HPV prevalence among Mexican women with neoplastic and normal cervixes.

Genital human papillomavirus (HPV) infection is causally linked to cervical cancer, yet little is known regarding HPV prevalence in cancerous and normal women in Mexico, a country with a high cervical cancer incidence. We studied 185 Mexican women among the patients attending gynecological outpatient clinics in four hospitals in Mexico City. Each woman had a Pap smear, a colposcopy, and, when necessary, a biopsy. HPVs were identified by a consensus-primer-based polymerase chain reaction (PCR) assay. HPV was detected in 87% of 69 cancers, 83% of 24 high-grade squamous intraepithelial lesions (HGSILs), 33% of 21 low-grade squamous intraepithelial lesions (LGSILs), and 17% of 71 normals. Twenty-one of the 32 HPV types tested were detected at least once. The ratio of high-risk:low-risk types was 87:6 in HGSILs and cancers, compared to 11:8 for LGSILs and normals. In invasive cancers, HPV types found at the highest frequency were, in descending order: HPV-16, -18, and -45, followed by -39, -59, and -58 with the same frequency. HPV-16 and related types were present in 52% of the cancer cases, as well as in 79% of HGSILs, and HPV-18 and related types were present in 36% of the cancers but in only 12.5% of the HGSILs. HPV-16 was predominant in squamous carcinomas, and HPV-18 and related types were predominant in adenosquamous carcinoma. Both biopsies and scrapes were tested for HPVs in 63 women, all of them with cervical neoplasia. Identical HPV results were obtained in 89% of the samples, but additional types were often identified in scrapes. HPV prevalence and type distribution in cervical cancer in Mexico was similar to the reported worldwide, as well as in other Latin American countries.

Human papillomavirus, anal squamous intraepithelial lesions, and human immunodeficiency virus in a cohort of gay men.

Cross-sectional associations between human papillomavirus (HPV), anal squamous intraepithelial lesions (SIL), and human immunodeficiency virus (HIV) were studied in a cohort of gay men. HPV DNA was detected by generic and type-specific polymerase chain reaction (PCR) probes and hybrid capture assay (HC). HPV virus load was estimated by HC relative light unit (RLU) ratio. HPV prevalence, number of HPV types detected, and HC RLU ratios were each greater in HIV-positive than HIV-negative participants. Further, among HIV-positive men, HC RLU ratio was inversely associated with CD4 cell count. SIL was more frequent in HIV-positive participants, particularly those with a CD4 cell count <200/microL and was positively associated with HPV. Men with a high HC RLU ratio were nearly 3 times more likely to have SIL than were those both PCR- and HC-negative. These data support that HIV augments HPV-associated anal disease in this population.

Male sexual behavior and human papillomavirus DNA: key risk factors for cervical cancer in Spain.

BACKGROUND: It is now established that certain types of human papillomaviruses (HPVs) are the sexually transmitted agents etiologically linked to cervical cancer. Studies assessing the contribution of the male's sexual behavior and genital HPV DNA status to the risk of development of cervical neoplasia in sexual partners have yielded inconsistent results. PURPOSE: This study evaluates the role of men's sexual behavior and the presence of HPV DNA in the penis on the development of cervical cancer in their sexual partners in Spain, a low-risk area for cervical neoplasia. METHODS: Husbands (n = 633) of women participating in two case-control studies of cervical neoplasia were interviewed to obtain information on lifestyle habits, including sexual practices. Cytologic samples were taken from the distal urethra and the surface of the glans penis of 183 husbands of case women and of 171 husbands of control women. These samples were analyzed by a polymerase chain reaction-based system using a generic probe and 25 type-specific probes for the detection and typing of HPV DNA. Serologic specimens were also obtained and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae. RESULTS: The presence of HPV DNA in the husbands' penis conveyed a fivefold risk of cervical cancer to their wives (adjusted odds ratio [OR] for HPV DNA positivity = 4.9; 95% confidence interval [CI] = 1.9-12.6). The risk of cervical cancer was strongly related to HPV type (adjusted OR for HPV type 16 = 9.0; 95% CI = 1.1-77.5), to the husbands' number of extramarital partners (adjusted OR = 11.0; 95% CI = 3.0-40.0; for > or = 21 women versus one), and to the number of prostitutes as extramarital sexual partners (adjusted OR = 8.0; 95% CI = 2.9-22.2; for > or = 10 women versus none). Presence of antibodies to C. trachomatis (adjusted OR = 2.6; 95% CI = 1.4-4.6) and an early age at first sexual intercourse of the husband (adjusted OR = 3.2; 95% CI = 1.7-5.9; for < or = 15 years versus > or = 21 years) were also associated with cervical neoplasia in the wife. After adjustment for these variables and for the wife's pack-years of smoking, the husband's smoking was moderately associated with cervical cancer in his wife (adjusted OR = 2.5; 95% CI = 1.4-4.4; for > or = 26.2 pack-years versus none). CONCLUSIONS: The study supports the role of men as vectors of the HPV types that are related to cervical cancer. Life-time number of female sexual partners, number of female prostitutes as sexual partners, and detection of HPV DNA in the penis of husbands are all surrogate markers of exposure to HPV during marriage. IMPLICATIONS: Men who report multiple sexual partners or who are carriers of HPV DNA may be vectors of high-risk HPV types and may place their wives at high risk of developing cervical cancer. Prostitutes are an important reservoir of high-risk HPVs.

Difficulty in elucidating the male role in cervical cancer in Colombia, a high-risk area for the disease.

BACKGROUND: Epidemiologic evidence has been inconclusive in linking men's sexual behavior and genital human papillomaviruses (HPVs) with cervical cancer risk in their sexual partners in areas with a high incidence of cervical cancer. PURPOSE: This study assesses the role of men's sexual behavior and the presence of penile HPV DNA on the risk of their wives' developing cervical neoplasia in an area in Colombia with a high incidence of cervical cancer. METHODS: A total of 210 husbands of women with cervical intraepithelial neoplasia grade III (n = 118) or invasive squamous cell carcinoma of the cervix (n = 92) and a total of 262 husbands of women recruited as control subjects (173 and 89, respectively) were interviewed. Questionnaires included detailed information on sexual behavior. Exfoliated cells were obtained from the glans penis and from the distal urethra of the penis. The specimens were analyzed for HPV DNA by use of a polymerase chain reaction-based assay that included a generic probe and 25 type-specific probes. Serum specimens were collected and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae. RESULTS: Limited education (adjusted odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.9-9.8; for no schooling versus secondary or higher education) and presence of antibodies to C. trachomatis (adjusted OR = 2.5; 95% CI = 1.5-4.4) in husbands were the only identified risk factors for cervical neoplasia in their wives. The prevalence of HPV DNA in the penis was 25.7% among husbands of case women and 18.9% among husbands of control women (adjusted OR = 1.2; 95% CI = 0.6-2.3). Neither the lifetime number of female sexual partners (adjusted OR = 1.0; 95% CI = 0.4-2.6; for > 50 partners versus one to five) nor the lifetime number of female prostitutes as sexual partners (adjusted OR = 1.2; 95% CI = 0.7-2.0; for > or = 21 prostitutes versus one to five) was associated with the risk of cervical cancer. CONCLUSIONS: Our results are compatible with the hypothesis that in the population of Cali, whose women are at high risk of developing cervical cancer, exposure to HPV among young men is a common occurrence and is mediated by contacts with large numbers of female sexual partners and prostitutes. These widespread sexual practices limit the power of case-control studies to detect significant associations between men's sexual behavior and the cervical cancer risk in their sexual partners. HPV DNA detection in the penis of adult men is a poor reflection of lifetime exposure or of etiologically relevant exposure to HPV. The role of C. trachomatis in cervical carcinogenesis deserves further investigation. IMPLICATIONS: Further research is needed to elucidate the male's role in cervical carcinogenesis in populations at high risk for cervical cancer. HPV DNA prevalence surveys and studies of the natural history of HPV in young men will be of great value.

Importance of human papillomavirus endemicity in the incidence of cervical cancer: an extension of the hypothesis on sexual behavior.

The risk of cervical cancer for a woman depends largely on the probability of being infected with some specific types of Human Papillomavirus (HPV). In the control groups of four case-control studies in Colombia and Spain we have shown a strong correlation between the number of sexual partners of males and females and HPV DNA prevalence in the genital tract. Our results suggest that the lifetime number of sexual partners in both sexes are surrogates of the probability of HPV infection and, as such, insufficiently explain the geographical variation in the incidence of cervical cancer. It is proposed that the high rates of cervical cancer in Latin America are linked to the largely unknown characteristics of the HPV endemicity in the population and to the absence of widespread screening for cervical neoplasia. Reliable surveys on the HPV prevalences in selected social groups (i.e., young males and prostitutes) as well as in populations in countries at different risk of cervical cancer are required.