Lack Of Circumcision Research Articles

Rapid Progressivity in a 62-Year-Old Circumcised Man with Penile Cancer: A Case Report

Penile cancer is a rare malignancy globally, including in Indonesia, with notable morbidity and mortality rates. This case report discusses a 62-year-old male with a penile mass, emphasizing the diagnostic challenges and the importance of early intervention in penile cancer cases. The patient presented with a progressively growing penile mass, dysuria, and penile pain. Clinical examination revealed a palpable, reddish mass on the penile shaft with unclear borders, a urethral fistula, and enlarged inguinal lymph nodes. Laboratory results showed white blood cell count, haemoglobin, platelet count, glucose, blood urea nitrogen, and creatinine abnormalities. An open biopsy suggested verrucous carcinoma, later revised to penile squamous cell carcinoma with inguinal lymph node metastases. Penile cancer, particularly squamous cell carcinoma, primarily affects older, uncircumcised men. Verrucous carcinoma, though rare, is associated with poor hygiene and lack of circumcision. Notably, misdiagnoses may occur due to the limited scope of open biopsies. Penile cancer is preventable, and its significant risk factors are modifiable. Penile carcinoma, although uncommon, poses severe consequences for affected individuals. Early diagnosis and intervention are crucial for improved outcomes. This case highlights the challenges in diagnosis, emphasizing the need for comprehensive assessments and awareness of the modifiable risk factors associated with penile cancer.

Clinico-Etiological Aspects of Patients Suffering from Genital Lesions: A Cross-Sectional Study from India

Background: Genital dermatoses can interfere with sexual functioning and self-image. Sexually transmitted infections (STIs) are among the top 10 diseases in India. Objectives: This study aimed to document the burden, clinico-etiological, and demographic profile of patients presenting with genital lesions, determine the proportions of the pediatric and human immunodeficiency virus (HIV)-seropositive patients, and identify contributory factors. Methods: This was a hospital-based cross-sectional observational study conducted at a tertiary hospital in Pune, India, in the Department of Dermatology and Pediatrics over a period of 2 months (July-August 2022). Patients presenting with genital lesions were enrolled after obtaining written informed consent. Relevant information was recorded using a predesigned proforma. Results: A total of 83 patients comprised 77 adults, 3 (3.6%) pediatric patients and adolescents each, and 15 (18.1%) HIV-seropositive individuals. The adult male-to-female ratio was 1.2: 1. The mean age of adults was 37.01 ± 14.57 years. The most common STI and non-STI lesions were herpes genitalis and tinea cruris, respectively, with a similar trend in the HIV-seropositive group. All three pediatric cases had non-STI lesions; however, 66.7% of adolescents had STIs (vulvovaginal candidiasis and genital warts). Overall, there was a slightly higher preponderance of non-STI lesions (53.75%), and the majority of patients had lesions of infectious nature (86.25%). The most common identifiable risk factor was lack of circumcision (51.25%), followed by unprotected intercourse (22.5%). The presence of risk factors was significantly associated with male gender (P = 0.0001). Conclusions: This study emphasizes that besides STIs, non-STIs contribute substantially to genital diseases.

Etiologies of genital inflammation and ulceration in symptomatic Rwandan men and women responding to radio promotions of free screening and treatment services.

IntroductionThe longstanding inadequacies of syndromic management for genital ulceration and inflammation are well-described. The Rwanda National Guidelines for sexually transmitted infection (STI) syndromic management are not yet informed by the local prevalence and correlates of STI etiologies, a component World Health Organization guidelines stress as critical to optimize locally relevant algorithms.MethodsRadio announcements and pharmacists recruited symptomatic patients to seek free STI services in Kigali. Clients who sought services were asked to refer sexual partners and symptomatic friends. Demographic, behavioral risk factor, medical history, and symptom data were collected. Genital exams were performed by trained research nurses and physicians. We conducted phlebotomy for rapid HIV and rapid plasma reagin (RPR) serologies and vaginal pool swab for microscopy of wet preparation to diagnose Trichomonas vaginalis (TV), bacterial vaginosis (BV), and vaginal Candida albicans (VCA). GeneXpert testing for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) were conducted. Here we assess factors associated with diagnosis of NG and CT in men and women. We also explore factors associated with TV, BV and VCA in women. Finally, we describe genital ulcer and RPR results by HIV status, gender, and circumcision in men.ResultsAmong 974 men (with 1013 visits), 20% were positive for CT and 74% were positive for NG. Among 569 women (with 579 visits), 17% were positive for CT and 27% were positive for NG. In multivariate analyses, factors associated with CT in men included younger age, responding to radio advertisements, <17 days since suspected exposure, and not having dysuria. Factors associated with NG in men included not having higher education or full-time employment, <17 days since suspected exposure, not reporting a genital ulcer, and having urethral discharge on physical exam. Factors associated with CT in women included younger age and < = 10 days with symptoms. Factors associated with NG in women included younger age, lower education and lack of full-time employment, sometimes using condoms vs. never, using hormonal vs. non-hormonal contraception, not having genital ulcer or itching, having symptoms < = 10 days, HIV+ status, having BV, endocervical discharge noted on speculum exam, and negative vaginal wet mount for VCA. In multivariate analyses, only reporting >1 partner was associated with BV; being single and RPR+ was associated with TV; and having < = 1 partner in the last month, being pregnant, genital itching, discharge, and being HIV and RPR negative were associated with VCA. Genital ulcers and positive RPR were associated with being HIV+ and lack of circumcision among men. HIV+ women were more likely to be RPR+. In HIV+ men and women, ulcers were more likely to be herpetic rather than syphilitic compared with their HIV- counterparts.ConclusionsSyndromic management guidelines in Rwanda can be improved with consideration of the prevalence of confirmed infections from this study of symptomatic men and women representative of those who would seek care at government health centers. Inclusion of demographic and risk factor measures shown to be predictive of STI and non-STI dysbioses may also increase diagnostic accuracy.

Mobile Device Usage by Gender Among High-Risk HIV Individuals in a Rural, Resource-Limited Setting.

Background: Mobile health (mHealth) is a promising tool to deliver healthcare interventions to underserved populations. We characterized the use of mobile devices in rural KwaZulu-Natal, South Africa to tailor mHealth interventions for people living with HIV and at risk for acquiring HIV in the middle-income country. Methods: We surveyed participants in community settings and offered free HIV counseling and testing. Participants self-reported their gender, age, relationship, and employment status, receipt of monthly grant, condomless sex frequency, and circumcision status (if male). Outcomes included cell phone and smartphone ownership, private data access, health information seeking, and willingness to receive healthcare messages. We performed multivariable logistic regression to assess the relationship between demographic factors and outcomes. Results: Although only 10% of the 788 individuals surveyed used the phone to seek health information, 93% of cell phone owners were willing to receive healthcare messages. Being young, female, employed, and in a relationship were associated with cell phone ownership. Smartphone owners were more likely to be young, female, and employed. Participants reporting condomless sex or lack of circumcision were significantly less likely to have private data access or to purchase data. Conclusions: mHealth interventions should be feasible in rural KwaZulu-Natal, though differ by gender. As women are more likely to own smartphones, smartphone-based mHealth interventions specifically geared to prevent the acquisition of or to support the care of HIV in young women in KwaZulu-Natal may be feasible. mHealth interventions encouraging condom use and medical male circumcision should consider the use of nonsmartphone short message service and be attuned to mobile data limitations-especially when targeting men.

Sex effects in pyelonephritis.

Urinary tract infections (UTIs) are generally considered a disease of women. However, UTIs affect females throughout the lifespan, and certain male populations (including infants and elderly men) are also susceptible. Epidemiologically, pyelonephritis is more common in women but carries increased morbidity when it does occur in men. Among children, high-grade vesicoureteral reflux is a primary risk factor for upper-tract UTI in both sexes. However, among young infants with UTI, girls are outnumbered by boys; risk factors include posterior urethral valves and lack of circumcision. Recent advances in mouse models of UTI reveal sex differences in innate responses to UTI, which vary somewhat depending on the system used. Moreover, male mice and androgenized female mice suffer worse outcomes in experimental pyelonephritis; evidence suggests that androgen exposure may suppress innate control of infection in the urinary tract, but additional androgen effects, as well as non-hormonal sex effects, may yet be specified. Among other intriguing directions, recent experiments raise the hypothesis that the postnatal testosterone surge that occurs in male infants may represent an additional factor driving the higher incidence of UTI in males under 6months of age. Ongoing work in contemporary models will further illuminate sex- and sex-hormone-specific effects on UTI pathogenesis and immune responses.

1657. Notes From the Field: A Survey of Mobile Device Usage Among Individuals in KwaZulu-Natal, South Africa

BackgroundmHealth (mobile health) is a promising tool to deliver healthcare interventions to underserved populations. Across low- and middle-income countries (LMIC), the prevalence of smartphones has risen to 42%. Effective mHealth deployment in LMIC requires an understanding of how LMIC populations use mobile technology. We characterized the use of mobile devices in rural KwaZulu-Natal, South Africa to tailor mHealth interventions for people living with HIV and at risk for acquiring HIV.MethodsWe surveyed participants in community settings and offered free HIV counseling and testing. Participants self-reported their gender, age, relationship status, living distance from preferred clinic, receipt of monthly grant, condomless sex frequency, and circumcision status (if male). Outcomes included cell phone and smartphone ownership, private data access, health information seeking, and willingness to receive healthcare messages. We performed multivariable logistic regression to assess the relationship between demographic factors and outcomes.ResultsAmong 788 individuals surveyed, the median age was 28 (IQR 22–40) years, 75% were male, and 86% owned personal cell phones, of which 43% were smartphones. The majority (59%) reported having condomless sex and most (59%) males reported being circumcised. Although only 10% used the phone to seek health information, 93% of cell phone owners were willing to receive healthcare messages. Being young, female, and in a relationship were associated with cell phone ownership. Smartphone owners were more likely to be young and female, less likely to live 10–30 minutes from preferred clinic, and less likely to receive a monthly grant. Those reporting condomless sex or lack of circumcision were significantly less likely to have private data access.ConclusionMost participants were willing to receive healthcare messages via phone, indicating that mHealth interventions may be feasible in rural KwaZulu-Natal. Smartphone-based mHealth interventions specifically geared to prevent or support the care of HIV in young women in KwaZulu-Natal may be feasible. mHealth interventions encouraging condom use and medical male circumcision should consider the use of non-smartphone SMS and be attuned to mobile data limitations.Disclosures All authors: No reported disclosures.

A clinico-epidemiological study of HIV seroconcordant and serodiscordant couples

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the present study was to assess the epidemiological and risk factors that are likely to influence HIV transmission among married couples and to study the pattern of sexually transmitted infections among both concordant and discordant HIV infected couples..&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross-sectional study was done on 100 HIV patients and their married partners attending to Institute of Venereology, Madras Medical College, Tamil Nadu. Detailed history of their high risk sexual behaviour, previous veneral diseases (PVDs) was noted and physical and genital examination was done. All the partners of HIV cases were examined for HIV to know the serostatus (seroconcordant and serodiscordant).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Among the 100 married couples, 65 couples were seroconcordant for HIV and 35 couples were serodiscordant. Of them, 94 males and 71 females were positive for HIV. History of PVDs was found in 34 patients (28 were seroconcordants and 6 were serodiscordants). The most common STD in the males noticed was ano-genital warts (n=11) and genital ulceration (n=11) is associated with maximum seroconcordance rates. Whereas in the females it was bacterial vaginosis (n=11).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The findings suggest that risk factors such as STDs, PVDs in males, anal intercourse, sexual contact during menstruation, avoidance of condom during sexual act and lack of circumcision was significantly associated with presence of HIV concordance in the study population. Duration and frequency of sexual contact with partner, previous venereal diseases in females and ART were found not to influence the transmission of HIV.&lt;/p&gt;

Increasing trend of penile cancer cases in Bali compared to other regions in Indonesia

Penile cancer is a rare type of cancer in developed countries and found high in the developing country. This study aims to compare penile cancer cases in Bali and other regions in Indonesia. A 10 years review cases from cancer registry of Pathologic Anatomy Indonesia were done from 2004 to 2013. Penile cancer cases were found highest in Bali compared to other regions in Indonesia. This cancer showed an increase in number from the year of 2004 and reached its peak in 2013. Penile cancer is the most common cancer found in Balinese male population from the latest cancer registry in 2013. Risk factors associated with penile cancer are phimosis, lichen sclerosis, HPV infection, and history of wart or condyloma, lack of circumcision, multiple sex partners, and early sexual activity. Lack of circumcision is an important risk factor found in Bali. Penile cancer shows an improvement during the last 10 years and provides a new insight on the cancer issues in Bali. A preventive efforts such as improving hygiene factors on male reproductive organs, do circumcision, save sex practice and new recommendations for a routine male HPV vaccination may further reduce penile cancer cases.

Updates on the epidemiology and risk factors for penile cancer.

Penile cancer is a rare neoplasm representing less than 1% of all malignancies in the USA and Europe but is a significant public health hazard in the developing world. Male neonatal circumcision has been associated with a dramatic decrease in penile cancer rates with countries such as Israel, where circumcision is widely performed, having the lowest incidence in the world at <0.1% of malignancies. Many risk factors have been identified for penile cancer including phimosis, lack of circumcision, obesity, lichen sclerosis, chronic inflammation, smoking, UVA phototherapy, socioeconomic status, human papillomavirus (HPV) infection and immune compromised states. The relationship between these factors and invasive disease varies and continues to be investigated. Our objective was to present a contemporary overview of the epidemiology and risk factors for invasive penile cancer.

Genital Human Papillomavirus Infection in Indian HIV-Seropositive Men Who Have Sex With Men.

The incidence of penile cancer in Indian men is high. Little is known about genital human papillomavirus (HPV) infection in Indian HIV-seropositive men who have sex with men (MSM), a population that may be at particularly high risk for genital HPV infection and, potentially, penile cancer. In this study, we assessed the prevalence and risk factors for genital HPV infection in this population. Three hundred HIV-seropositive MSM were recruited from 2 clinical sites in India. They were tested for genital HPV infection using L1 HPV DNA polymerase chain reaction with probes specific for 29 types and a mixture of 10 additional types. Participants received an interviewer-administered questionnaire that included questions on demographics and behaviors. Human papillomavirus data were available from 299 participants. The prevalence of any HPV type in the penis and scrotum was 55% and 54%, respectively. Human papillomavirus type 35 was the most common oncogenic HPV type followed by HPV-16. In multivariate analysis, being the insertive partner with 100+ male partners increased the odds of any penile HPV infection compared with not being insertive with any partners (odds ratio, 2.5; 95% confidence interval, 1.3-5.1). Circumcision was protective against penile HPV infection (odds ratio, 0.39; 95% confidence interval, 0.19-0.76). The prevalence of penile and scrotal HPV infection was high among Indian HIV-seropositive MSM. The most common oncogenic HPV type in this population, HPV-35, is not included in any currently available HPV vaccines. Insertive anal sex with men and lack of circumcision were the primary risk factors for penile HPV infection in this population.

Programmed death ligand 1 expression and human papillomavirus status: penile cancer prognostic factors and new therapeutic opportunities

Penile cancer is a rare malignancy with limited treatment options beyond local resection and lymph node dissection. Risk factors for penile cancer development include phimosis, smoking, lack of circumcision, and human papillomavirus (HPV) infection. Based on cancer incidence and histologic subtyping, penile cancer is often stratified by HPV status. Cohort studies have found that HPV positive tumors have better prognosis. The success of HPV vaccination for the prevention of cervical cancer and genital warts has resulted in new recommendations for vaccination of men. However, these efforts would not be expected to improve outcomes in men with HPV negative tumors. New therapeutic strategies are needed to improve outcomes in men with advanced penile cancer. Programmed death ligand 1 (PD-L1) targeted treatments have been successful in other malignancies including melanoma and non-small cell lung cancer. Determining the frequency of PD-L1 positive tumor cells in penile cancer is needed to establish the potential benefit of using these targeted therapies in penile cancer patients. Evaluating the relationship between PD-L1 expression and HPV status may provide support for the proposed dual pathway to malignant transformation. Comparing PD-L1 status to HPV status should add another prognostic factor while expanding the therapeutic options for this malignancy.

Disparities in Penile Cancer.

Although penile cancer is a rare malignancy in developed nations, racial and socioeconomic differences exist in the incidence of the disease and its associated survival-related outcomes. A search of the literature was performed for research published between the years 1990 and 2015. Case reports and non-English-language articles were excluded, instead focusing specifically on large, population-based studies. The incidence of penile cancer is higher in Hispanic and African American men compared with whites and Asians. Men with penile cancer also appear to have a distinct epidemiological profile, including lower educational and income levels, a history of multiple sexual partners and sexually transmitted infections, and lack of circumcision with the presence of phimosis. African American men presented at a younger age with a higher stage of disease and worse survival rates when compared with white men. Rates of cancer-specific mortality increased with age, single marital status, and among those living in regions of lower socioeconomic status. An understanding of sociodemographical differences in the incidence and survival rates of patients with penile cancer can help advance health care policy changes designed to improve access and minimize disparities in cancer care for all men alike.

Study of clinical profile and risk factors associated with febrile urinary tract infection in preschool children

Background: Urinary tract infection (UTI) is a term applied to a variety of clinical conditions ranging from asymptomatic presence of bacteria in the urine to severe infection of the kidney with resultant sepsis. According to The National Institute for Health and Clinical Excellence (NICE) guidelines, urinary tract infection is defined by a combination of clinical features and the presence of bacteria in urine. The risk factors of UTI are age, gender, constipation, lack of circumcision, not taking anthelmintic and lack of toilet training. Methods: This was across sectional study conducted on febrile preschool children, aged 3 to 6 years, who attended the outpatient department of Sri Siddhartha Medical College, Tumkur. Children with symptoms suggestive of UTI were enrolled, and a written informed consent was obtained from the parents. They were then interviewed using structured questionnaire for UTI. Results: Out of 194 febrile preschool children, 21 cases were diagnosed to have UTI. Of the 194 cases, 102 (52.6%) were females and 92 (47.42%) were male. Out of 21 urine culture positive cases 14 (66.6%) were females and 7 (33.33%) were males. Occurrence of UTI was 7.6% in febrile males, 13.72% in febrile females and had the estimated overall occurrence is 10.8%. Fever was present in all the cases. Besides fever, 47.62% children had increased frequency, 42.86% had excessive crying while micturition and 38.10% had chills and rigors. Foul smelling urine was present in 33.33% of children while 23.81% had abdominal pain. Out of 92 male children studied 16 (17.39%) males had phimosis, of which 2 (12.5%) developed urinary tract infections. Constipation was seen in 3 (14.29%) children with UTI. Worm infestation was seen in 5 (23.81%) children with UTI. Conclusions: Children with urinary tract infections usually present with nonspecific symptoms and signs and hence a urine analysis and culture should always be part of an initial diagnostic evaluation of urinary tract infections. Female sex, constipation, not taking anthelmintic, lack of toilet training and phimosis are significant risk factors for febrile urinary tract infection in children.

Penile cancer: Perspective from a Canadian tertiary care centre.

Penile squamous cell carcinoma (SCC) is rare in North America; however, the morbidity can be devastating. This analysis represents the first reported penile cancer experience at a tertiary care centre in Canada. We carried out a retrospective review of all patients who received care at our centre for penile SCC from 2005 until the present time. Epidemiological and clinical data were collected for all patients. Survival analysis was performed using Kaplan-Meier methods with log-rank test and Cox regression for univariate and multivariate analysis, respectively. We identified 42 patients who were treated at our centre for penile SCC. Of these, 29% underwent excisional biopsy, 38% had partial penectomy, and 33% had total penectomy. Five patients with high-risk tumours underwent modified inguinal lymph node dissection (ILND), while 7 patients had radical ILND for clinically palpable disease. Overall, the median cancer specific survival (CSS) was undefined, with a 60% survival at 102 months. However CSS was significantly correlated to pT stage, pN stage, and tumour grade. The median follow-up was 25 months (interquartile range: 11-48). These findings confirm the poor CSS of patients with positive lymph nodes in penile SCC. Patients with pN0 after ILND had a durable CSS. Risk factors for penile SCC were confirmed as elevated body mass index, positive smoking history, and lack of circumcision. This first epidemiologic report on penile SCC from a Canadian tertiary care centre should be expanded to other national centres.

Penile Cancer in Cali, Colombia: 10 Years of Casuistry in a Tertiary Referral Center of a Middle-Income Country

Background: Penile cancer is a rare disease in Colombia; in Cali, it represents 0.7% of all cancers. Penile cancer has been associated with old age, bad hygiene, smoking and lack of circumcision. This study aimed to describe the sociodemographic and clinica characteristics of patients with penile cancer who consulted to a tertiary referral hospital. Methods: A case series of all penile cance cases at a reference institution in Cali during 2001-2010. Socioeconomic, demographic and clinical features of patients were described, and bivariate analyses were carried out. Results: There were 46 penile cancer cases. The average age was 60 ± 16.9 years. The main reason for consultation was an exophytic mass on the penis (75.0%). The most common location was the glans (69.6%), and the more frequent histology type was the squamous cell carcinoma (95.7%). With regard to risk factors, 65.5% of the patients had history of smoking and90.9% did not have circumcision. Patients who underwent radical amputation had higher rates of positive nodes (55% vs. 13.5%, p=0.015) and ulcerative lesions (77.8% vs. 29.7%, p=0.018) than those who did not have the procedure done. Recurrence was associated with the presence of lymphadenopathy (p=0.02) and history of circumcision (p=0.015). Conclusion: Most of the patients with penile cancer found in this study had old age, history of tobacco use and lack of circumcision. Patients who presented with lymph node metastasis had to undergo more radical procedures and suffered a greater rate of recurrence compared with those without lymph node involvement. Robust studies to determine the risk factors among low-income populations are required.

Prevalence and Incidence of HIV Infection, Trends, and Risk Factors Among Persons Aged 15–64 Years in Kenya

Enhanced HIV surveillance using demographic, behavioral, and biologic data from national surveys can provide information to evaluate and respond to HIV epidemics efficiently. From October 2012 to February 2013, we conducted a 2-stage cluster sampling survey of persons aged 18 months to 64 years in 9 geographic regions in Kenya. Participants answered questionnaires and provided blood for HIV testing. We estimated HIV prevalence, HIV incidence, described trends in HIV prevalence over the past 5 years, and identified factors associated with HIV infection. This analysis was restricted to persons aged 15-64 years. HIV prevalence was 5.6% [95% confidence interval (CI): 4.9 to 6.3] in 2012, a significant decrease from 2007, when HIV prevalence, excluding the North Eastern region, was 7.2% (95% CI: 6.6 to 7.9). HIV incidence was 0.5% (95% CI: 0.2 to 0.9) in 2012. Among women, factors associated with undiagnosed HIV infection included being aged 35-39 years, divorced or separated, from urban residences and Nyanza region, self-perceiving a moderate risk of HIV infection, condom use with the last partner in the previous 12 months, and reporting 4 or more lifetime number of partners. Among men, widowhood, condom use with the last partner in the previous 12 months, and lack of circumcision were associated with undiagnosed HIV infection. HIV prevalence has declined in Kenya since 2007. With improved access to treatment, HIV prevalence has become more challenging to interpret without data on new infections and mortality. Correlates of undiagnosed HIV infection provide important information on where to prioritize prevention interventions to reduce transmission of HIV in the broader population.

Modern diagnostic and treatment regimens are needed to achieve the best cancer and quality of life control.

Modern diagnostic and treatment regimens are needed to achieve the best cancer and quality of life control.

Human papillomavirus, lichen sclerosus and penile cancer: A study in Belgium

PurposeThe prevalence of penile cancer varies between 1.5 (industrialized countries) and 4.5 per 100,000 men (non-industrialized countries). Predominant histological subtype is squamous cell carcinoma (SCC). Human papillomavirus (HPV) is found in 40–46% of cases: penile cancer is considered to behave as vulvar cancer. Non HPV related risk factors are lack of circumcision, phimosis, chronic inflammation, and smoking. The role of lichen sclerosus (LS) is unclear. Clinical diagnosis is difficult and treatment often mutilating. Preventive measures can be taken since the risk factors are known: the use of the prophylactic HPV vaccines may contribute. We measured the prevalence of HPV and LS in penile cancer in Belgium. Materials and methodsWe found 76 samples of penile lesions in the archives of the departments of Histology of four university hospitals in Belgium. Real-time PCR of type-specific HPV DNA was performed targeting 18 HPV types. Principal resultsPatients with penile intraepithelial neoplasia (PeIN) were 56.1 years of age: patients with invasive penile cancer (IPC) 68.5 (p=0.009). Fifty-five samples (55/76) were adequate for HPV targeting. Overall HPV DNA was 70.9%: 89.5% in samples of PeIN (n=19) and 61.1% in samples of IPC (n=36). Invasive penile cancer samples were less likely to be HPV infected (p=0.028). HPV 16 was most prevalent: 48.3%: 20% PeIN, and 28.3% IPC. HPV DNA of the types, included in the prophylactic vaccines, was found in 33% of PeIN and 31.7% of IPC samples. Thrice, low risk HPV (lrHPV) types 6 (1 IPC) and 11 (1 PeIN, 1 IPC) were solely present. There was no difference in the presence of LS between HPV positive and HPV negative samples (p=0.944). ConclusionsPrevalence of HPV DNA in penile lesions in Belgium is high. However, the prophylactic vaccines may contribute to primary prevention of only a subset of cases. The role of LS remains unclear.

Penile Squamous Cell Carcinoma

Penile squamous cell carcinoma (SCC) is uncommon in Europe, where it accounts for approximately 0.7% of all malignant tumors in men. The main risk factors are poor hygiene, lack of circumcision, human papillomavirus (HPV) infection, and certain chronic inflammatory skin diseases. HPV infection is detected in 70% to 100% of all penile in situ SCCs and in 30% to 50% of invasive forms of the disease, mainly basaloid and warty SCCs. In situ tumors can be treated conservatively, but close monitoring is essential as they become invasive in between 1% and 30% of cases. The treatment of choice for penile SCC is surgery. Inguinal lymph node irradiation is no longer recommended as a prophylactic measure, and it appears that selective lymph node biopsy might be useful for reducing the morbidity associated with prophylactic inguinal lymph node dissection. Survival is directly related to lymph node involvement. Improving our knowledge of underlying molecular changes and their associated genotypes will open up new therapeutic pathways.

Phimose

Phimosis is a common condition in which the foreskin cannot be retracted over the glans penis. First appearing at 8 weeks gestation as a ridge of thickened epithelium, the prepuce grows forward over the developing glans. Physiological phimosis is common in male patients up to 3 years of age. Balanoposthitis is an inflammation of the foreskin and glans and occurs in 4-11% of uncircumcised boys. Lack of circumcision has been identified as a risk factor for urinary tract infection in infants as well as several sexually transmitted diseases and penile cancer in adults. Local steroid application showed satisfactory success rates of more than 80% and is recommended as first choice therapy. Male circumcision carried out under the age of 14 years without medical indications is unlawful and classified as bodily harm under German law.