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Background. Circumcision and lower human papillomavirus (HPV) viral loads in men are possibly associated with a reduced risk of HPV transmission to women. However, the association between male circumcision and HPV viral load remains unclear.Methods. Swab specimens from the glans and shaft of the penis were collected from men enrolled in a circumcision trial in Kisumu, Kenya. GP5+/6+ polymerase chain reaction (PCR) was used to identify HPV DNA types. HPV-16 and HPV-18 loads were measured with a LightCycler real-time PCR and classified as high (>250 copies/scrape) or low (≤250 copies/scrape).Results. A total of 1159 men were randomly assigned to undergo immediate circumcision, and 1140 men were randomly assigned to the control arm (these individuals were asked to remain uncircumcised until the study ended). The hazard of acquisition of high-viral load infections in the glans was lower in the circumcision arm, compared with the control arm, for HPV-16 (hazard ratio [HR], 0.32 [95% confidence interval {CI}, .20–.49]) and HPV-18 (HR, 0.34 [95% CI, .21–.54]). The 6-month risk of HPV persistence among men with high-viral load infections in the glans at baseline was lower in the circumcision arm, compared with the control arm, for HPV-16 (risk ratio [RR], 0.36 [95% CI, .18–.72]) and HPV-18 (RR 0.34 [95% CI, .13–.86]). Weaker and less precise results were obtained for shaft samples.Conclusions. Male circumcision could potentially reduce the risk of HPV transmission to women by reducing the hazard of acquisition, and the risk of persistence of high-HPV viral load infections in the glans in men. [ABSTRACT FROM PUBLISHER]

Background.Little is known about type-specific associations between prevalent human papillomavirus (HPV) infections and risk of acquiring other HPV types in men. Data on natural clustering of HPV types are needed as a prevaccine distribution to which postvaccine data can be compared.Methods.Using data from a randomized controlled trial of male circumcision in Kisumu, Kenya, adjusted mean survival ratios were estimated for acquisition of any-HPV, high-risk (HR) HPV, and individual HR-HPV types among men uninfected as compared to those infected with vaccine-relevant HPV types 16, 18, 31, 45, 6, or 11 at baseline.Results.Among 1097 human immunodeficiency virus–negative, uncircumcised men, 2303 incident HPV infections were detected over 2534 person-years of follow-up. Although acquisition of individual HR-HPV types varied by baseline HPV type, there was no clear evidence of shorter times to acquisition among men without vaccine-relevant HPV-16, -18, -31, -45, -6, or -11 infections at baseline, as compared to men who did have these infections at baseline.Conclusions.These prospective data on combinations of HPV infections over time do not suggest the potential for postvaccination HPV type replacement. Future surveillance studies are needed to definitely determine whether elimination of HPV types by vaccination will alter the HPV type distribution in the population. [ABSTRACT FROM AUTHOR]

Background. There is little information on multiple human papillomavirus (HPV) infections and the potential for type competition in men, yet competition may impact the type-specific efficacy of HPV vaccination. Methods. Among 2702 uncircumcised men in Kisumu, Kenya, who were seronegative for human immunodeficiency virus, the observed numbers of HPV types detected were compared with the expected number, which was simulated under the assumption of independent infections. To assess the potential for HPV type competition, adjusted odds ratios for pairwise combinations of prevalent HPV type infections were estimated using semi-Bayesian methods. Results. Half of all men were HPV positive, of whom 57% had multiple HPV types. We observed men without HPV infection and with ≥4 HPV types more often than expected if infections were independent. No negative associations between individual HPV types were observed. HPV types 31, 39, 56, 58, and 59 were positively associated with both carcinogenic vaccine types HPV-16 and HPV-18 (2-sided P value <.05). Conclusions. Men who were HPV infected were likely to test positive for >1 HPV type. Cross-sectional associations between individual HPV types were positive and did not appear to be type-specific. Thus, we did not identify HPV types that are candidates for potential HPV type competition in men. [ABSTRACT FROM AUTHOR]

Background. Few data on the effect of human papillomavirus (HPV) infection on human immunodeficiency virus (HIV) acquisition are available. Methods. HIV-seronegative, sexually active, 18-24-year-old Kenyan men participating in a randomized trial of male circumcision provided exfoliated penile cells from 2 anatomical sites (glans/coronal sulcus and shaft) at baseline. The GP5+/6+ polymerase chain reaction assay ascertained a wide range of HPV DNA types at the baseline visit. The risk of HIV infection was estimated using Kaplan-Meier methods and hazard ratios from proportional hazards models. Results. Of 2168 uncircumcised men with baseline HPV data, 1089 (50%) were positive for HPV DNA. The cumulative incidence of HIV infection by 42 months was 5.8% (95% confidence interval [CI], 3.6%-7.9%) among men with HPV-positive glans/coronal sulcus specimens, versus 3.7% [95% CI, 1.8%-5.6%] among men with HPVnegative glans/coronal sulcus specimens (P=.01). Controlling for subsequent circumcision status, baseline herpes simplex virus type 2 serostatus, and sexual and sociodemographic risk factors, the hazard ratio for HIV infection among men with HPV-positive glans/coronal sulcus specimens was 1.8 (95% CI, 1.1-2.9), compared with men with HPV-negative glans/coronal sulcus specimens. Conclusion. The results suggest an independent increased risk of HIV seroconversion among HPV-positive men. If this finding is confirmed in other studies, HPV prevention could be another tool for HIV prevention. [ABSTRACT FROM AUTHOR]

To investigate the prevalence and determinants of human papillomavirus (HPV) infection, the primary cause of cervical cancer, we studied 1741 women >/=15 years of age from Lampang and Songkla, Thailand. Exfoliated cervical cells were collected for Papanicolaou smear screening and DNA detection of 36 different HPV types. Serum immunoglobulin G antibodies against L1 virus-like particles (anti-VLPs) of HPV-16, -18, -31, -33, and -58 were evaluated using enzyme-linked immunosorbent assay. Overall, 110 women (6.3%) were HPV DNA positive; the most common types were HPV-16, -52, and -72. The age-standardized prevalence of HPV DNA was higher among the 1035 women from Lampang (9.1%; 95% confidence interval [CI], 7.1-11.1) than among the 706 women from Songkla (3.9%; 95% CI, 2.3%-5.6%). Anti-VLPs were found in 21.8% of all women and were more frequent among women from Lampang (29.2%) than among women from Songkla (10.9%). Major risk factors for cervical HPV DNA were age <35 years, HSV-2 seropositivity, and having a husband with extramarital sexual partners.