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Human Papillomavirus Detection by Penile Site in Young Men From Kenya

Smith, Jennifer S. PhD, MPH*; Moses, Stephen MD, MPH; Hudgens, Michael G. PhD*; Agot, Kawango PhD, MPH; Franceschi, Silvia MD§; Maclean, Ian W. PhD; Ndinya-Achola, J O. DLSHTM; Parker, Corette B. Dr.PH; Pugh, Norma MS; Meijer, Chris J. L. M. PhD#; Snijders, Peter J. F. PhD#; Bailey, Robert C. PhD, MPH**

doi: 10.1097/OLQ.0b013e318065b8ef
Article

Background: Limited data are available on whether sampling from the penile shaft or urethra increases detection of penile HPV infection in men beyond that found in the glans and coronal sulcus.

Methods: Within a randomized clinical trial, a validation study of penile sampling was conducted in Kisumu, Kenya. Young men (18–24 years) were invited to provide penile exfoliated cells using prewetted Dacron swabs to determine the best site for HPV detection. β-Globin gene PCR and HPV DNA type GP5+/6+ PCR status were ascertained from 3 anatomical sites.

Results: A total of 98 young HIV-seronegative, uncircumcised men participated. Penile HPV prevalence varied by anatomical site: 50% in penile exfoliated cells from the glans, coronal sulcus, and inner foreskin tissue; 43% in the shaft and external foreskin tissue; and 18% in the urethra (P <0.0001). For each anatomical site, over 87% of samples were β-globin positive. Beyond that found in the glans/coronal sulcus, urethral sampling resulted in no increase in HPV positivity and shaft sampling resulted in an additional 7.3% of overall HPV positivity. The prevalence of high-risk HPV positivity varied by anatomical site: 39% in glans/coronal sulcus, 31% in shaft, and 13% in the urethra (P <0.0001). HPV 16 was the most common type identified.

Discussion: Penile HPV prevalence was approximately 50% among young men in Kisumu, Kenya. Urethral sampling for HPV detection in men added no sensitivity for HPV detection over that found from sampling the glans/coronal sulcus and penile shaft. These data will help inform studies on HPV transmission dynamics, and on the efficacy of HPV prophylactic vaccines on penile HPV carriage in men.

A validation study of penile sampling was conducted among young, uncircumcised men in Kenya and found that overall penile HPV DNA prevalence was approximately 50%. Beyond that found in the glans/coronal sulcus, urethral sampling resulted in no increase in HPV positivity and shaft sampling resulted in an additional 7.3% of overall HPV positivity.

From the *Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina; †Department of Medical Microbiology, Community Health Sciences, and Medicine, University of Manitoba, Manitoba, Canada; ‡UNIM Project, Kisumu, Kenya; §International Agency for Research on Cancer (IARC), Lyon, France; ∥University of Nairobi, Nairobi, Kenya; ¶RTI International, Research Triangle Park, North Carolina; #Department of Pathology, VU University Medical Center, Amsterdam, the Netherlands; and **Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Illinois.

Supported by an RO1 grant from the National Cancer Institute, NIH, CA114773-01, by Grant No. AI50440 from the Division of AIDS, National Institute of Allergies and Infectious Disease, NIH, and by Grant No. HCT 44,180 from the Canadian Institutes of Health Research (CIHR). S. Moses is the recipient of an Investigator Award from the Canadian Institutes of Health Research. J. Smith was supported through the Centers for AIDS Research, National Institute of Allergy and Infectious Diseases (grant 5 P30 AI050410-07).

Correspondence: Jennifer S. Smith, PhD, MPH. E-mail: JenniferS@unc.edu.

Received for publication February 7, 2007, and accepted March 29, 2007.

© Copyright 2007 American Sexually Transmitted Diseases Association