HPV prevalence in the foreskins of asymptomatic healthy infants and children: Systematic review and meta-analysis

Bora Lee,Dae In Kim,Jae Heon Kim,Sang Wook Lee

doi:10.1038/s41598-017-07506-z

Abstract

The true HPV prevalence in the foreskins of infants and children has been little documented, but reporting on this prevalence is of great importance given its impact on the rationale for treating asymptomatic boys. We searched multiple databases from 1960 to 2016 for observational or prospective studies that reported on HPV prevalence in foreskins. We conducted a meta-analysis using a random-effects model to pool for HPV prevalence in the foreskins of infants and children. Eight studies, with a total of 556 infants and children with phimosis, were eligible for the meta-analysis. The pooled overall prevalence of general HPV, high-risk HPV, low-risk HPV, HPV 16/18, HPV 16, and HPV 18 were 17.3 (95%CI: 0.8–46.3), 12.1 (95% CI: 0.9–31.5), 2.4 (95% CI: 0.0–11.2), 4.8 (95% CI: 0.0–16.8), 1.7 (95% CI: 0.0–5.1), and 0 (95% CI: 0–0.5), respectively. The estimated HPV prevalence in foreskins was not zero among infants and children, which implies HPV transmission other than by sexual contact. Considering that high-risk HPV is detected in asymptomatic infants and children, future studies are warranted to determine whether preventive treatments in asymptomatic infants and children could be effective in preventing persistence or transmission of high-risk HPV.

Highlights

Human papillomavirus (HPV) infection is a threat to public health, causing medical problems from warts to cancer including cervical and penile cancer[1]
The two most recent meta-analyses, by Van Howe et al.[5] and Zhu et al.[6], indicate a limited role of circumcision in preventing genital HPV infections; the authors concluded that there is no association between circumcision and protection against HPV infection because even reduced HPV prevalence by circumcision does not reflect reduced HPV acquisition and clearance
Issues of sample accuracy unless specimens are acquired by circumcision because the foreskin has great importance in carrying HPV

Summary

Introduction

Human papillomavirus (HPV) infection is a threat to public health, causing medical problems from warts to cancer including cervical and penile cancer[1]. To demonstrate this issue, RCTs are necessary with samples of infants or children with extremely long follow-up; such studies would be both costly and difficult to execute. RCTs are necessary with samples of infants or children with extremely long follow-up; such studies would be both costly and difficult to execute Before such RCTs are performed, and to discuss the role of circumcision in preventing genital HPV infection related to cervical and penile cancer, the first step would be to investigate the true HPV prevalence among males without a sexual contact history. Clinicians seldom focus on non-sexual routes of HPV transmission, there is evidence of other modes of transmission including vertical and horizontal[7, 8]

Objectives

Methods

Results

Conclusion