INTRODUCTION AND OBJECTIVES

Human papilloma virus (HPV) is a common sexually transmitted infection (STI) in the US that can lead to both malignant transformation and genital warts. Recently, a vaccine has been developed against the 4 major strains of HPV. The American Committee for Immunization Practices has given a permissive recommendation for boys aged 11-26 years, but does not place it on the routine vaccination schedule. We aim to estimate the prevalence of HPV infection in males in the US population using a nationwide sample.

METHODS

The NHANES database was queried for all men 18-59 years old during the years 2013-2014. During these years, the survey included penile swabs that were tested for HPV infection from 37 strains using PCR. Information was also obtained regarding other STIs, HPV vaccination, and circumcision status. HPV infection was further stratified into those known to cause genital warts, HPV 6 and 11 (LRHPV), and those known to be “high risk” and implicated in penile cancer, HPV 16 and 18 (HRHPV). Logistic regression was used to evaluate circumcision status with HRHPV, when excluding those that had received HPV vaccination.

RESULTS

A total of 1,520 men had complete information on HPV infection and circumcision status. As seen in table 1, 45.2% of men had HPV infection from any strain. LRHPV was present in 2.9%, whereas HRHPV was present in 5.8% of men. Only 7.8% of all men, and 13.4% of men 18-29 years had received HPV vaccination. In addition, 77.8% of men had been circumcised. Circumcised men had an increased risk of HRHPV (OR 2.0, p=0.03) but no increased risk of LRHPV (OR 1.05, p=0.9).

CONCLUSIONS

Surprisingly, almost half of all men tested positive for HPV on penile swab in this nationwide sample. Only a small proportion of young males have received vaccination against HPV. More men were positive for HPV strains associated with penile cancer than HPV strains that cause genital warts. Interestingly, circumcised men had a two-fold increased risk of these high-risk HPV infections.