Peniscopia no rastreamento das lesões induzidas pelo papilomavirus humano / Peniscopy in screening lesions induced by human papilloma virus

JUSTIFICATIVA E OBJETIVOS: O impacto da infecção pelo papilomavirus (HPV) no homem é um problema médico que carece de informações confiáveis sobre sua epidemiologia, etiopatogenia e correlação com o quadro anatomoclínico da mulher. O objetivo deste estudo foi o de descrever os aspectos epidemiológicos e clínicos das lesões induzidas por HPV em parceiros de mulheres com diagnóstico de HPV que foram submetidos à peniscopia. MÉTODO: Aplicou-se o método descritivo retrospectivo por meio de questionário estruturado no atendimento a 1890 pacientes submetidos à peniscopia, em ambulatórios do Sistema Único de Saúde(SUS), em Maceió, AL, entre março de 2004 e abril de 2009. RESULTADOS: A peniscopia foi positiva em 119 pacientes(6,3%) e 49 (41%) apresentaram confirmação histológica para HPV. Não se teve acesso ao exame de biologia molecular para o HPV. Dos 119 casos confirmados anatomopatologicamente tiveram como indicação de peniscopia por apresentar parceira com HPV. A faixa etária de maior acometimento foi de 20 a 39 anos(1295 casos); 40 a 76 anos (554 casos); 16 a 19 anos (554 casos).O local de maior frequência da lesão peniana foi o prepúcio interno (31% casos); púbis (14,3%); prepúcio externo (10%); corpo(18,8%); glande (10,4%) e períneo escrotal (13%). CONCLUSÃO: A peniscopia com biópsia dirigida para estudo anatomopatológico permitiu de modo eficiente e acessível,o diagnóstico e tratamento das lesões induzidas por HPV nos homens, prevenindo a forma verrucosa da doença. A faixa etária em que predominou a infecção foi a de 20 a 30 anos, com idade média de 34,5 anos. O local mais frequente da lesão foi o prepúcio interno. Recomenda-se maior investimento público na assistência e o uso de métodos contraceptivos de barreira.

BACKGROUND AND OBJECTIVES: The impact of infection with human papillomavirus (HPV) in humans is a medical problem that lacks reliable information about its epidemiology,pathogenesis and correlation with clinical knowledge about the woman. This study aimed to describe the epidemiological and clinical aspects of the lesions induced by human papillomavirus (HPV) in partners of women diagnosed as HPV carriers, who underwent peniscopy. METHOD: It was applied a retrospective descriptive methodt hrough a structured questionnaire during the attendance of 1890 patients who underwent peniscopy, in ambulatories of the Sistema Único de Saúde (SUS), in Maceió, AL, between March 2004 and April 2009. RESULTS: Peniscopy was positive in 119 men (6.3%) and 49(41%) presented histological confirmation for the HPV. There was no access to the molecular biology exam to HPV. Of 119 anatomopathologically confirmed cases there was indication of peniscopy because of presenting a female partner with HPV. The agein which was observed the major involvement was between 20 and 39 years (1295 cases); 40 and 70 years (554 cases); 16 and 19 years (554 cases). The most frequent location for the penile lesion were the inner prepuce (31% cases); pubis (14.3%); outer prepuce (10%); body (18.8%); glans (10.4%) and perineal scrotal (13%). CONCLUSION: Peniscopy with directed biopsy to the anatomopathological study of the lesion, enabled in an efficient and accessible way, the diagnosis and treatment of the lesions inducedby the HPV in men, preventing the verrucous form of the disease.The age in which the HPV predominates is between 20 and 30 years, with a mean age of de 34.5. The most frequent locationfor the lesion was shown to be in the inner prepuce. It is recommended greater public investments in the assistance to the use of contraceptive methods.

Deteccion de la infección por virus papiloma humano en hombres: Penescopía como método de cribado / Detection of infection by human papilloma virus in men: Peniscopy as screening method

Este trabajo es el resultado de la preocupación relativa y la escasa atención que se le presta al hombre, como portador y posible trasmisor del Virus Papiloma Humano. La población estudiada quedó conformada por 45 hombres, de 18 a 60 años de edad, que concurrieron al consultorio de Dermatología del Hospital Dr. J M Cullen de la ciudad de Santa Fe. Se confeccionó una ficha clínica protocolizada y se les realizó una penescopía. La penescopía resultó positiva en el 53,3% de la muestra tomada. Se encontró asociación estadísticamente significativa con la falta de uso del preservativo regularmente (p=0,01) y con la promiscuidad (p=0,008). No se vislumbró asociación estadísticamente significativa entre el resultado de la penescopía con otras patologías y antecedentes personales relacionados. Las lesiones encontradas fueron: máculas (p=0,037), pápulas (p=0,000) y vegetaciones (p=0,245). Los resultados señalan que es recomendable realizar penescopía como instrumento diagnóstico, especialmente por ser económica y simple de efectuar. Además se concluyó que el uso de preservativo de manera regular así como evitar la promiscuidad, son esenciales para la prevención de infecciones con VPH.

Introduction: in most of the cases, the Human Papilloma Virus (HPV) infection is transmitted through sexual contact. The competent immune system limits its spread, making it latent or subclinical, and its clinical symptoms rarely result in high mortality. It's difficult to estimate precisely its incidence in males due to the lack of epidemiological studies. In this work, the peniscopy was selected as the screening method of the subclinical disease due to its high sensitivity and low cost. General objective: to detect male carriers of the Human Papilloma Virus (HPV), possible transmitters of the virus. Material and methods: the population studied consisted of 45 men, between 18 and 60 years old, who assisted to the Dermatology Department of the Hospital J M Cullen in the city of Santa Fe due to different conditions, between the months of July and December, 2007. A clinical record was made and a peniscopy was performed as screening method. A non experimental, prospective, descriptive and cross-section design was employed. The Statistical Package for the Social Science (SPSS) 11.5® program was used. In the descriptive analysis, the statistical association was determined by means of the chi-square test and contingency tables. A statistically significant association was considered when p<0.05 was found. Results: the peniscopy was positive in 53.3% of the sample taken. A statistically significant association was found due to the lack of regularity in the use of condom (p=0.01) and to promiscuity (p=0.008). The lesions found were maculae (p=0.037), papules (p=0.000) and vegetations (p=0.245). Conclusion: the results show that it's advisable to perform a peniscopy as a diagnostic measure, specially because it is inexpensive and simple to perform. The regular use of condom, as well as the avoidance of promiscuity, is essential to prevent HPV infections.

A citologia uretral como ferramenta na detecção de efeito citopático do papilomavírus humano (HPV) em pacientes com peniscopia característica de infecção viral / The role of urethral cytophatology in detection of cytopatic features of Human Papillomavirus (HPV) in patients with peniscopy characteristic of viral infection

O objetivo deste trabalho foi avaliar a eficiência da citopatologia uretral na detecção de papilomavírus humano em 37 pacientes diagnosticados com lesões HPV-induzidas pela peniscopia, na Policlínica Santa Beatriz (São Luís - MA). Avaliou-se a ocorrência das diferentes faixas etárias, a positividade para efeito citopático por HPV pela citopatologia uretral comparado com a peniscopia e a associação dos resultados obtidos quando a parceira era portadora da virose. A faixa etária mais freqüente estava compreendidaentre 20 e 39 anos (86,5%) com média de idade de 31,2. A citopatologia uretral apresentou positividade para a virose de 13,5%. Todos os pacientes com citopatologia uretral com efeito citopático compatível para HPV tinham parceiras com história anterior de HPV,porém 40,6% dos pacientes com citopatologias uretrais negativas possuíam parceiras com história anterior de HPV.

The goal of this work was to assess the efficiency of urethral cytopathology in detection of human papillomavirus (HPV)carried out in 37 male patients attended at Clínica Santa Beatriz (São Luís-MA) with previous positive peniscopy for HPV. We evaluated the positiveness of urethral cytopathology compared with peniscopy in different band age and the influence of the partner in the transmission of the disease. The most frequent age was between 20 to 39 years (86.5%), with age average of 31.2%. Urethral cytopathology presented positiveness for cytopatic effects in 13.5% of the cases. All males evaluated with positive cytopatic effect for HPV had partner with previous HPV diagnosis, although 40.6% of the subjects presented negative urethral cytopathology.