Risk factors, prevalence, and site concordance of human papillomavirus in high-risk Greek men

Abstract

The aim of this study was to determine the risk factors, genotype-specific prevalence, and concordance of human papillomavirus (HPV) infections at three anatomical sites in a cohort of high-risk Greek men. Patients were recruited from sexually transmitted infection and HIV clinics in Athens. Samples were obtained from oral, penile, and anal sites of 294 study participants and HPV testing was performed on 882 samples using next-generation sequencing. Patients also completed a questionnaire assessing risk factors for infection. The mean age of the participants was 33.1, 30% identified as men who have sex with men (MSM), and 21% were HIV positive. The prevalence of HPV was 49%; it was the highest at anal sites (33%) compared with 23% at penile sites (P=0.008) and 4% at oral sites (P<0.001). The most common HPV types in order of frequency were 6, 44, 16, 53, and 89. The genotype concordance rate was the highest between the penile and anal sites (7%), followed by 2% for anal-oral concordance. Identifying as MSM [adjusted odds ratios (aOR)=6.75, P<0.001] and being HIV positive (aOR=2.89, P=0.026) were significant risk factors for anal HPV infection, whereas alcohol use (aOR=0.45, P=0.002) was associated negatively with infection. The only significant risk factor for oral infection was an older age of sexual debut (aOR=1.32, P=0.038). Nearly half of our study participants tested positive in at least one of three anatomical sites. Using next-generation sequencing, we could identify high-risk types that are not covered by the current vaccine and would be missed by traditional HPV testing kits.

Low concordance of oral and genital HPV infection among male patients with sexually transmitted infections in Vietnam

“…Among males with STIs in Hanoi, the prevalence of oral HPV infections was 8.1%, which was higher than that observed in Greece (3.7%) [12], but lower than that observed in the United States (15.3%) [20], Japan (18.8%) [18], and Italy (37.0%) [21]. Information about oral HPV infections among Vietnamese women was available from only a single study.…”

“…To prevent HPV infections, and the subsequent development of cancer in men, it is important to know the status of HPV infections in the oral cavity and in the genitals. Previous studies have reported that the prevalences of concurrent HPV infections in the oral cavity and the genitals were 1.9 and 8.8%, among general male population in China and the United States, respectively [8, 9]; 9% in heterosexual men with human immunodeficiency virus (HIV) infections in Spain [10]; and 0–7% in men who have sex with men (MSM), with and without HIV infections, in the United Kingdom, Spain, and Greece [10–12]. Among the general Chinese and American male persons concurrently infected with HPV in oral and genital sites, 36.2–60.5% showed similar or identical HPV genotype(s) in the two sites [8, 9, 13].…”

Concordance of Beta-papillomavirus across anogenital and oral anatomic sites of men: The HIM Study

“…The natural history of α-HPV infections at anogenital epithelia and the oral cavity are associated with sexual behavior as these infections are mostly sexually transmitted. Despite a common mode of transmission, oral-cervical type-specific α-HPV agreement is low among women (Fakhry et al, 2006; Steinau et al, 2017; Termine et al, 2009, 2011), and in men α-HPV agreement, although rare, is higher between the penile and anal sites (7%) compared to anal-oral concordance (2%) (King et al, 2015; Tsikis et al, 2017; van Rijn et al, 2014). Interestingly, among men with genital warts, agreement of α-HPV types between the anal canal and genital wart was 78.1%, while concordance between oral and genital wart types was 60.9% (Kofoed et al, 2014).…”

Human Papillomavirus (HPV) Infection in Males: A Need for More Awareness

“…Variation in prevalence has also been observed based on differences in the infected sites. In a Greek population, it was highest at anal sites (33%) compared with 23% at penile sites and 4% at oral sites [39]. In another study, the prevalence of HPV infection was 73% at anal site, 26% at penile site, and 16% at oral site [46].…”