High Prevalence of Human Papillomavirus on Anal and Oral Samples from Men and Women with External Anogenital Warts: The HERCOLES Study
Carmen Lisboa, Irene Santo, Jacinta Azevedo, Luis Azevedo, Angela Pista, Camila Dias, Maria Joaõ Cunha
Human papillomavirus (HPV) infection is highly prevalent 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 genital 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 infection was more common in women (58.8%) and in men who have sex with men (67.7%). We found that anogenital 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.
Human papillomavirus infection is highly prevalent in sexually active population and has been associated with anal and oropharyngeal cancers. This study estimates the prevalence 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 common in women and in men who have sex with men. Overall, we demonstrated a high human papillomavirus burden in this population beyond anogenital warts, suggesting a greater impact of human papillomavirus vaccination.