An Article published Online First by The Lancet shows that approximately 50% of men from a sample of the general population are infected with the human papillomavirus (HPV). Per year, 6% of men will acquire a new HPV 16 infection, the virus most well known for causing cervical cancer in women and also causing cancers in men. Furthermore having multiple partners, female or male, makes a man much more likely to have HPV infection. The Article is by Professor Anna R Giuliano, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA, and colleagues.
In the USA, an estimated 32 000 cases of cancers in men and women in 2009 were attributable to HPV infection. These were cancers of the cervix, vagina, vulva, penis, oral cavity, head and neck, and anal canal. Anogenital warts are the most common outcome of HPV, with 205 cases per 100 000 diagnosed every year in the USA. In addition to the diseases HPV causes directly in men, the virus is readily transmitted from men to women and greatly affects the risk of disease in women. Thus understanding the nature of HPV in men is of crucial public health importance and can be used in modeling to establish whether vaccinating men would be cost effective.
The study analysed 1159 men aged 18 to 70 years (mean 32 years) from the USA, Brazil, and Mexico, all of whom were HIV negative and had no history of cancer. They were assessed every six months for an average of more than two years. The incidence of a new genital HPV infection with any HPV type was 38.4 per 1000 person months. The chances of cancer-causing (oncogenic) HPV infection was 2.4 times higher from men who had had 50 or more female partners compared with no partners or just one partner; and 2.6 times higher for men who had at least three male anal sex partners compared with no recent partners. The median duration of HPV infection was 7.5 months for any HPV and 12 months for the cancer-causing HPV type 16. The authors say: 'We noted no association with age and incidence of any, oncogenic, or non-oncogenic HPV types, although the probability of clearing these infections increased with age."
They conclude: "The incidence of genital HPV infection in men was high and relatively constant across age groups in Brazil, Mexico, and the USA. The results from this study provide much needed data about the incidence and clearance of HPV infection in men; these data are essential for the development of realistic cost-effectiveness models for male HPV vaccination internationally."
In a linked Comment, Dr Joseph Monsonego, Institute of the Cervix, Paris, France, says : "The cost-benefit ratio of vaccinating men to protect women from cervical neoplasia has yet to be definitively established. However, as more diseases are prevented through male vaccination, notably anal cancer, the greater the cost-effectiveness of routine vaccination of both sexes. Although we will continue to encourage protective measures, condom use and safe sex practices are of little value in clinical practice, with prevention of HPV transmission and its consequences still unconfirmed. HPV vaccination of men will protect not only them but will also have implications for their sexual partner."
Professor Anna R Giuliano, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. T) +1 813-745-6820 E) anna.giuliano@moffitt.org / Michelle.Foley@moffitt.org
Joseph Monsonego, Institute of the Cervix, Paris, France. E) jmonsonego@wanadoo.fr
For full Article and Comment see: http://press.thelancet.com/hpvmen.pdf
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Journal
The Lancet