Multiple-type HPV infection in asymptomatic men: Prevalence and associated factors.

B207

Introduction: Human papillomavirus (HPV) is sexually transmitted and causes cervical cancer. Persistent infection with HPV-16 and -18 is the strongest risk factor for cervical dysplasia. Infection with multiple HPV types has been associated with persistence of HPV infection in men and women. This study sought to determine the prevalence of multiple-type HPV infection in asymptomatic men and to identify associated factors. Methods: We tested 463 men ages 18-40 years for HPV at 6 anatomic sites and in semen. Participants had no history of genital warts and had sexual intercourse with a woman in the past year. HPV testing by PCR and reverse line blot genotyping for 37 types was conducted in each of the 7 sampling sites. Men completed a self-administered questionnaire. Multiple HPV infection was defined as having > 2 HPV types at any site. This outcome was alternately compared to a reference group of men with no HPV infection and to a reference group of men with single-type HPV infection. Single HPV infection was also compared to no infection. Multivariate logistic regression was used to identify independent risk factors. Results: Of all men, 127 (27.4%) had multiple HPV infection, accounting for 41.9% of the 303 men with any HPV infection. Multiple HPV infection was more likely to occur at the penile shaft (38.5% of HPV-positive shaft samples) or glans/corona (36.3%) than at the scrotum (21.6%), urethra (7.4%), or anal sites (11.9%-14.1%, all p < 0.01). Men with multiple HPV infection were more likely than HPV-negative men to currently smoke >10 cigarettes per day (adjusted odds ratio [AOR]: 2.7, 95% confidence interval [CI]: 1.3-5.7), to have more lifetime number of female sex partners (AOR: 3.8 for 6-10 vs 1-5 partners, 95% CI: 1.8-7.9) and a greater frequency of sexual intercourse in the past 3 months (AOR: 2.7 for > 26 times vs none, 95% CI: 1.01-7.2) and to have genital warts detected during the clinical visit (AOR: 10.4, 95% CI: 2.7-40.5). Single infection was not statistically significantly associated with any factor. Using the men with single HPV infection as the reference, lifetime number of sex partners (AOR: 3.2 for 6-10 vs 1-5 partners, CI: 1.5-7.0) and current genital warts (AOR: 31.8, CI: 3.9-257.7) were associated with multiple HPV. Conclusions: Infection with multiple HPV types, particularly on penile skin, is common in asymptomatic men. Current genital warts and more lifetime number of female sex partners were independently associated with the detection of multiple HPV types, compared to men with single infection and to men with no infection. The influence of multiple HPV on persistence and transmission will be of interest in future longitudinal studies of men and sex partners.