La circumcisió masculina pot reduir el risc de contraure algunes malalties de transmissió sexual

Uns resultats sorprenents que ara ja gaudeixen d'evidència científica. Mitjançant un estudi multicèntric de més de 1000 dones amb les seves respectives parelles, es va aconseguir quantificar per primer cop la sospita que existia entre la comunitat científica: que la circumcisió masculina s'associa a un menor risc de virus del papiloma humà (VPH) al penis, i un risc menor de càncer de coll d'úter en la seva parella. A més a més, existeix també una forta evidència científica que mostra que aquesta senzilla intervenció quirúrgica redueix la infecció per VIH. Dades molt importants i que han donat suport a estudis observacionals i assajos clínics realitzats a l'Àfrica. De tota manera, els mecanismes que redueixen aquest risc d'infecció per VIH o VPH no es coneixen encara. Existeixen algunes hipòtesis. Per exemple, un possible mecanisme seria que amb l'eliminació del prepuci, s'estan eliminant també les cèl·lules receptores de la infecció, de manera que es redueix l'àrea d'exposició a la infecció. Tot i això, actualment l'Organització Mundial de la Salut (OMS) dóna suport a la introducció de la circumcisió masculina com una de les millors estratègies preventives en homes adults en països d'alt risc que no es poden permetre la implantació d'altres estratègies de prevenció del VIH, del VPH i altres malalties de transmissió sexual.Unos resultados sorprendentes que ahora ya gozan de evidencia científica. Mediante un estudio multicéntrico de más de 1000 mujeres con sus respectivas parejas, se logró cuantificar por primera vez la sospecha que existía entre la comunidad científica: que la circuncisión masculina se asocia a un menor riesgo de Virus del Papiloma Humano (VPH) en el pene, y un menor riesgo de cáncer de cuello de útero en su pareja. Además, existe también una fuerte evidencia científica que muestra que esta sencilla intervención quirúrgica reduce la infección por VIH. Datos muy importantes y que se han apoyado en estudios observacionales y ensayos clínicos realizados en África. De todos modos, los mecanismos que reducen este riesgo de infección por VIH o VPH no se conocen todavía. Existen algunas hipótesis. Por ejemplo, un posible mecanismo sería que con la eliminación del prepucio, se están eliminando también las células receptoras de la infección, de manera que se reduce el área de exposición a la infección. Sin embargo, actualmente la Organización Mundial de la Salud (OMS) apoya la introducción de la circuncisión masculina como una de las mejores estrategias preventivas en hombres adultos en países de alto riesgo que no se pueden permitir la implantación de otras estrategias de prevención del VIH, del VPH y otras enfermedades de transmisión sexual

Human Papillomavirus (HPV) infection in pregnant women and mother-to-child transmission of genital HPV genotypes: a prospective study in Spain

Background: Studies on HPV infection in pregnant women and HPV transmission to the child have yielded inconsistent results. Methods: To estimate mother-to-child HPV transmission we carried out a prospective cohort study that included 66 HPV-positive and 77 HPV-negative pregnant women and their offspring attending a maternity hospital in Barcelona. To estimate HPV prevalence and genotype distribution in pregnancy we also carried out a related screening survey of cervical HPV-DNA detection among 828 pregnant women. Cervical cells from the mother were collected at pregnancy (mean of 31 weeks) and at the 6-week post-partum visit. Exfoliated cells from the mouth and external genitalia of the infants were collected around birth, at the 6-week post-partum visit, and around 3, 6, 12, and 24 months of age. All samples were tested for HPV using PCR. Associations between potential determinants of HPV infection in pregnant women and of HPV positivity in infants were also explored by logistic regression modelling. Results: Overall cervical HPV-DNA detection in pregnant women recruited in the HPV screening survey was 6.5% (54/828). Sexual behavior-related variables, previous histories of genital warts or sexually transmitted infections, and presence of cytological abnormalities were statistically significantly and positively associated with HPV DNA detection in pregnant women recruited in the cohort. At 418 infant visits and a mean follow-up time of 14 months, 19.7% of infants born to HPV-positive mothers and 16.9% of those born to HPV-negative mothers tested HPV positive at some point during infants' follow-up. The most frequently detected genotype both in infants and mothers was HPV-16, after excluding untyped HPV infections. We found a strong and statistically significant association between mother's and child's HPV status at the 6-week post-partum visit. Thus, children of mothers' who were HPV-positive at the post-partum visit were about 5 times more likely to test HPV-positive than children of corresponding HPV-negative mothers (p = 0.02). Conclusion: This study confirms that the risk of vertical transmission of HPV genotypes is relatively low. HPV persistence in infants is a rare event. These data also indicate that vertical transmission may not be the sole source of HPV infections in infants and provides partial evidence for horizontal mother-to-child HPV transmission

Human Papillomavirus (HPV) infection in pregnant women and mother-to-child transmission of genital HPV genotypes: a prospective study in Spain

Background: Studies on HPV infection in pregnant women and HPV transmission to the child have yielded inconsistent results. Methods: To estimate mother-to-child HPV transmission we carried out a prospective cohort study that included 66 HPV-positive and 77 HPV-negative pregnant women and their offspring attending a maternity hospital in Barcelona. To estimate HPV prevalence and genotype distribution in pregnancy we also carried out a related screening survey of cervical HPV-DNA detection among 828 pregnant women. Cervical cells from the mother were collected at pregnancy (mean of 31 weeks) and at the 6-week post-partum visit. Exfoliated cells from the mouth and external genitalia of the infants were collected around birth, at the 6-week post-partum visit, and around 3, 6, 12, and 24 months of age. All samples were tested for HPV using PCR. Associations between potential determinants of HPV infection in pregnant women and of HPV positivity in infants were also explored by logistic regression modelling. Results: Overall cervical HPV-DNA detection in pregnant women recruited in the HPV screening survey was 6.5% (54/828). Sexual behavior-related variables, previous histories of genital warts or sexually transmitted infections, and presence of cytological abnormalities were statistically significantly and positively associated with HPV DNA detection in pregnant women recruited in the cohort. At 418 infant visits and a mean follow-up time of 14 months, 19.7% of infants born to HPV-positive mothers and 16.9% of those born to HPV-negative mothers tested HPV positive at some point during infants' follow-up. The most frequently detected genotype both in infants and mothers was HPV-16, after excluding untyped HPV infections. We found a strong and statistically significant association between mother's and child's HPV status at the 6-week post-partum visit. Thus, children of mothers' who were HPV-positive at the post-partum visit were about 5 times more likely to test HPV-positive than children of corresponding HPV-negative mothers (p = 0.02). Conclusion: This study confirms that the risk of vertical transmission of HPV genotypes is relatively low. HPV persistence in infants is a rare event. These data also indicate that vertical transmission may not be the sole source of HPV infections in infants and provides partial evidence for horizontal mother-to-child HPV transmission

Male circumcision and the incidence and clearance of genital human papillomavirus (HPV) infection in men: the HPV Infection in men (HIM) cohort study

Background: Reported associations of male circumcision (MC) with human papillomavirus (HPV) infection in men have been inconsistent. Methods: 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. Results: 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). Conclusions: 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

Male circumcision and prevalence of genital human papillomavirus infection in men : a multinational study

Background: Accumulated evidence from epidemiological studies and more recently from randomized controlled trials suggests that male circumcision (MC) may substantially protect against genital HPV infection in men. The purpose of this study was to assess the association between MC and genital HPV infection in men in a large multinational study. Methods: A total of 4072 healthy men ages 18-70 years were enrolled in a study conducted in Brazil, Mexico, and the United States. Enrollment samples combining exfoliated cells from the coronal sulcus, glans penis, shaft, and scrotum were analyzed for the presence and genotyping of HPV DNA by PCR and linear array methods. Prevalence ratios (PR) were used to estimate associations between MC and HPV detection adjusting for potential confounders. Results: MC was not associated with overall prevalence of any HPV, oncogenic HPV types or unclassified HPV types. However, MC was negatively associated with non-oncogenic HPV infections (PR 0.85, 95% confident interval: 0.76-0.95), in particular for HPV types 11, 40, 61, 71, and 81. HPV 16, 51, 62, and 84 were the most frequently identified genotypes regardless of MC status. Conclusions: This study shows no overall association between MC and genital HPV infections in men, except for certain non-oncogenic HPV types for which a weak association was found. However, the lack of association with MC might be due to the lack of anatomic site specific HPV data, for example the glans penis, the area expected to be most likely protected by MC

Comprehensive Control of Human Papillomavirus Infections and Related Diseases

Infection with human papillomavirus (HPV) is recognized as one of the major causes of infection-related cancer worldwide, as well as the causal factor in other diseases. Strong evidence for a causal etiology with HPV has been stated by the International Agency for Research on Cancer for cancers of the cervix uteri, penis, vulva, vagina, anus and oropharynx (including base of the tongue and tonsils). Of the estimated 12.7 million new cancers occurring in 2008 worldwide, 4.8% were attributable to HPV infection, with substantially higher incidence and mortality rates seen in developing versus developed countries. In recent years, we have gained tremendous knowledge about HPVs and their interactions with host cells, tissues and the immune system; have validated and implemented strategies for safe and efficacious prophylactic vaccination against HPV infections; have developed increasingly sensitive and specific molecular diagnostic tools for HPV detection for use in cervical cancer screening; and have substantially increased global awareness of HPV and its many associated diseases in women, men, and children. While these achievements exemplify the success of biomedical research in generating important public health interventions, they also generate new and daunting challenges: costs of HPV prevention and medical care, the implementation of what is technically possible, socio-political resistance to prevention opportunities, and the very wide ranges of national economic capabilities and health care systems. Gains and challenges faced in the quest for comprehensive control of HPV infection and HPV-related cancers and other disease are summarized in this review. The information presented may be viewed in terms of a reframed paradigm of prevention of cervical cancer and other HPV-related diseases that will include strategic combinations of at least four major components: 1) routine introduction of HPV vaccines to women in all countries, 2) extension and simplification of existing screening programs using HPV-based technology, 3) extension of adapted screening programs to developing populations, and 4) consideration of the broader spectrum of cancers and other diseases preventable by HPV vaccination in women, as well as in men. Despite the huge advances already achieved, there must be ongoing efforts including international advocacy to achieve widespread optimally universal implementation of HPV prevention strategies in both developed and developing countries. This article summarizes information from the chapters presented in a special ICO Monograph 'Comprehensive Control of HPV Infections and Related Diseases' Vaccine Volume 30, Supplement 5, 2012. Additional details on each subtopic and full information regarding the supporting literature references may be found in the original chapters. (C) 2013 Elsevier Ltd. All rights reserved

El rol de la circuncisión masculina en la infección genital por el virus del papiloma humano

Introducción: El efecto protector de la circuncisión masculina (CM) y la infección genital por el virus del papiloma humano (VPH) y las enfermedades relacionadas no ha sido consistente en todos los estudios. Objetivo: El objetivo de esta tesis ha sido estudiar el rol de la CM en la infección por el VPH genital en los hombres. Metodologia: En primer lugar, se examinó el efecto de la CM en la infección de VPH en el pene mediante revisiones sistemáticas de la literatura para poder evaluar el efecto de la CM con distintos indicadores de la infección por el VPH. En segundo lugar, se evaluó la asociación entre la CM y la prevalencia, la incidencia y la resolución del VPH genital en los hombres en el estudio prospectivo HIM. Con un total de 4074 hombres entre 18-70 años de Brasil, México y los Estados Unidos de América es uno de los estudios más grandes realizado hasta la fecha que permite explorar estas asociaciones. Para la detección de ADN del VPH, se combinaron en una única muestra células exfoliadas del surco coronal/glande, cuerpo del pene y escroto. Resultados: Los resultados del metanálisis muestran una prevalencia global de VPH genital menor entre los hombres circuncidados en comparación a los hombres no circuncidados. En cambio, la CM no está asociada con una reducción de la incidencia o un aumento de la resolución del VPH. La CM no está asociada con una reducción en la prevalencia de las verrugas genitales. Los resultados del estudio HIM indican que la prevalencia de VPH genital es menor entre los hombres circuncidados en comparación a los hombres no circuncidados pero sólo con los tipos de VPH no oncogénicos. La CM no está asociada con la incidencia o la resolución del VPH, excepto para ciertos tipos específicos de VPH. Conclusiones: Esta tesis muestra que no existe una asociación clara entre la CM y las diferentes medidas de la infección por el VPH genital en los hombres. La combinación de diferentes localizaciones del pene y del escroto probablemente limita la capacidad para identificar un efecto de la CM en la infección por el VPH en el pene distal, la zona probablemente más protegida por la eliminación del prepucio.Background: The protective effect of male circumcision (MC) and genital human papillomavirus (HPV) infection and related diseases has not been consistent across all studies. Objective: The purpose of this thesis was to study the association between MC and genital HPV infection in men. Methods: First, we examined the effect of MC on HPV infection in the penis by systematic reviews of the literature to be able to evaluate the effect of MC with different indicators of HPV infection. Second, we evaluated the association between MC and the prevalence, incidence and clearance of genital HPV infection in men in the prospective HIM study. A total of 4074 men between 18-70 years were enrolled in a study conducted in Brazil, Mexico and the United States of America. It is one of the largest studies conducted to date to explore these associations. Exfoliated cell specimens from the coronal sulcus/glans, penile shaft, and scrotum were collected and combined into one sample per person for HPV DNA detection. Results: The meta-analysis results show an overall reduction in the prevalence of genital HPV infection among circumcised men compared to uncircumcised men. In contrast, MC is not associated with the incidence and clearance of genital HPV infection. MC is not associated with a reduction in the prevalence of genital warts. The results of the HIM study indicate that the prevalence of genital HPV is lower among circumcised men compared to uncircumcised men but only with non-oncogenic HPV types. MC is not associated with the incidence and clearance of genital HPV infection, except for certain HPV types. Conclusions: This thesis shows that the association between MC and different measures of genital HPV infection in men is no clear. The combination of different locations of the penis and scrotum probably limits the ability to identify an effect of MC on HPV infection in the distal penis, the area most likely protected by removal of the foreskin

Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean.

The incidence of cervical cancer in Latin America and the Caribbean (LAC) is among the highest in the world. Because there are major demographic shifts happening in LAC countries (population growth, urbanization and ageing) cervical cancer incidence and mortality will likely continue to be a significant public health problem. Overall human papillomavirus (HPV) prevalence in the LAC general population has been found to be 2-fold higher than the average worldwide prevalence. The large HPV and cancer burden may be explained by the highly prevalent HPV variants of HPV types -16 and 18, which have an increased oncogenic potential. Given the major mode of transmission of genital HPV is sexual, certain, patterns of sexual behaviour (early age at first sexual intercourse, number of sexual partners and sexual behaviour of the partner) are associated with an increased risk of HPV genital acquisition. Although HPV infection is necessary for carcinogenesis, certain co-factors (high parity, long term use of oral contraceptives, smoking and co-infection with the human immunodeficiency virus (HIV)) help in the progression from infection to cancer. Many studies that have contributed to this evidence have been carried out in LAC and are reviewed and summarised in this article. Since HPV vaccines will likely take years to implement, and many more years to show impact on disease, cervical cancer screening programmes remain as the key intervention to control disease in LAC in the years to come

El Rol de la circuncisión masculina en la infección genital por el virus del papiloma humano /

Introducción: El efecto protector de la circuncisión masculina (CM) y la infección genital por el virus del papiloma humano (VPH) y las enfermedades relacionadas no ha sido consistente en todos los estudios. Objetivo: El objetivo de esta tesis ha sido estudiar el rol de la CM en la infección por el VPH genital en los hombres. Metodologia: En primer lugar, se examinó el efecto de la CM en la infección de VPH en el pene mediante revisiones sistemáticas de la literatura para poder evaluar el efecto de la CM con distintos indicadores de la infección por el VPH. En segundo lugar, se evaluó la asociación entre la CM y la prevalencia, la incidencia y la resolución del VPH genital en los hombres en el estudio prospectivo HIM. Con un total de 4074 hombres entre 18-70 años de Brasil, México y los Estados Unidos de América es uno de los estudios más grandes realizado hasta la fecha que permite explorar estas asociaciones. Para la detección de ADN del VPH, se combinaron en una única muestra células exfoliadas del surco coronal/glande, cuerpo del pene y escroto. Resultados: Los resultados del metanálisis muestran una prevalencia global de VPH genital menor entre los hombres circuncidados en comparación a los hombres no circuncidados. En cambio, la CM no está asociada con una reducción de la incidencia o un aumento de la resolución del VPH. La CM no está asociada con una reducción en la prevalencia de las verrugas genitales. Los resultados del estudio HIM indican que la prevalencia de VPH genital es menor entre los hombres circuncidados en comparación a los hombres no circuncidados pero sólo con los tipos de VPH no oncogénicos. La CM no está asociada con la incidencia o la resolución del VPH, excepto para ciertos tipos específicos de VPH. Conclusiones: Esta tesis muestra que no existe una asociación clara entre la CM y las diferentes medidas de la infección por el VPH genital en los hombres. La combinación de diferentes localizaciones del pene y del escroto probablemente limita la capacidad para identificar un efecto de la CM en la infección por el VPH en el pene distal, la zona probablemente más protegida por la eliminación del prepucio.Background: The protective effect of male circumcision (MC) and genital human papillomavirus (HPV) infection and related diseases has not been consistent across all studies. Objective: The purpose of this thesis was to study the association between MC and genital HPV infection in men. Methods: First, we examined the effect of MC on HPV infection in the penis by systematic reviews of the literature to be able to evaluate the effect of MC with different indicators of HPV infection. Second, we evaluated the association between MC and the prevalence, incidence and clearance of genital HPV infection in men in the prospective HIM study. A total of 4074 men between 18-70 years were enrolled in a study conducted in Brazil, Mexico and the United States of America. It is one of the largest studies conducted to date to explore these associations. Exfoliated cell specimens from the coronal sulcus/glans, penile shaft, and scrotum were collected and combined into one sample per person for HPV DNA detection. Results: The meta-analysis results show an overall reduction in the prevalence of genital HPV infection among circumcised men compared to uncircumcised men. In contrast, MC is not associated with the incidence and clearance of genital HPV infection. MC is not associated with a reduction in the prevalence of genital warts. The results of the HIM study indicate that the prevalence of genital HPV is lower among circumcised men compared to uncircumcised men but only with non-oncogenic HPV types. MC is not associated with the incidence and clearance of genital HPV infection, except for certain HPV types. Conclusions: This thesis shows that the association between MC and different measures of genital HPV infection in men is no clear. The combination of different locations of the penis and scrotum probably limits the ability to identify an effect of MC on HPV infection in the distal penis, the area most likely protected by removal of the foreski