Abstract
There is growing evidence of a significant burden of human papillomavirus (HPV) infection and associated disease in men. High rates of HPV infection have been observed in men from sub-Saharan Africa where HIV prevalence is high. HIV infection increases HPV prevalence, incidence and persistence and is strongly associated with the development of anogenital warts and anal, penile and head and neck cancers in men. Despite increasing access to antiretroviral therapy, there appears to be little benefit in preventing the development of these cancers in HIV-positive men, making prevention of infection a priority. New prevention options that are being introduced in many African countries include male circumcision and HPV vaccination. However, more data are needed on the burden of HPV disease in men before boys are included in HPV vaccination programmes.
Highlights
This review provides an update on current evidence regarding the epidemiology of human papillomavirus (HPV) infection and disease in men, the effects of HIV on HPV infection and disease in men in sub-Saharan Africa (SSA), and the prospects for prevention in this setting
Persistent HPV disease progression suggest that the incidence of HR anogenital HPV infection in men is high, ranging from 35.7/100 person years in South African men to 40/100 person-years in East African men participating in male circumcision (MC) trials.[16,17,18]
More keratinised epithelium may present a barrier to infection, and if infected, may be less likely than mucosal surfaces to induce an immune response, given the relative distance from draining lymphatics and lymph nodes. [23,25] Recent data from a study comparing type-specific HPV antibody pre valence with the corresponding prevalence of HPV DNA detected in the external genitalia and anal canal in heterosexual men and men who have sex with men (MSM) support this notion
Summary
Among men aged 14 - 59 years in the USA, 12.2% of men were seropositive for any vaccine type, with a peak prevalence of 18% among men aged 50 - 59 years.[5] In a similar population-based study in Australia, peak prevalence of any vaccine type was 31.5% among men aged 40 - 49 years;[6] and a study from the Netherlands estimated that the seroprevalence of any HR-HPV in men aged ≥14 years was 20%.[7] There is some evidence that seroprevalence appears to be rising as a result of changes in sexual behaviour and earlier age of sexual debut. In a related study from the Netherlands comparing serosurveillance rates of HR-HPV in the periods 1995 - 1996 and 2006 - 2007, overall HR-HPV seroprevalence rates were significantly higher in the later survey, compared with the earlier survey across all age groups.[8]
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