Male circumcision and the incidence and clearance of genital human papillomavirus (HPV) infection in men: the HPV Infection in men (HIM) cohort study
1 Unit of Infections and Cancer (UNIC), Cancer Epidemiology Research Program (CERP), Catalan Institute of Oncology (ICO), IDIBELL. L'Hospitalet de Llobregat 08908, Barcelona, Spain
2 CIBER en Epidemiología y Salud Pública, CIBERESP (Epidemiology and Public Health Biomedical Research Consortium), Madrid, Spain
3 Program in Public Health and the Methodology of Biomedical Research, Universitat Autonoma de Barcelona (UAB). Campus Universitat Autonoma, s/n. Cerdanyola del Valles 08193, Barcelona, Spain
4 H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA
5 Department of Radiology and Basic Oncology, School of Medicine, University of Sâo Paulo and School of Medical Sciences, Santa Casa de Sâo Paulo 01223-001, Brazil
6 Instituto Nacional de Salud Publica, Cuernavaca 62100, Mexico
7 Instituto Mexicano del Seguro Social, Cuernavaca 62140, Mexico
8 The University of Texas, School of Public Health, Houston, TX 77030, USA
BMC Infectious Diseases 2014, 14:75 doi:10.1186/1471-2334-14-75Published: 10 February 2014
Reported associations of male circumcision (MC) with human papillomavirus (HPV) infection in men have been inconsistent.
4,033 healthy men were examined every six months for a median of 17.5 months. In each study visit, exfoliated cell specimens from the coronal sulcus/glans penis, penile shaft, and scrotum were collected and combined into one sample per person for HPV DNA detection. Samples were tested for 37 HPV types. Cox proportional hazards models were used to evaluate the association between MC and the incidence and clearance of HPV infections and specific genotypes.
The overall incidence of new HPV infections did not differ by MC status (for any HPV, adjusted hazard ratio (aHR) 1.08, 95% confidence interval (CI) 0.91-1.27). However, incidence was significantly lower among circumcised versus uncircumcised men for HPV types 58 (p = 0.01), 68 (p < 0.001), 42 (p = 0.01), 61 (p < 0.001), 71 (p < 0.001), 81 (p = 0.04), and IS39 (p = 0.01), and higher for HPV types 39 (p = 0.01) and 51 (p = 0.02). Despite the lack of an overall association in the risk of HPV clearance by MC (for any HPV, aHR 0.95, 95% CI 0.88-1.02), median times to clearance were significantly shorter among circumcised than uncircumcised men for HPV types 33 (p = 0.02) and 64 (p = 0.04), and longer for HPV types 6 (p < 0.001), 16 (p < 0.001), and 51 (p = 0.02).
MC is not associated with the incidence and clearance of genital HPV detection, except for certain HPV types. The use of a single combined sample from the penis and scrotum for HPV DNA detection likely limited our ability to identify a true effect of MC at the distal penis.