engleski

Diagnostic and therapeutical procedutres for subclinical human papillomavirus infection in male sexual partner of women with cervical intraepithelial neoplasia

Introduction: Human papilomaviruses (HPV) are the most common viral sexually transmitted infection. They are associated with spectrum of diseases, from benign vulgar verruca, genital warts, to malignant cervical, vulvar, anal or penile cancer. Genital warts are one of the most common HPV related benign lesions of the both male and female genitourinary tract. Male patients generally present no clinical lesions, and those that have female partner with cervical intraepithelial neoplasia (CIN) might constitute a HPV reservoir. Material and methods: We studied 180 patients, 90 asymptomatic and 90 men with genital warts whose partner had CIN grade 1 -3 which was diagnosed by Pap smear. Exfoliated cells were taken from clinical evident lesions (genital wart), and from the predilections sites in asymptomatic males (frenulum, corona sulcus, penis shaft, glans penis and uretral meatus). All smaples are analyzed by Digene Hybrid Capture method for the presence of HPV DNA. The peniscopy with previous use of 5% acetic acid was performed in 90 asymptomatic male sexual partners. The peniscopy findings are divided into subclinical condyloma and penile intraepithelial neoplasia (PIN). In 30 selected patients, who had negative HPV detection finding using Hybrid Capture II method, the INNO-LiPA genotypisation method was performed. Results: The average age was 29, 74 years (median 28). The average duration of relationship was 33, 6 months (2, 8 years). Positive HPV was found in 55 (57, 9%) men with genital warts and in 40 (42, 1% asymptomatic men. In men with genital warts using HPV detection 61, 1% were positive and 44, 1% were positive in asymptomatic men group. The highest number of high-risk HPV was found in men whose partners had CIN III (20%), and the highest number of low-risk HPV was found in men whose partners had CIN I (46, 7%). The most subclinical condyloma were found in men whose partner had CIN I, and the most PIN were found in men whose partners had CIN III (but that result wasn't statistically significant. Out of 90 asymptomatic men, 63 (70%) had positive peniscopy. Men whose partners had CIN III had the highest number of positive pensicopy finding. Concordance between peniscopy findings and findings from HPV detection using Digene Hybrid Capture II method was found in 59 (65, 6%) patients. After using INNO-LiPA method we wound 17 (56, 7%) of positive HPV finding in the group of men who had negative findings using Digene Hybrid Capture II. The highest number (7 (41, 2%) of positive findings were found in men whose partners had CIN III. Concordance of peniscopy finding and INNO-LiPA findings was fooud in 86, 7% patients. With the results from our study the diagnostic and therapeutic algorithm for genital HPV infection is suggested. Conclusion: Men are usually reservoir of the virus, which lives in subclinical or latent from on genital mucous membranes, and this asymptomatic infections can be oncogenic factor(s) in development of cervical cancer. Early diagnosis and treatment of HPV in men is important to reduce HPV infection and reinfection among partners.

Human papillomavirus infection; cervical intraepithelial neoplasia; diagnostic and therapeutical procedures

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