Consistent condom use reduces the genital human papillomavirus burden among high-risk men: the HPV infection in men study

(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.