Circumcision and human papillomavirus infection in men: A site-specific comparison

Background. Lack of circumcision has been identified as a risk factor for male genital human papillomavirus (HPV) infection, although this association has not been consistently supported. Methods. Specimens for HPV testing were collected from a cohort of 379 (primarily heterosexual) adult males. HPV prevalence in the glans penis and coronal sulcus, penile shaft, scrotum, semen, and urine was compared by circumcision status. Results. Overall, HPV DNA prevalence ranged from 6% in semen to 52% in the penile shaft. The prevalence of any HPV infection in the glans/corona was significantly higher in uncircumcised men (46%) than in circumcised men (29%) (odds ratio [ OR], 1.96 [ 95% confidence interval {CI}, 1.02 - 3.75], adjusted for demographic characteristics and sexual history). Uncircumcised men also had an increased risk of oncogenic HPV infection (adjusted OR, 2.51 [ 95% CI, 1.11- 5.69]) and infection with multiple HPV types (adjusted OR, 3.56 [ 95% CI, 1.50 - 8.50]). Among uncircumcised men, HPV prevalence in the foreskin (44%) was comparable to that in the glans/ corona, and type- specific positivity was observed between the 2 sites (kappa = 0.52). Conclusions. Uncircumcised men have an increased risk of HPV infection, including with oncogenic HPV, specifically localized to the glans/corona, possibly because of its proximity to the foreskin, which may be particularly vulnerable to infection.