Prevalence and Risk Factors of Genital Human Papillomavirus (HPV) Infections in Healthy Males

Abstract

Background and objectives: Prevalence of genital human papillomavirus (HPV) infection in the general population is not known. No one test alone can detect all HPV infections. Goal of this study: To determine the prevalence of and risk factors for genital human papillomavirus (HPV) infections in healthy males. Voluntary Finnish Army conscripts were examined using peniscopy, cytology (PAP smear) and polymerase chain reaction (PCR) in brush cytology samples. Study design: A total of 1,471 (99.6%) males completed the questionnaire soliciting their sexual habits, and 432 of them enrolled in the clinical study. Results: The study group differed from the nonattenders in that they reported more often genitourinary symptoms (P < 0.001), had more casual sexual partners (P = 0.002), and previous STDs (P < 0.001). Classical genital warts were present in 24/432 (5.6%) and papular lesions in 8/432 (1.9%) males. Acetowhite lesions were disclosed in 151/432 (35.0%) cases, of which 61 (14.1%) had peniscopically typical flat HPV lesions. Koilocytes were found in 13/201 (6.5%) PAP smears. HPV DNA was disclosed by PCR in 16.5% (47/285) of the adequate cell smears, and in 7.1% of the males with no peniscopic abnormalities. When considering the men with HPV-positive PCR findings and/or typical peniscopic pattern as HPV-infected (26.2%), many casual partners, previous STDs and no use of condom were significant risk factors for genital HPV infections in the logistic regression analysis. Conclusions: The reliable assessment of the prevalence of genital HPV infections in healthy males is not only skewed by the selection of the study group by symptoms and promiscuity, but also by the lack of a universally acceptable screening method. The data confirm sexual promiscuity as the most important risk factor for genital HPV infections.