Alarcón-Herrera A, Cervantes-Sánchez A, Meneses-Miranda T, Castillejos-López M, Astudillo-de la Vega H, Tena-Suckf ML

Language: Spanish
References: 18
Page: 274-280
PDF size: 141.87 Kb.

ABSTRACT

Objective: The aim of this study was to identify human papillomavirus lesions in a group of men whose sexual partners had cervical intraepithelial lesions associated with low-grade HPV confirmed by PCR-DNA. We carried out a correlation between urethral cytology penoscopy data and PCR-DNA results.
Methods: We studied 100 male volunteers with an age range of 21- 45 (median 30 years) and divided them into two groups according to the identified virus; two groups were conformed, a high risk and a low risk virus.
Results: For the penoscopy data we included the following: type of hirsutoide papillomatosis in 40 (40%) cases, common warts in 24 (24%) cases, papillomatosis in plaque in 6 (6%) and 47% displayed an urethra with a foamy appearance. In urethral cytology we did not find evidence of koilocytes in 58% and 42% showed no koilocytes. Inflammation was observed in 44 cases; an added infection was noted among 60 cases. Depending on the type of infection we found: non-specific bacteria in 8%, bacillary in 10%, mixed infection in 12%, changes suggestive of Gardnerella vs 24%, and Chlamydia treatment in 6%. Dyskeratosis was noted in 47% of study participants. 67 patients were treated with imiquimod cream 5% and 33% received non-specific treatment. Regarding improvement we noted that 67 (67%) cases showed 46/67 hypochromic stains after treatment with imiquimod. Disappearance of the lesions in the penis were observed among 65 cases and only 35 remained with lesions. Regarding high-risk HPV wefound a significant difference in odor (p =,004, phi = .004), urethral discharge (p = .007), pearly papules in raphe (p = .023), with inflammation, dyskeratosis and added infection (p = .000 respectively). We also noted hypochromic spots or skin discoloration after treatment with imiquimod among 5% of subjects (p = .046).
Conclusions: In our study we observed that high-risk HPV is associated with increased penile lesions and frank evidence of koilocytes in urethral cytology. We recommend that sexual partners of women with cervical lesions associated with HPV complete a control study with penoscopy data and urethral cytology, since most have concurrent infections and lesions that can treated in early stages.

REFERENCES

1. Omar R, Choudhury M, Fischer J, Ezpeleta C. A Pap test for men. Male urethral smears as screening tool for detecting subclinical human papillomavirus infection. Urology 1991;37:110-115.

2. Rymark P, Forslund O, Hansson BG, Lindholm K. Genital HPV infection not a local but a regional infection: experience from a female teenage group. Genitourin Med 1993;69:18-22.

3. Hogewoning CJ, Bleeker MC, van den Brule AJ, Voorhorst FJ, van Andel RE, Risse EK, et al. Pearly penile papules: still no reason for uneasiness. Am Acad J Dermatol 2003;49:50-54.

4. Bleeker MC, Hogewoning CJ, Voorhorst FJ, van den Brule AJ, Berkhof J, Hesselink AT, et al. HPV-associated flat penile lesions in men of a non-STD hospital population: less frequent and smaller in size than in male sexual partners of women with CIN. Int J Cancer 2005;113:36-41.

5. Bleeker MC, Hogewoning CJ, Voorhorst FJ, van den Brule AJ, Snijders PJ, Starink TM, et al. Condom use promotes regression of human papillomavirusassociated penile lesions in male sexual partners of women with cervical intraepithelial neoplasia. Int J Cancer 2003;107:804-810.

6. Winkler B, Crum CP. Chlamydia trachomatis infection of the female genital tract. Pathogenetic and clinicopathologic correlations. Pathol Annu 1987;22:193-223.

7. Syrjänen K, Mäntyjärvi R, Väyrynen M, Parkkinen S, Holopainen H, Syrjänen S, et al. Coexistent chlamydial infections related to natural history of human papillomavirus lesions in uterine cervix. Genitourin Med 1986;62:345-351.

8. Wikström A, Hedblad MA, Johansson B, Kalantari M, Syrjänen S, Lindberg M, et al. The acetic acid test in evaluation of subclinical genital papillomavirus infection: a comparative study on penoscopy, histopathology, virology and scanning electron microscopy findings. Genitourin Med 1992;68:90-99.

9. Kataoka A, Claesson U, Hansson BG, Eriksson M, Lindh E. Human papillomavirus infection of the male diagnosed by Southern-blot hybridization and polymerase chain reaction: comparison between urethra samples and penile biopsy samples. J Med Virol 1991;33:159-164.

10. Leyva-López AG, Aranda-Flores CE, Conde-González C, Lazcano-Ponce EC. Low yield of HPV DNA determination in the distal region of the male urethra. Salud Publica Mex 2003;45(Suppl 5):S589-S593.

11. Wikström A, von Krogh G, Hedblad MA, Syrjänen S. Papillomavirusassociated balanoposthitis. Genitourin Med 1994;70:175-181.

12. Pakendorf UW, Bornman MS, Du Plessis DJ. Prevalence of human papilloma virus in men attending the infertility clinic. Andrologia 1998;30:11-14.

13. Saxena SB, Feriozi D. An evaluation of urethral smear by Papanicolaou stains in men with urethritis. J Adolesc Health Care 1988;9:76-81.

14. Syed TA, Cheema KM, Khayyami M, Ahmad SA, Ahmad SH, Ahmad S, et al. Human leukocyte interferon-alpha versus podophyllotoxin in cream for the treatment of genital warts in males. A placebo-controlled, double-blind, comparative study. Dermatology 1995;191:129-132.

15. Erkek E, Basar H, Bozdogan O, Emeksiz MC. Giant condyloma acuminata of Buschke-Löwenstein: successful treatment with a combination of surgical excision, oral acitretin and topical imiquimod. Clin Exp Dermatol 2009;34:366-368.

16. De Giorgi V, Salvini C, Chiarugi A, Paglierani M, Maio V, Nicoletti P, et al. In vivo characterization of the inflammatory infiltrate and apoptotic status in imiquimod-treated basal cell carcinoma. Int J Dermatol 2009;48:312-321.

17. Hsueh PR. Human papillomavirus, genital warts, and vaccines. J Microbiol Immunol Infect 2009;42:101-106.

18. D’Hauwers KW, Tjalma WA. HPV in men. Eur J Gynaecol Oncol 2008;29:338- 340.