Clinical course and prognostic factors of human papillomavirus infections in men.

BACKGROUND AND OBJECTIVES: Biological behavior of male genital human papillomavirus (HPV) infection is incompletely understood, and the clinical value of treatment is obscure. GOAL OF THIS STUDY: To evaluate the clinical course and possible prognostic factors of genital HPV infections in men. STUDY DESIGN: A total of 318 consecutive high-risk men for HPV infection (94.3% partners of HPV-infected women) were examined using peniscopy, histology, cytology, and in situ hybridization (ISH). Only the men with exophytic warts or clinical symptoms were treated, if they insisted on it (n = 55). The others with (n = 150) or without (n = 113) HPV suggestive lesions were followed-up only at 6-month intervals. Survival analysis was used to calculate the cure rates in different subgroups of the males, categorized according to the potential prognostic factors (i.e., age, treatment, lesion morphology, HPV type, female findings, and sexual habits). RESULTS: The calculated median cure time of the HPV-positive men was 15.2 months (95% confidence interval 12.2-21.3 months) and it did not differ significantly in the male groups treated or only followed-up (P = 0.56). In univariate survival analysis, only the ISH-positivity (P = 0.002) and the anamnestic use of condom (P = 0.05) were significant prognostic factors. The condom use also had a protective effect (P = 0.04) against the appearance of new HPV-suggestive lesions in initially healthy males. Although the treatment did not significantly affect the overall cure rate, the number of lesions decreased, however, after therapy (i.e., fewer widespread infections), and the appearance of new HPV lesions seemed to be less frequent in the treated than in nontreated males. CONCLUSIONS: The low success rate of therapy and the obviously benign clinical course of all subclinical HPV lesions of the male genitalia justify the follow-up of all lesions with HPV-suspicious morphology only. On the other hand, treatment seems to exert a favorable effect on clinical HPV infections, new exophytic warts and penile intraepithelial lesions (PIN) lesions being rare in adequately treated males.

Low concordance of genital human papillomavirus (HPV) lesions and viral types in HPV-infected women and their male sexual partners.

BACKGROUND AND OBJECTIVES: To evaluate the concordance of genital human papillomavirus (HPV) lesions and viral types in HPV-infected women and their male sexual partners. STUDY DESIGN: Examination of 270 consecutive women with abnormal Papanicolaou (Pap) smear and their male partners using colposcopy, peniscopy, surgical biopsy and in situ hybridization (ISH). Polymerase chain reaction (PCR) was used in male cases negative with ISH. RESULTS: The highest HPV DNA detection rate in women was in cervical intraepithelial neoplasia (CIN III) lesions (96%), HPV 16 being the most frequent type. Of the males, 193 (71.5%) showed histologically confirmed HPV infection, condyloma acuminata (23 cases) and penile intraepithelial neoplasia (PIN) lesions (20 cases) being invariably ISH positive (87% and 80%, respectively). Subclinical flat lesions (113 cases) were mostly ISH negative (70.3%). Of the 270 couples typed by ISH, both partners were positive in 66 (24.4%) cases, but only 15 (22.7%) of them had the same HPV type in their genital tract. By PCR, only seven new HPV DNA positive cases were detected among 77 men negative by ISH. CONCLUSION: Although some association was seen between intraepithelial neoplasia and high-risk HPV types, the concordance of different HPV types between the sexual partners was extremely low. The female findings were not predictive in searching for the male partners with the high risk HPV types, either. HPV DNA detection rate in men seems to depend on morphology of the HPV lesions.

Diagnosis of genital human papillomavirus (HPV) lesions in the male: correlation of peniscopy, histology and in situ hybridisation.

OBJECTIVE: To assess the diagnostic criteria of genital HPV lesions in male sexual partners of HPV infected women. METHODS: Peniscopically directed biopsy specimens (from 693 lesions in 300 men) were examined on light microscopy and in situ hybridisation (ISH) for HPV types 6,11,16,18,31,33 and 42. The predictive value of different histological criteria for ISH positivity was also evaluated using stepwise logistic regression analysis. RESULTS: Flat HPV lesions were most accurately predicted by the punctuation pattern on peniscopy, giving the concordance between peniscopy and histology between peniscopy and histology of 79.5% (66/83) and that between peniscopy and ISH of 56.6% (47/83). Diffuse acetowhite pattern disclosed a typical HPV lesion in only 17.8% (13/73), and HPV DNA was found in 11.0% (8/73) of cases. Of the 114 biopsy specimens from peniscopically healthy areas adjacent (0.5-1 cm) to the lesions, 93.0% (106/114) were normal on light microscopy, and HPV DNA was found in only 2.6%. Penile intraepithelial neoplasia (PIN) lesions were most frequently ISH positive, 81.1% (30/37), 50% showing HPV 16 and/or 18 DNA. Lesions classified as HPV-suspicious or nonspecific on light microscopy were HPV DNA-positive in 16.9% (11/65) and 8.1% (13/160), the frequency of high-risk HPV types being 3.1% and 1.3%, respectively. In logistic regression analysis, koilocytosis was the most powerful predictor of ISH-positivity in the flat lesions (without PIN), the risk ratio being 3.7. CONCLUSION: No conclusive peniscopic criteria for male HPV infections could be established, making histological evaluation mandatory. Care should be exercised in interpreting as HPV lesions the cases devoid of koilocytosis, HPV typing being essential in confirming the diagnosis in doubtful cases.