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The optimal sites for sampling heterosexual men for human papillomavirus (HPV) detection: the HPV detection in men study.
J Infect Dis 2007; 196(8):1146-1152.
Giuliano AR, Nielson CM, Flores R, Dunne EF, Abrahamsen
M, Papenfuss MR, Markowitz LE, Smith D, Harris RB.
Abstract
Background. Human papillomavirus (HPV) infection in men contributes to infection
and cervical disease in women as well as to disease in men. This study aimed
to determine the optimal anatomic site(s) for HPV detection in heterosexual
men.Methods. A cross-sectional study of HPV infection was conducted in 463
men from 2003 to 2006. Urethral, glans penis/coronal sulcus, penile shaft/prepuce,
scrotal, perianal, anal canal, semen, and urine samples were obtained. Samples
were analyzed for sample adequacy and HPV DNA by polymerase chain reaction
and genotyping. To determine the optimal sites for estimating HPV prevalence,
site-specific prevalences were calculated and compared with the overall prevalence.
Sites and combinations of sites were excluded until a recalculated prevalence
was reduced by <5% from the overall prevalence.Results. The overall prevalence
of HPV was 65.4%. HPV detection was highest at the penile shaft (49.9% for
the full cohort and 47.9% for the subcohort of men with complete sampling),
followed by the glans penis/coronal sulcus (35.8% and 32.8%) and scrotum (34.2%
and 32.8%). Detection was lowest in urethra (10.1% and 10.2%) and semen (5.3%
and 4.8%) samples. Exclusion of urethra, semen, and either perianal, scrotal,
or anal samples resulted in a <5% reduction in prevalence.Conclusions.
At a minimum, the penile shaft and the glans penis/coronal sulcus should be
sampled in heterosexual men. A scrotal, perianal, or anal sample should also
be included for optimal HPV detection.