European Journal of Obstetrics & Gynecology and Reproductive Biology
The role of high-risk HPV-DNA testing in the male sexual partners of women with HPV-induced lesions
Introduction
The cause–effect relationship between human papillomavirus (HPV) and cancers of the uterine cervix, vagina, and vulva has been constantly studied, pointing out very clear mechanisms of interaction [1], [2]. The carrier of this infection can, depending on intrinsic and extrinsic factors, develop lesions (intra-epithelial neoplasia) that lead to uterine, vulvar, penile, and anal cancer [1].
The role of the sexual partners of women infected by HPV in the progression of this disease is still unknown. However, any partner could be responsible for re-infecting the woman [3]. It is believed that men who have not been circumcised might have a higher risk of transmitting the virus to their sexual partners [4], [5].
According to the recommendation of the guidelines on sexually transmitted diseases (STD), every sexual partner of an infected woman must be examined in order to identify, treat, and prevent the continuation of the disease [6]. Despite the recommendation, investigation into the presence of HPV in men who are sexual partners of infected women has not been consensual [7], [8], [9], [10], [11]. The detection of acetowhite lesions on male genitalia has led to many unnecessary biopsies. Cytological examinations, in the same way, also have a poor diagnostic capacity [4], [8]. Unfortunately, the identification of the presence of HPV in men is far more difficult than in women, due to the smaller quantity of plane squamous non-keratinized mucosa of the male genital organ in relation to that of the female [3]. The acetowhite lesions as defined by Wikstrom et al. [12] are usually investigated by an examination using optic magnification called peniscopy. Recent studies have demonstrated that even when carried out by experienced professionals, the method has very low specificity in the detection of high-grade lesions associated with HPV, leading to unnecessary biopsies [7], [13]. Recently, the identification of HPV with a high or low risk of developing malignant lesions in human tissue has been carried out by molecular biology examinations, using techniques such as polymerase chain reaction (PCR) or hybrid capture (hc2), which have high sensitivity and specificity [9], [14]. However, some authors consider that the test for HPV-DNA in the masculine distal urethra is of little use in the diagnosis of high-grade intra-epithelial lesions [8]. On the other hand, others observed good results in the tracing of HPV-DNA in six different male genital sites, using the second-generation hybrid capture technique, though with low histopathological correlation [9]. In spite of the good results, these authors reported no association between the findings and the high- or low-grade intra-epithelial lesions. Multiple site testing increased the number of HPV-infected men [14]. Perhaps the association of peniscopy and the identification of high-risk HPV using the molecular biology technique could be helpful in selecting the men who are at greater risk of having a high-grade intra-epithelial penile lesion, minimizing the excessive number of unnecessary biopsies.
The objective of this study was to check whether the presence of high-risk HPV in the sexual partners of HPV-infected women might be helpful in avoiding unnecessary penile biopsies in the presence of acetowhite lesions.
Section snippets
Materials and methods
A non-interventional cross-sectional study evaluated, between April 2003 and June 2005, the presence of the high-risk HPV-DNA in 54 asymptomatic men who were the sexual partners of women who had had a histopathological diagnosis of any low-grade squamous intra-epithelial lesions. In order to avoid confounding factors and enroll a homogeneous study population, all sexual partners of women with high-grade lesions were excluded.
The participants studied underwent a peniscopy using a 14×
Results
The age of the studied partners varied between 18 and 60 years (mean 29 years). The hybrid capture technique and peniscopy identified 14 cases of high-risk HPV-DNA (25.9%) and 13 cases (24.07%) of acetowhite lesions respectively in the penis of the 54 males studied. The high-risk HPV-DNA test was positive in four cases (30.7%) among men with acetowhite lesions and in 10 cases (24.3%) of men without lesions (not significant; Table 1). Peniscopy identified the most significant acetowhite lesions,
Discussion
The real incidence and prevalence of HPV infection in asymptomatic men are difficult to estimate, due mainly to the silent behavior of this virus, not only in men but also in women. The role of the sexual partners of women with HPV-associated lesions has been widely discussed; however, there is no established agreement. It is not clear whether the sexual partner can cause the woman problems or even if there is a risk of his lesion progressing [10]. Studies have observed that the diagnosis and
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