Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer in Female Partners

Castellsagué, Xavier; Bosch, F. Xavier; Muñóz, Núbia; Meijer, Chris J.L.M.; Shah, Keerti V.; Sanjosé, Sílvia de; Eluf‐Neto, José; Ngelangel, Corazon A.; Chichareon, Saibua; Smith, Jennifer S.; Herrero, Rolando; Franceschi, Silvia

doi:10.1097/00006254-200209000-00009

Cited by 139 publications

(205 citation statements)

References 31 publications

(51 reference statements)

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“…In two reports, Castellsagué et al (1997Castellsagué et al ( , 2002 Although our results showed that 50% of the infected couples presented the same HPV types in CIN group, and were, then, higher than the ones published, we believe that the 50% disagreement in infecting types is due to such differences in the genital tract of men and women (Table 3). On the other hand, 50% of agreement among sexual partners leads us to suggest a vicious circle of infections among couples, perpetuating HPV in this group.…”

Section: Discussioncontrasting

confidence: 65%

Human Papillomavirus (Hpv) Infection of Sexual Partners of Women Presenting Cervical Intraepithelial Neoplasia

Cavalcanti¹,

Afonso²,

Moysés³

et al. 2008

VR&R

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Human papillomavirus (HPV) infections of the genital tract are the most prevalent sexually transmitted viruses worldwide. Oncogenic HPV types cause pre-malignant lesions that can progress to cervical carcinoma. In the male genital tract, most HPV infections are sub-clinical and associated with a vicious circle [stet] of treatment-reinfection of women.Nevertheless, HPV pathogenic processes are still poorly understood. The literature suggests that different HPV types can be found among sexual partners. In our study, we aimed to verify HPV infections in female patients as well as in their sexual partners, to test this hypothesis. The HPV DNA prevalence in women with Cervical Intraepithelial Neoplasia (CIN) was 92.5% compared with 25% for normal women, with a statistically significant difference (p<0.001). In male samples, the HPV DNA prevalence in partners from CIN women was 50% and for normal women partners, it was 17.5%. In the group of CIN women, we observed that 20 couples had HPV DNA in both partners. However, only 50% of the couples shared the same HPV type. In the group of normal women, only 6 couples were simultaneously infected by HPV, and from them only 33.3% had the same virus type.These results may be attributed to differences in local immunity and organization of the genital epithelia of each sex. On the other hand, female lesions would not be the result of re-infection by sexual partners, but rather a true recurrence of a latent infection. Finally, such 40% of agreement among all couples leads us to suggest a vicious circle [stet] of infectious processes, perpetuating HPV in the sexually active population.

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Section: Discussioncontrasting

confidence: 65%

Human Papillomavirus (Hpv) Infection of Sexual Partners of Women Presenting Cervical Intraepithelial Neoplasia

Cavalcanti¹,

Afonso²,

Moysés³

et al. 2008

VR&R

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“…This low DNA quantity is further reflected by the relatively high number of ␤-globin PCR-negative penile swabs (i.e., 24%) found in the present and another study. 16 As a consequence, defining HPV clearance in males was complicated. Analyses of viral clearance (defined as 2 consecutive negative HPV tests), restricted to men who were HPV-positive at baseline, showed that the HPV clearance rate was higher in the condom group compared to the noncondom group, though significance was not reached due to the low number of men analyzed [2-year rate of viral clearance was 27% in the condom group (n ϭ 26) vs. 7% in the noncondom group (n ϭ 15), p ϭ 0.2].…”

Section: Influence Of Hpv Status On the Clinical Course Of Flat And Pmentioning

confidence: 99%

“…Compared to uncircumcised men, Castellsagué et al 16 found a reduced risk of penile HPV infection among circumcised men and, in the case of a history of multiple sexual partners, a reduced risk of cervical cancer in their current female partners. The authors argue that the penile shaft and the outer surface of the foreskin are covered by keratinized, stratified, squamous epithelium, which provides a protective barrier against HPV infection.…”

Section: Influence Of Hpv Status On the Clinical Course Of Flat And Pmentioning

confidence: 99%

Condom use promotes regression of human papillomavirus–associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia

Bleeker

Hogewoning

Voorhorst

et al. 2003

Intl Journal of Cancer

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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). Key words: penile lesion; clinical course; condom use; human papillomavirusInfection with high-risk types of HPV is the main causative agent for cervical cancer and its precursor lesions, i.e., CIN 1-3. 1 The relationship between the natural history of CIN lesions and the presence of HPV has been clarified. 2 However, the number of studies on the clinical behavior of HPV infection in men is limited.Of the male sexual partners of women with cervical lesions, 50 -65% have HPV-associated penile lesions, i.e., flat lesions, papular lesions and condylomata acuminata. [3][4][5] The natural history of these lesions and HPV infection in men are incompletely understood because of the use of either insensitive (in situ hybridization) or unreliable (cytology) techniques for HPV detection in previous studies. [5][6][7] Moreover, penile lesions studied before were often biopsied or treated, resulting in interference with the clinical course.Studying HPV-associated penile lesions is hampered by a clinical pitfall: most of these lesions are flat, cause no clinical symptoms and are difficult to detect by the naked eye unless a careful visual inspection is performed. These lesions are easily detectable using a penoscope and application of acetic acid. Using the latter approach on male sexual partners of women with CIN lesions in a non-STD setting, we observed penile lesions in 68% of cases, with a predominance of flat penile lesions. A smaller number had papular lesions, and only a few had condylomata acuminata. HPV DNA, mainly of high-risk HPV types, was detected by PCR in 59% of penile swabs. 8 Sexual intercourse is the predominant mode of acquiring HPV infection. 9 Previous studies in men have shown that failure to use a condom is associated with HPV infection and that consistent condom use reduces the risk of acquiring genital warts. 10,11 Of interest is the work of Hippelainen et al.,6 who studied the clinical course of HPV infections in men. Most of these men were partners of HPV-inf...

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“…1 Circumcision is generally considered as a simple, rapid operation with efficacy for protection against HIV and other sexually transmitted infections, as confirmed in numerous, highquality studies. [2][3][4][5][6][7] Circumcision has been reported to adversely affect sexual function; 8 however, the majority of studies, including highquality ones [9][10][11] and ones with data arising from randomized controlled trials (RCTs), 12,13 show no difference or improvement in sexual function, sensitivity and satisfaction after circumcision. All of the data were considered by the American Academy of Pediatrics in formulating its 2012 policy, which concluded that there were no adverse effects on these parameters.…”

Section: Introductionmentioning

confidence: 99%

Effects of circumcision on male sexual functions: a systematic review and meta-analysis

Liu¹,

Wang²,

Wazir³

et al. 2013

Asian J Androl

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This meta-analysis was performed to assess sexual functions following adult male circumcision. We searched the Cochrane Central Register of Controlled Trials, PUBMED, EMBASE, the Cochrane Database of Systematic Review and Web of Science from their inception until January 2013 to identify all eligible studies that reported on men's sexual function after circumcision. The Cochrane Collaboration's RevMan 5.2 software was employed for data analysis, and the fixed or the random effect model was selected depending on the proportion of heterogeneity. We identified 10 studies, which described a total of 9317 circumcised and 9423 uncircumcised men who were evaluated for the association of circumcision with male sexual function. There were no significant differences in sexual desire (odds ratio (OR): 0.99; 95% confidence interval (CI): 0.92-1.06), dyspareunia (OR: 1.12; 95% CI: 0.52-2.44), premature ejaculation (OR: 1.13; 95% CI: 0.83-1.54), ejaculation latency time (OR: 1.33; 95% CI: 0.69-1.97), erectile dysfunctions (OR: 0.90; 95% CI: 0.65-1.25) and orgasm difficulties (OR: 0.97; 95% CI: 0.83-1.13). These findings suggest that circumcision is unlikely to adversely affect male sexual functions. However, these results should be evaluated in light of the low quality of the existing evidence and the significant heterogeneity across the various studies. Well-designed and prospective studies are required for a further understanding of this topic.

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Male Circumcision, Penile Human Papillomavirus Infection, and Cervical Cancer in Female Partners

Cited by 139 publications

References 31 publications

Human Papillomavirus (Hpv) Infection of Sexual Partners of Women Presenting Cervical Intraepithelial Neoplasia

Human Papillomavirus (Hpv) Infection of Sexual Partners of Women Presenting Cervical Intraepithelial Neoplasia

Condom use promotes regression of human papillomavirus–associated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia

Effects of circumcision on male sexual functions: a systematic review and meta-analysis

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