Elsevier

Preventive Medicine

Volume 53, Supplement 1, 1 October 2011, Pages S36-S41
Preventive Medicine

Review
Genital HPV infection and related lesions in men

https://doi.org/10.1016/j.ypmed.2011.08.002Get rights and content

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.

Section snippets

Genital HPV infection in men

The reported prevalence of genital HPV DNA in men has ranged from 1.3% to 72.9% (with most studies reporting ≥ 20%) (Dunne et al., 2006). Variation in reported prevalence is likely due to differences in sampling techniques, the populations studied, genital sites sampled (e.g., scrotum, shaft, glans, etc.), and HPV DNA detection methods used. The use of a more sensitive sampling technique (i.e., a pre-wetted Dacron swab rather than a cytobrush or collecting a urine sample (Weaver et al., 2004))

Genital warts

The majority of HPV infections are asymptomatic with an estimated 70% of incident infections clearing within 1 year (Dunne et al., 2006). If an infection does not clear however it can progress to disease. Anogenital warts are the most common clinical manifestation of HPV infection (Scheurer et al., 2005). Though they are benign and not associated with mortality, they are a source of psychosocial distress (Jeynes et al., 2009) and can cause physical discomfort including pain, bleeding and itching

Penile intraepithelial neoplasia

Penile intraepithelial neoplasia (PIN) is a heterogeneous condition that currently does not have standard clinical protocols for diagnosis. Because of the similarities in histologic characteristics, the classifications for PIN I, II and III have been “borrowed” from those assigned to CIN. Benign clinical conditions such as lichen sclerosus or psoriasis may appear similar to PIN on visual inspection alone; therefore, misclassification of PIN is possible without histological confirmation from a

Incidence and prevalence of penile cancer

Invasive penile cancer is rare and accounts for less than 0.5% of all cancers in men worldwide (Parkin & Bray, 2006). Between 1998 and 2003, the annual age-adjusted incidence rate of penile cancer in the US was 0.81 per 100,000 men and accounted for only 0.1% of male invasive cancers (Hernandez et al., 2008b). The disease most commonly affects men ages 50–70 years (Bleeker et al., 2009). Incidence of penile cancer in the US is highest among Hispanics and men who live in the Southern US or areas

HPV prevalence in penile cancer

Though the etiology of penile cancer is still unknown, approximately 40% of all penile tumors are thought to be attributable to HPV infection (Human papillomaviruses, 2007). HPV DNA has been detected in 14%–100% of invasive penile carcinomas (Bezerra et al., 2001a, Chan et al., 1994, Cupp et al., 1995, Ferreux et al., 2003, Gregoire et al., 1995, Heideman et al., 2007, Humbey et al., 2003, Iwasawa et al., 1993, Krustrup et al., 2009, Levi et al., 1998, Lont et al., 2006, Maden et al., 1993,

Risk factors for penile cancer

The risk factors most strongly associated with penile cancer are lack of neonatal circumcision (Brinton et al., 1991, Daling et al., 2005, Maden et al., 1993), phimosis (the inability of uncircumcised men to fully retract the foreskin) (Brinton et al., 1991, Daling et al., 2005, Hellberg et al., 1987, Maden et al., 1993, Madsen et al., 2008, Tsen et al., 2001), anogenital warts (Aynaud et al., 1994, Daling et al., 2005, Maden et al., 1993, Madsen et al., 2008), and HPV infection (Brinton et

Prevention of genital HPV infection and genital warts through vaccination

Several reports have demonstrated the efficacy of the quadrivalent HPV vaccine (HPV4) in preventing genital disease caused by HPV 6/11/16/18 in females including the precancerous lesions CIN 2 and 3 (FUTURE II Study Group, 2007, Brown et al., 2009, Garland et al., 2007, Wheeler et al., 2009). Male vaccination with the quadrivalent HPV vaccine has also been shown to significantly reduce HPV-associated anogenital infection and disease in men. In a recently completed international Phase III trial

Conflict of Interest

None to report.

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