners and inversely associated with number of female sex partners. Conclusions MSM with prevalent high-risk HPV infection should be considered at increased risk for nontransient infection.

In human papillomavirus (HPV)-associated carcinogenesis, HPV infection characteristics such as viral load may play an important role in lesion development. The purpose of this study was to determine the association between quantitative assessment of oncogenic HPV viral load, and abnormal cytology among women residing along the United States–Mexico border. A cross-sectional study of 2,319 women was conducted between 1997 and 1998. Viral load of oncogenic HPV types (16, 18, 31, 39, 45, 51, 52, and 58) was measured among 173 HPV (+) women using quantitative real-time PCR. Overall, HPV 16, 31, 52 and 58 showed the highest viral load. Single type infection had higher viral loads compared to multiple type infections. HPV viral load declined significantly (p = 0.04) with age. No significant association was observed with other known HPV risk factors such as oral contraceptive use, parity, sexual and STD history. Viral load was independently associated with degree of cervical lesions. An adjusted odds ratio (AOR) of 4.7 for the association between increasing total viral load and Atypical Squamous Cells of Undetermined Significance (ASCUS)/Atypical Glandular Cells of Undetermined Significance (AGUS) was observed (p for trend

Human papillomavirus (HPV) is the main etiologic agent of anogenital cancers, including cervical cancer, but little is known about the type-specific prevalence of HPV in men. Participants were men aged 18-70 years attending a sexually transmitted disease clinic. Penile skin swabs were assessed for HPV DNA using polymerase chain reaction with reverse line-blot genotyping. Of 436 swabs collected, 90.1% yielded sufficient DNA for HPV analysis. Men with inadequate swab samples were significantly more likely to be white and circumcised than men with adequate swab samples. The prevalence of HPV was 28.2%. Oncogenic HPV types were found in 12.0% of participants, nononcogenic types were found in 14.8% of participants, multiple types were found in 6.1% of participants, and unknown types were found in 5.9% of participants. The most prevalent subtypes were nononcogenic 6, 53, and 84. HPV positivity was not associated with age. These results indicate that HPV infection among men at high risk is common but that characteristics of male HPV infection may differ from those of female infection.

Although the sexual transmission of human papillomavirus (HPV) is common [1], these infections are typically transient and asymptomatic; however, some infections will result in anogenital warts, dysplastic lesions, and/or neoplasms, which create a substantial disease burden in both sexes [2]. The prevention, screening, diagnosis and treatment of these HPV-associated diseases generate a considerable economic burden within societies [3]. Although HPV transmission between sexes is common, some aspects of HPV natural history seem to differ between heterosexual men and women. For example, the prevalence of genital HPV is higher among men than among women [4, 5]. Furthermore, incidence among men remains relatively stable across the life span [6] whereas incidence among women may decline [7]. Although men and women in these studies were from different populations, the differences suggest transmission rates may differ by sex; however, there have been few reports estimating HPV transmission incidence within couples, and these reports are equivocal regarding relative male-to-female and female-to-male transmission rates [8–11]. We reported elsewhere that monogamy was not associated with concordance of genital HPV among asymptomatic heterosexual couples [12]. Our objective in the current study was to characterize type-specific genital HPV incidence among heterosexual partners across a broad age range and to investigate the effects of monogamy and relationship duration on incidence. Understanding more about the natural history of HPV within these couples may provide new insights into prevention strategies.

At present it is unknown whether the higher prevalence of human papillomavirus (HPV) infection among smokers in men is attributed to a higher probability of acquiring an infection or because of longer infection persistence. Thus, we investigated the role of smoking on the (acquisition) and clearance (persistence) of genital HPV infections among 4,026 men in The HPV in Men (HIM) Study, a multinational prospective study of the natural history of genital HPV infection in men. Genital HPV infections were grouped any-, oncogenic-, and non-oncogenic HPV infections and smoking status was categorized as current-, former, and never smokers. The incidence of any-, oncogenic-, and non-oncogenic HPV infections was significantly higher among current smokers compared to former- and never smokers (P < 0.01). In multivariable analyses adjusting for sexual behavior and potential confounders, when compared to never smokers, current smokers exhibited significantly higher probability of acquiring any- (Hazard Ratio [HR] = 1.23; 95% confidence interval [CI] 1.02 – 1.50) and non-oncogenic (HR = 1.21; 95% CI 1.00 – 1.45) infections and a borderline significant probability for oncogenic infections (HR = 1.18; 95% CI 0.98 – 1.41). Although the median duration of HPV infection was generally longer among current smokers, we found no statistically significant associations in the multivariable analyses. Overall, these results demonstrated that current smoking exhibited the highest incidence and highest probability of acquiring genital HPV infections.

(See the editorial commentary by Hariri and Warner on pages 367–9.) Human papillomavirus (HPV) infection is the most common sexually transmitted infection (STI) worldwide [1]. Approximately 50% of men [2, 3] and 40% of women [4] in the United States are infected with HPV at any given time. HPV transmission occurs via skin-to-skin contact, usually during sexual intercourse, and is often transmitted unknowingly, because most infections are asymptomatic. HPV infection can lead to benign disease, including anogenital warts [5], or to malignant cancers of the cervix, vagina, vulva, anal canal, penis, and oropharynx [6]. At present, prophylactic vaccination is the only proven and available method of primary HPV prevention; however, the vaccine is only routinely available for those younger than 26 years, and vaccine dissemination rates in the United States remain low [7, 8]. Therefore, effective methods are still needed to prevent HPV infection and reduce HPV transmission among men and women. Male condoms offer substantial protection against acquisition of many STIs [9], including human immunodeficiency virus infection, gonorrhea, chlamydial infection, herpes simplex virus type 2 infection, and syphilis. However, data on the efficacy of condoms in preventing HPV acquisition are limited. Consistent condom use has been associated with a decreased likelihood of HPV acquisition among young women [10]; however, data among men are sparse [9, 11]. Some cross-sectional studies have demonstrated protective associations between condom use and prevalence of genital HPV infection [12–15]. Only 2 prospective studies of condom efficacy have been conducted in men, and the studies were restricted by small sample sizes and short follow-up times; however, their results suggest that condom use may reduce the risk of acquiring genital HPV infections [16] and may promote the regression of HPV-related lesions [17]. To our knowledge, no study has had sufficient power to examine the efficacy of condom use in reducing HPV acquisition and decreasing HPV infection duration in men or the ability to detect differences in condom efficacy across sexual behavior risk groups or sex partner types. Using data from a large cohort of sexually active men, we assess whether consistent condom use reduces the risk of acquiring new genital HPV infections or decreases the duration of HPV infections. The association between condom use and genital HPV infection was further evaluated according to sexual risk behaviors and partnerships.

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.

Background: It is largely unknown if antihuman papillomavirus (HPV) serum antibody responses vary by anatomic site of infection in men. Methods: This study assessed type-specific anti-HPV serum antibody prevalence associated with corresponding HPV DNA detection in the external genitalia and the anal canal of 1,587 heterosexual men and 199 men who have sex with men (MSM). Results: We observed that HPV 6 and 16 seroprevalence was higher in the presence of same HPV-type infection in the anal canal compared with same HPV-type infection in the external genitalia only, and among MSM compared with the heterosexual men. Seropositivity to HPV 6 was strongly associated with HPV 6 DNA detection in the anal canal but not in the external genitalia alone among both heterosexual men [adjusted prevalence ratio (APR), anal+/genital+ vs. anal−/genital−: 4.2, 95% confidence interval (CI), 11.7–10.5; anal+/genital− vs. anal−/genital−: 7.9 (95% CI, 3.7–17.0)] and MSM [APR, anal+/genital+ vs. anal−/genital−: 5.6 (95% CI, 2.7–11.9); anal+/genital− vs. anal−/genital−: 3.2 (95% CI, 2.1–4.9)]. Similar associations between seropositivity to HPV 16 and anal HPV 16 DNA detection were only observed in MSM [anal+/genital+ vs. anal−/genital−: 3.1 (95% CI, 2.0–5.0); anal+/genital− vs. anal−/genital−: 2.2 (95% CI, 1.3–3.5)]. Conclusion: Our data showed that seroprevalence varied by anatomic site of HPV infection, suggesting differences in epithelium type present at these anatomic sites may be relevant. Impact: Our finding is instrumental in advancing our understanding of immune mechanism involved in anatomic site–specific antibody response. Cancer Epidemiol Biomarkers Prev; 21(9); 1542–6. ©2012 AACR.

Comparative studies of genital human papillomavirus (HPV) among men having sex with men (MSM), men having sex with women and men (MSWM), and men having sex with women (MSW) have not been conducted so far; however, such comparisons may be important for planning prevention strategies like vaccination.Men, aged 18 to 70 years, were enrolled in a study of genital HPV in São Paulo, Brazil; Cuernavaca, Mexico; and Tampa, FL. Men were classified as MSM (n = 170), MSWM (n = 214), and MSW (n = 3326) based on self-reported sexual behavior. Genotyping for HPV was conducted on cells from the penis and scrotum. Prevalence data were adjusted by country. Factors potentially associated with genital HPV were assessed using multivariable Poisson regression.Genital HPV prevalence was typically higher among MSWM than among MSM or MSW for groups of HPV genotypes including nononcogenic types (51%, 36%, and 42%, respectively), and multiple types (37%, 24%, and 29%, respectively). Age and alcohol consumption in the past month were associated with oncogenic HPV among both MSM and MSWM; however, there were no statistically significant associations between sexual behaviors and genital HPV among MSM or MSWM.Prevalence of genital HPV may be higher among MSWM than among MSW or MSM. Number of female sex partners was associated with genital HPV among MSW, but number of male anal sex partners was not associated with genital HPV among MSM and MSWM.

Human papillomavirus (HPV) is a necessary cause for cervical cancer [1] and is the most common sexually transmitted infection [2, 3]. In men, HPV infection contributes to the burden of such diseases as genital warts and several cancers, including cancer of the anus and of the penis [2]. Although multiple HPV types are often found in the external genitalia of men [4–6], to our knowledge, no information is available on whether certain combinations of HPV types might be found together in a coinfection more or less often than what would be expected by sexual transmission and common risk factors. This issue is particularly relevant to inform the monitoring of benefits of vaccination of women or men on the incidence of HPV infection in men. The removal of certain HPV types through vaccination could, in theory, indirectly increase or decrease the prevalence of other untargeted types. Previous studies have attempted to assess clustering patterns of multiple HPV types in women [7–15]. Clustering of HPV types has been assessed using statistical methods based on mixed models or similar approaches [7, 14–18]. These methods allow the investigator to control for the apparent positive association between all HPV types induced by common acquisition modalities. Overall, studies in women suggested that HPV coinfections in the cervix occur at random. In the present analysis, we investigated the patterns of HPV coinfections among men from the HPV in Men (HIM) study, a population-based cohort study of the natural history of anogenital HPV infection.

Human papillomavirus (HPV) causes anal, penile and oropharyngeal cancers in men. Genital HPV prevalence in men appears to vary by world region with men residing in Asia having among the lowest prevalence. Unfortunately, there is little information on prevalence of HPV infection in men by race. The purpose of this study was to examine HPV prevalence by race across three countries. 3,909 men ages 18–70 years enrolled in an ongoing prospective cohort study of the natural history of HPV in men (The HIM Study) were included in the analysis. Participants completed risk factor questionnaires and samples were taken from the penile epithelium and scrotum for HPV detection. HPV testing of the combined DNA extract was conducted using PCR and genotyping. Asian/Pacific Islanders had the lowest HPV prevalence of 42.2% compared to Blacks (66.2%), and Whites (71.5%). The Asian/Pacific Islander race was strongly protective in univariate analysis (prevalence ratio (PR) = 0.59; 95% confidence interval (CI): 0.48–0.74) and multivariate analysis for any HPV infection (PR = 0.65; 95% CI: 0.52–0.8). Stratified analysis by lifetime number of female partners also showed strong inverse associations with the Asian/Pacific Islander race. We consistently observed the lowest prevalence of HPV infection among Asian/Pacific Islanders with moderate inverse associations even after various adjustments for potential confounding factors. Unmeasured behavioral factors, sexual mixing with low risk women, and/or race-specific differences in the frequency of germline variations among immune regulating genes may underlie these associations. Further studies among Asian populations that incorporate measures of immuno-genetics are needed to understand this phenomenon.

Background: Oral human papillomavirus type-16 (HPV16) infection is a risk factor for oropharyngeal cancer. We examined oral HPV infection among healthy men. Methods: Oral rinse/gargle specimens and questionnaire data were collected from 1,688 healthy men aged 18 to 74 (median = 31 years), from the United States, Mexico, and Brazil. HPV16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59, and noncarcinogenic HPV types were detected using Roche Linear Array. Results: Oral HPV DNA was detected in 67 of 1,680 (4.0%, 95% CI = 3.1%–5.0%) β-globin–positive specimens; carcinogenic HPVs were detected in 1.3% (95% CI = 0.8%–2.0%; n = 22) and HPV16 was the most commonly detected carcinogenic HPV type (0.6%, 95% CI = 0.2%–1.1%; n = 10). The prevalence of oral HPV infection was similar by country except for HPV55, which had notably higher prevalence in Mexico (3.0%) than Brazil (0%) or the United States (0.2%). Oral HPV prevalence nonsignificantly increased over increasing age categories (Ptrend = 0.096). The strongest predictor of oral HPV was current tobacco use, which increased the odds 2.5-fold (95% CI = 1.4–4.4). Oral sexual behaviors were not associated with oral HPV infection. Conclusions: Oral HPV16 infection was rare in healthy men, especially at younger ages, and was positively associated with current tobacco use. Impact: Oral HPV appears to be about 10-fold less prevalent than infection at genital sites in men (4% vs. ∼40%, respectively). It remains unclear whether this reflects reduced exposure or if the oral region is more resistant to HPV infection compared with anogenital sites. Cancer Epidemiol Biomarkers Prev; 20(1); 172–82. ©2011 AACR.

Although the primary cause of anal cancer is human papillomavirus (HPV) infection in the anal canal, little attention has been paid to the epidemiology of anal HPV infection in men who have sex with women (MSW).Exfoliated cells from the anal canal of 902 MSW in Brazil (São Paulo), Mexico (Cuernavaca), and the United States (Tampa) were tested for HPV DNA.The prevalence of HPV infection in the anal canal (12.0%) was similar among MSW in each city (P=.77), whereas 7.0% had infection with oncogenic types. Men in Tampa had a 4-fold higher prevalence of infection with HPV type 16 (HPV-16) than that among men in São Paulo or Cuernavaca (P.001). Duration of relationship with a primary sex partner and ever having oral or anal sex with a man was associated with infection with any HPV type and with any oncogenic type, whereas lifetime number of female sex partners was associated with infection with any HPV type.Anal canal HPV infection is commonly found among MSW, and the prevalence of infection with HPV-16 may differ substantially by geography. Men who have a larger lifetime number of female sex partners, who are in a sexual relationship of1 year in duration, and who have a history of oral or anal sex with men were most likely to have an anal HPV infection.

Background: A vaccine to prevent human papillomavirus (HPV) 6, HPV 11, HPV 16, or HPV 18 and associated diseases is licensed for females, and it may be licensed for men in the future. There are limited data on HPV 6/11, 16, and/or 18 seroprevalence in men. Methods: A total of 490 men aged 18 to 40 years were enrolled in a study of HPV in men in Tucson, AZ, and Tampa, FL. Enrolled men completed a self-administered questionnaire, and HPV serology was performed using HPV 6/11, 16, and 18 VLP assays. Results: Overall, seroprevalence to HPV 16 was 12.1%, HPV 6/11 was 9.7%, and to HPV 18 was 5.4%. Seroprevalence to HPV 6/11, 16, and/or 18 was 21% and was highest among 35 to 40 year olds (48%); prevalence in this age group was significantly higher compared to the 18 to 24 year olds (adjusted odds ratio (aOR) 6.8, 95% confidence interval (CI) 3.7, 12.8). Independent predictors of seropositivity to HPV 6/11, 16, and/or 18 were older age, greater number of female sex partners in the past 3 months, and current smoking. Conclusions: HPV vaccine-type seroprevalence was highest in 35 to 40 year old men. These data on the epidemiology of HPV seroprevalence in men are useful for discussions regarding recommendations for HPV vaccine if licensed for use in men.

Understanding the natural history of sexually transmitted infections requires the collection of data on sexual behavior. However, there is concern that self-reported information on sexual behavior may not be valid, especially if study participants are culturally and linguistically distinct. The authors completed a test-retest reliability study of 1,069 men recruited in Brazil, Mexico, and the United States in 2005 and 2006. All of the men completed the same computer-assisted self-interview approximately 3 weeks apart. Refusal rates, kappa coefficients, and intraclass correlation coefficients were calculated for the full sample and by country, age, and lifetime number of female sex partners. Reliability coefficients for each study site and the combined population were high for almost all questions. With few exceptions, the authors found high test-retest reliability with a computer-assisted self-interview on sexual behavior used in 3 culturally and linguistically distinct countries.

Human papillomavirus (HPV) causes cervical cancer and is strongly associated with other anogenital cancers. Multiple-type HPV infection has been associated with lengthier infection and precancerous lesions. Little is known about multiple-type HPV prevalence and associated factors in men. We examined the prevalence of and risk factors for multiple-type HPV in primarily asymptomatic men. Detection of 37 HPV types in male anogenital epithelium and semen was completed in 463 men in two U.S. cities. The proportions of men with multiple HPV of any type and with multiple oncogenic or nononcogenic types were calculated. Factors associated with multiple HPV were evaluated using multinomial logistic regression. Overall, 22.9% of men had multiple-HPV, 8.6% of men had multiple oncogenic types, and 13.4% had multiple nononcogenic types. Greater proportions of samples at the shaft, glans/corona, and scrotum had multiple HPV types (18.7%, 12.8%, and 7.3%, respectively) than did other anogenital sites (all ≤2.8%). Factors independently associated with multiple-type HPV were Hispanic ethnicity [adjusted odds ratio (AOR), 2.45; 95% confidence interval (95% CI), 1.05-5.67], concurrent detection of genital warts (AOR, 10.40; 95% CI, 1.12-96.6), smoking ≥10 cigarettes/d (AOR, 3.00; 95% CI, 1.07-8.43), greater lifetime number of female sexual partners (AOR, 13.73 for ≥21 versus 1-5; 95% CI, 5.34-35.3), and condom use less than half the time (AOR, 2.03; 95% CI, 1.07-3.84). Detection of multiple HPV types in this study of primarily asymptomatic men was common, particularly at external genital sites. Lifetime number of female sex partners, condom use, and smoking were modifiable factors associated with multiple HPV. (Cancer Epidemiol Biomarkers Prev 2009;18(4):1077–83)

Background. Our understanding of factors associated with acquisition and clearance of human papillomavirus (HPV) in men has been limited. This study sought to determine factors associated with those aspects of HPV infection in a cohort of US men. Methods. A total of 285 men aged 18 – 44 years were monitored every 6 months for 18 months. Risk-factor information was obtained at each visit by use of a self-administered questionnaire. A continuous-time 2-state Markov model was applied. Results. Lifetime number of sex partners reported at enrollment was the most significant risk factor for acquisition of all types of HPV. Men reporting 16 lifetime sex partners were at significantly elevated risk of any HPV infection (adjusted hazard ratio [AHR], 2.8 [95% confidence interval {CI}, 1.1–7.1]), oncogenic HPV infection (AHR, 9.6 [95% CI, 2.4 –37.8]), and nononcogenic HPV infection (AHR, 3.6 [95% CI, 1.3–9.9]), compared with those reporting 0 – 4 partners. Circumcised men were 3 and 6 times more likely to clear infection with any and oncogenic HPV types, respectively. In addition, having had 16 lifetime sex partners was associated with greater likelihood of clearance of oncogenic HPV infection (AHR, 4.9 [95% CI, 1.2–19.8]). Conclusion. The key factor associated with acquisition of HPV was lifetime number of sex partners, whereas circumcision was the most significant determinant for clearance of any HPV infection and oncogenic HPV infection. Human papillomavirus (HPV) infection in men contributes significantly to infection and subsequent cervical disease in women [1– 4]. Studies of HPV infection in heterosexual couples have shown that males’ sexual behavior and HPV infection status are significantly associated with their female partners’ risk of precancerous le

Accurate knowledge about human sexual behaviors is important for increasing our understanding of human sexuality; however, there have been few studies assessing the reliability of sexual behavior questionnaires designed for community samples of adult men. A test-retest reliability study was conducted on a questionnaire completed by 334 men who had been recruited in Tucson, Arizona. Reliability coefficients and refusal rates were calculated for 39 non-sexual and sexual behavior questionnaire items. Predictors of unreliable reporting for lifetime number of female sexual partners were also assessed. Refusal rates were generally low, with slightly higher refusal rates for questions related to immigration, income, the frequency of sexual intercourse with women, lifetime number of female sexual partners, and the lifetime number of male anal sex partners. Kappa and intraclass correlation coefficients were substantial or almost perfect for all non-sexual and sexual behavior items. Reliability dropped somewhat, but was still substantial, for items that asked about household income and the men's knowledge of their sexual partners' health, including abnormal Pap tests and prior sexually transmitted diseases (STD). Age and lifetime number of female sexual partners were independent predictors of unreliable reporting while years of education was inversely associated with unreliable reporting. These findings among a community sample of adult men are consistent with other test-retest reliability studies with populations of women and adolescents.

Background. Human papillomavirus (HPV) infections cause disease in men and women, and male-to-female HPV transmission influences the risk of cancer in females. The purpose of the present study was to describe the overall and age-specific incidence and clearance of HPV infections in men. Methods. In a prospective cohort study of 290 men aged 18-44 years, participants were examined at baseline and every 6 months, with a mean duration of follow-up of 15.5 months. Results. The period prevalence was 52.8% for any, 31.7% for oncogenic, and 30.0% for nononcogenic HPV infection. The 12-month cumulative risk of acquiring a new HPV infection was 29.2%. Incidences of HPV types 6, 11, 16, and 18 were 2.8, 0.5, 4.8, and 0.8 per 1000 person-months, respectively. The median time to clearance of any HPV infection was 5.9 months (95% confidence interval, 5.7―6.1 months), with comparable times to clearance for oncogenic and nononcogenic infections. Approximately 75% of men tested negative for any HPV 12 months after initial HPV detection. Age was not significantly associated with HPV incidence or duration of infection in men. Conclusion. HPV infection in men was common, with relatively rapid rates of acquisition and clearance.

Invasive cervical cancer is a preventable disease due to screening for precursor lesions using the Papanicolaou cytological testing (Pap smear). Participants were assessed regarding their access to and utilization of health care services, prevention orientation, history of chronic disease screening, and reproductive health history. Factors independently positively associated with Pap smear screening were age, clinical breast exam (CBE) in the last year, doctor recommendation of a Pap test, living in the United States, and checkup in the past year. Having a regular source of health care, as well as a doctor's recommendation for a Pap smear, appears to have a positive effect on women's Pap smear screening rates in U.S.–Mexico border communities.

Background: Human papillomavirus (HPV) is sexually transmitted and causes cervical cancer. Although HPV can infect men and women, little is known about infection in men. Specifically, the prevalence of type-specific HPV infection and the distribution of infections by anogenital anatomic site in men are incompletely characterized. Methods: We tested 463 men ages 18 to 40 years for HPV at the glans/corona, penile shaft, scrotum, urethra, perianal area, anal canal, and in a semen sample. Eligible men acknowledged no history of genital warts and had sexual intercourse with a woman within the past year. HPV testing by PCR and reverse line blot genotyping for 37 types was conducted on each of the specimens from the seven sampling sites. Results: When HPV results from any sampling site were considered, 237 (51.2%) men were positive for at least one oncogenic or nononcogenic HPV type, and another 66 (14.3%) men were positive for an unclassified HPV type. The types with the highest prevalence were HPV-16 (11.4%) and 84 (10.6%). External genital samples (glans/corona, shaft, and scrotum) were more likely than anal samples to contain oncogenic HPV (25.1% versus 5.0%). HPV-positive penile shaft and glans/corona samples were also more likely to be infected with multiple HPV types than other sites. Conclusions: More complete anogenital sampling and sensitive detection for 37 HPV types resulted in a higher HPV prevalence in primarily asymptomatic men than reported previously. The penile shaft was the site most likely to be HPV positive and harbored the greatest proportion of multiple type and oncogenic infections. These results have implications for research of HPV among men and transmission between partners. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1107–14)

Human papillomavirus (HPV) infection is the most common sexually transmitted infection and is the necessary cause of cervical cancer. An estimated 6.2 million people in the United States acquired a genital HPV infection in 2000 [1]. Approximately 60 HPV genotypes are known to infect the genital tract, 13 of which are considered to be high risk, or oncogenic [2, 3]. Although infection is most often asymptomatic and transient, oncogenic genotypes of HPV are strongly associated with cervical cancer and are associated to varying degrees with other anogenital cancers in both men and women [4]. Nononcogenic HPV genotypes can cause genital warts and other benign lesions; however, many HPV infections are clinically inapparent [5]. Factors associated with prevalent HPV infection in men include current and past sexual behavior, circumcision status, lack of condom use, history of other sexually transmitted infections, race and ethnicity, and education level [6–16]. The strength and significance of the reported associations vary across the populations under examination and depend on whether the outcome analyzed is all HPV types, oncogenic types, or nononcogenic types. The most consistently reported risk factor for HPV infection in men is a greater lifetime number of female sex partners [8–11, 13, 15], with some studies reporting an association with the recent number of female sex partners [8, 13]. Most studies that have evaluated the association between circumcision and HPV prevalence found a lower prevalence in circumcised men [6, 7, 11–14, 16]. Two studies have found younger age (e.g., 18–24 years old vs. ≥35 years old) to be associated with both oncogenic and nononcogenic HPV infection [13, 14]. A younger age at first sexual intercourse was associated with HPV infection in 1 of 4 studies that examined the association [6, 8–11]. When condom use was evaluated in male HPV prevalence studies, 5 studies found no association with HPV detection [9–12, 15], and 3 found a lower odds of detection associated with condom use [6, 10, 14]. Two prospective studies of HPV in men have reported factors associated with HPV acquisition and persistence. Risk factors for acquisition included anal intercourse with men and having had at least 3 sex partners, whereas protective factors were high socioeconomic status and condom use [11, 17]. Both studies reported that infection with multiple HPV types at baseline was a risk factor for persistent infection, and Lajous et al. reported a protective effect of circumcision on HPV persistence [11, 17]. The present study was conducted to determine the behavioral and health factors associated with HPV detection in the entire anogenital area among asymptomatic men in the United States.

Background and Objectives: Human papillomavirus (HPV) is the primary cause of cervical, anal, and other anogenital cancers, but risk factors for penile HPV detection in men have not been well-characterized. Goal: The goal of this study was to identify correlates of penile HPV detection in ethnically diverse men attending a sexually transmitted disease clinic. Study: A cross-sectional investigation was conducted among 393 men. Participants completed a risk-factor questionnaire and underwent testing for penile HPV DNA. Presence of HPV DNA was assessed using polymerase chain reaction with PGMY primers and reverse line blot genotyping. Logistic regression analyses were conducted to identify variables associated with any-type, oncogenic, and nononcogenic HPV. Results: Circumcision was associated with reduced risk for oncogenic, nononcogenic, and overall HPV. Regular condom use was associated with reduced risk for oncogenic and overall HPV. Conclusion: These findings, if confirmed by other studies, could impact public health practices and messages regarding HPV. HUMAN PAPILLOMAVIRUS (HPV) has been identified as the necessary, sexually transmitted etiologic agent of cervical cancer, cervical intraepithelial neoplasia (CIN), and other squamous cellbased anogenital cancers in women and men. In U.S. women, HPV causes 13,000 cases of cervical cancer each year. 1 HPV is also associated with 4000 cases of anal cancer each year in the United States, as well as many of the 4800 incident vulvar and vaginal cancers and 1000 penile cancers. 1‐ 4 Although much data exist on HPV infection in women, knowledge about penile HPV in men is limited. However, most recent studies suggest that prevalence of penile HPV in men is at least as high as cervical HPV prevalence in women. 5‐12 Moreover, several studies have demonstrated that the sexual behavior of men impacts rates of HPV infection, CIN, and cervical cancer in female sex partners, even after adjusting for female sexual behavior. 14 ‐18 The

The fundamental aim of this study was to identify factors crucial for the development of effective cancer prevention programs for American Indian (AI) populations. Toward that end, we developed an instrument to assess the influence of traditionalism on health risks such as smoking, consumption, and obesity. A population-based survey was conducted among 559 randomly selected women living on the Hopi reservation aged 18 years and older, from July through December 1993. To construct a traditionalism score, we conducted focus groups in the community. A multidimensional approach was adopted by assessing three dimensions of native culture: language usage; cultural participation, or participation in such activities as Hopi ceremonies; and percentage of life spent off-reservation. A mean score of the three dimensions was computed for each respondent. High levels of traditionalism were significantly associated with disease protective behaviors, such as practicing traditional Hopi activities to keep healthy (OR = 3.07), and significantly inversely associated with disease risk factors such as smoking (OR = 0.26) and obesity (OR = 0.60) independent of age, marital status, and education. As these data provide a strong rationale for the promotion of traditions in public health programs aimed at decreasing rates of chronic disease among AI women, we conclude this paper with a discussion of the importance of traditionalism and how it might be accurately assessed.

The purpose of this investigation was to assess the association between smoking and clearance of oncogenic human papillomavirus (HPV) infection.A prospective cohort study of 346 women aged 18-35 years was conducted. HPV testing was conducted with the Hybrid Capture II (HC II) system and polymerase chain reaction (PCR) with genotyping using the reverse line blot method. At each visit tobacco exposure, reproductive, and sexual histories were assessed. Probability of clearing an oncogenic HPV infection and duration of oncogenic HPV infections by smoking status was assessed.Regardless of method used, HC II or PCR, ever smokers maintained an HPV infection significantly longer (median duration of 8.5 months vs 10.7 months, never vs ever smokers), and had a lower probability of clearing an oncogenic infection compared with women who never smoked. Smoking duration was significantly associated with HPV clearance, and a dose response was observed. Older age (13 years) at smoking initiation was significantly associated with a reduced probability of clearing an oncogenic HPV infection.This is the first study to demonstrate that smoking promotes early cervical carcinogenic events by increasing duration of oncogenic HPV infections and decreasing probability of clearing oncogenic infections.

The natural history of type-specific human papillomavirus (HPV) infections was examined in a cohort of 331 women aged 18-35 years who self-referred for routine gynecological care. Participants underwent a gynecological examination at baseline and at approximately 4 and approximately 10 months after baseline. Cervical samples were collected for HPV testing and genotyping at each visit, as was information on reproductive, sexual, and medical histories. The rate of new HPV infections was 2.9% per month; the highest rates were observed for HPV types 16, 39, 84, and 51. Among women who tested negative for HPV at baseline, the cumulative probability of acquiring an oncogenic HPV strain during a 12-month follow-up period was 0.32, compared with 0.18 for nononcogenic strains. Women who had had >/=1 new male sex partner in the recent past were significantly more likely to acquire a new HPV infection (relative hazard, 2.39; 95% confidence interval, 1.20-4.76). The median time to clearance of infection was significantly longer for oncogenic strains (9.8 months) than for nononcogenic strains (4.3 months).

Background Previously we observed elevated HPV seroprevalence in men who had sex with men (MSM) and men who had sex with men and women (MSMW) compared to men who had sex with women (MSW). We hypothesise that the higher seroprevalence is associated with HPV infection at multiple anatomic sites, and the presence of mucosal epithelium infection as opposed to keratinised epithelium infection. We assessed associations between HPV seropositivity and prevalent HPV infection at anal canal and external genitalia in men to test the hypothesis. Methods Enrolment data for 1663 men, including 1474 MSW, 83 MSM and 106 MSMW, were analysed. HPV L1 VLP-based ELISA was used for serum antibody testing and Linear Array for HPV DNA testing. Associations were estimated for HPV 6 and 16, respectively, using logistic regression. MSM and MSMW were combined to form the group MSM. Results Overall HPV 6 and 16 seroprevalence was 9.9% and 14.1%. HPV 6 and 16 DNA was present in 2.2% and 2.7% of anal samples, and 6.4% and 7.3% of genital samples. Seroprevalence of HPV 6 and 16 was significantly higher in MSM compared to MSW (32.8 vs 6.9%; 34.4 vs 11.5%). Similarly, HPV 6 and 16 DNA was more frequently detected in anal samples (9.5 vs 1.2%; 9.0 vs 1.8%) and genital samples (7.4 vs 6.2%; 9.0 vs 7.1%) of MSM than MSW. Men with simultaneous anal and genital HPV infection (AOR—9.20 and 6.79) or anal HPV infection alone (AOR—19.93 and 3.19) were significantly more likely to be HPV 6 and 16 seropositive. There was no association of seropositivity with prevalent genital HPV 6 or 16 infection. Strong positive associations were detected in MSW and MSM who were anal HPV 6 positive, regardless of coinfection with genital HPV 6. In contrast, no association was observed among MSW with anal HPV 16, with or without genital coinfection. However, significant associations were observed in MSM with anal HPV 16 (with coinfection—AOR, 10.94, 95% CI, 1.18 to 101.68; without—AOR, 4.96, 95% CI, 1.40 to 17.57). Conclusion We found type-specific associations of HPV 6 and 16 seropositivity with prevalent anal HPV infection, but not with prevalent genital HPV infection alone. Anal HPV 6 infection was associated with seropositivity in both MSW and MSM, while anal HPV 16 infection was only associated with seropositivity in MSM. Our data suggest that, in men, anal HPV infection may be more efficient than genital HPV infection in inducing immune responses. This may have relevance for protective immunity or the lack thereof, conferred by natural infection.

Background: Reported associations of male circumcision (MC) with human papillomavirus (HPV) infection in men have been inconsistent. Methods: 4,033 healthy men were examined every six months for a median of 17.5 months. In each study visit, exfoliated cell specimens from the coronal sulcus/glans penis, penile shaft, and scrotum were collected and combined into one sample per person for HPV DNA detection. Samples were tested for 37 HPV types. Cox proportional hazards models were used to evaluate the association between MC and the incidence and clearance of HPV infections and specific genotypes. Results: The overall incidence of new HPV infections did not differ by MC status (for any HPV, adjusted hazard ratio (aHR) 1.08, 95% confidence interval (CI) 0.91-1.27). However, incidence was significantly lower among circumcised versus uncircumcised men for HPV types 58 (p = 0.01), 68 (p < 0.001), 42 (p = 0.01), 61 (p < 0.001), 71 (p < 0.001), 81 (p = 0.04), and IS39 (p = 0.01), and higher for HPV types 39 (p = 0.01) and 51 (p = 0.02). Despite the lack of an overall association in the risk of HPV clearance by MC (for any HPV, aHR 0.95, 95% CI 0.88-1.02), median times to clearance were significantly shorter among circumcised than uncircumcised men for HPV types 33 (p = 0.02) and 64 (p = 0.04), and longer for HPV types 6 (p < 0.001), 16 (p < 0.001), and 51 (p = 0.02). Conclusions: MC is not associated with the incidence and clearance of genital HPV detection, except for certain HPV types. The use of a single combined sample from the penis and scrotum for HPV DNA detection likely limited our ability to identify a true effect of MC at the distal penis.