Acta Dermato-Venereologica 99-6CompleteContent | Page 13

CLINICAL REPORT 557 High Prevalence of Human Papillomavirus on Anal and Oral Samples from Men and Women with External Anogenital Warts: The HERCOLES Study Carmen LISBOA 1,3 , Irene SANTO 2 , Jacinta AZEVEDO 2 , Luís AZEVEDO 3 , Ângela PISTA 4 , Camila DIAS 3 and Maria João CUNHA 5 ; on behalf of the HERCOLES Study Group Division of Microbiology, Department of Pathology, Faculty of Medicine, University of Porto and Department of Dermatovenereology, Hospital Centre of S. João, Porto, 2 Health Centre of Lapa, Consulta DST, 3 Faculty of Medicine, University of Porto (CIDES & CINTESIS), 4 National Institute of Health Doutor Ricardo Jorge, Lisbon, and 5 Sanofi Pasteur MSD, Portugal 1 Human papillomavirus (HPV) infection is highly pre- valent in the sexually active population. This study estimates the prevalence of HPV DNA in anal and oral samples from a cohort of men and women with incident anogenital warts. Anal and/or oral samples from 541 patients with anogenital warts were tested for 35 HPV genotypes using a PCR assay. The overall prevalence of anal HPV and oral HPV DNA was 59.9% (n  = 305/509; 95% confidence interval (CI) 55.6– 64.1%) and 14.5% (n  = 78/538; 95% CI 11.8–17.7%), respectively. Among patients with perianal warts, the anal HPV DNA prevalence was 92.3% (95% CI 87.0– 95.5%). Anal HPV DNA prevalence in patients with ge- nital warts but no perianal warts was 55.7% (95% CI 50.6–60.7%). Both anal and oral HPV infections were more common in men who have sex with men than in heterosexual men (90.4% versus 38.5% and 20.8% versus 11.8%, respectively). Anal high risk-HPV infec- tion was more common in women (58.8%) and in men who have sex with men (67.7%). We found that ano- genital warts represent a clinical marker for both anal and oral HPV infections, including anal high risk-HPV infections, particularly among women and men who have sex with men. Key words: HPV; anal canal; oral mucosa; anogenital warts; epidemiology. Accepted Feb 5, 2019; E-published Feb 6, 2019 Acta Derm Venereol 2019; 99: 557–563. Corr: Carmen Lisboa, MD, PhD, Department of Microbiology, Faculty of Medicine. Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal. E- mail [email protected] H uman papillomavirus (HPV) infection is associated with several different diseases in men and women. Anogenital warts (AGWs) represent the most common sexually transmitted disease (1) and low-risk (LR) HPV genotypes are implicated in these lesions. Nevertheless, there is a growing body of evidence that AGWs may be associated with an elevated risk of cancer. Many of these wart lesions shared exposure to the high-risk (HR) HPV genotypes. It has been reported that individuals who had anogenital warts had a higher risk of developing anal and SIGNIFICANCE Human papillomavirus infection is highly prevalent in sexu- ally active population and has been associated with anal and oropharyngeal cancers. This study estimates the pre- valence of human papillomavirus on anal and oral samples from men and women with external anogenital warts. We found a high prevalence of human papillomavirus on extra- genital sites (anal canal and oral mucosa) among patients with external anogenital warts. Both anal and oral human papillomavirus infections were more common in men who have sex with men than in heterosexual men. Anal high- risk HPV types (high risk as carcinogenic) were more com- mon in women and in men who have sex with men. Over- all, we demonstrated a high human papillomavirus burden in this population beyond anogenital warts, suggesting a greater impact of human papillomavirus vaccination. oral cancers (2). Additionally, HPV is highly prevalent in the sexually active population and has been associated with 80–85% of anal cancers (3) and 50% of oropharyn­ geal cancers (4). The estimate of oral HPV prevalence reported in two recent systematic reviews was 4.5% (5) and 5.5% (6) in healthy individuals. Furthermore, estimates of anal HPV DNA prevalence ranged from 27 to 43% in women (7, 8), from 12 to 36% among heterosexual men (HM) (9, 10) and from 47.2% to 92.6% among men who have sex with men (MSM), the higher proportions corresponding to HIV-positive MSM (9, 11). Nonetheless, only few stu- dies have evaluated the prevalence of HPV DNA in the anal canal and oral mucosa of patients with AGWs (12). Such data is important to improve our knowledge on the epidemiology of anal and oral HPV infection, namely in patients with AGWs, and ultimately to evaluate the role of prophylactic HPV vaccines in HPV-related diseases of the oropharynx and anal canal. This study aims to assess the type-specific prevalence of HPV in the anal canal and oral mucosa from patients with AGWs included in the HPV Epidemiological Re- search on COndyloma LESions (HERCOLES) study (13). Additionally, we evaluated the type-specific HPV DNA concordance among the different anatomical sites analysed. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3136 Acta Derm Venereol 2019; 99: 557–563