Date

October 2011

Document Type

Thesis

Degree Name

M.P.H.

Department

Dept. of Public Health and Preventive Medicine

Institution

Oregon Health & Science University

Abstract

Background: Human papillomavirus infection (HPV) is the most common sexually transmitted infection and is strongly associated with cervical and other anogenital cancers. Little is known about the epidemiology of HPV in men, and risk factor studies of HPV infection in men are just beginning to enter the literature. The objective of this study was to determine characteristics associated with HPV infection in men across multiple countries. Methods: A cross-sectional analysis was conducted among men without signs of HPV living in Brazil, Mexico, and the U.S., who enrolled in the HPV in Men (HIM) study from 2005-2006. 3,593 men reported ever having sex with a male or female partner and were included in the analysis. Participants were surveyed about sexual behaviors; tested for HPV with genital swab PCR and genotyping; and tested for chlamydia, syphilis, herpes simplex virus (HSV), and gonorrhea. Multivariable regression was used to estimate HPV prevalence ratios (PR) and identify factors independently associated with any HPV type and oncogenic HPV within the entire cohort and individual countries. For factors associated with HPV in any country, interaction terms by country were tested. Results: Overall HPV prevalence was 68%. Prevalence was highest in Brazil (74% positive for any HPV type, 36% positive for at least one oncogenic type), followed by the U.S. (67% positive for any type, 31% positive for oncogenic), and Mexico (63% positive for any type, 29% positive for oncogenic). Factors independently associated with any type of HPV within the entire cohort included increasing lifetime number of sexual partners, increasing recent number of sexual partners, younger age at sexual debut, co-infection with HSV, having a recent partner with genital warts or a recent abnormal Pap smear, and recent anal sex with another man. Factors independently associated with oncogenic HPV included increasing lifetime number of sexual partners, increasing recent number of sexual partners, younger age at sexual debut, co-infection with chlamydia, having a partner with genital warts or a recent abnormal Pap smear, identifying as a man who has sex with other men, being married, and high monthly alcohol intake. No interactions by country were statistically significant (all p > 0.8). Conclusions: In this large, multi-national cohort, HPV was highly prevalent among asymptomatic men (~70%). Risk factors for HPV did not vary by country, suggesting that characteristics associated with HPV infection in men are largely similar across different geographies. Factors associated with any type of HPV infection were similar to those for oncogenic HPV. Lifetime and recent number of sexual partners have emerged as two risk factors that have been consistently associated with all types of HPV infection both in our study and across the literature.

Identifier

doi:10.6083/M4HH6H21

School

School of Medicine

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