title: Sexual behaviour and less frequent bathing are associated with higher human papillomavirus incidence in a cohort study of uncircumcised Kenyan men.
abstract: OBJECTIVE
  Data on the acquisition of human papillomavirus (HPV) infection in men are limited, especially from developing regions including Africa. The objective of this study was to characterise and determine the risk factors of HPV acquisition among a cohort of uncircumcised men participating in a randomised controlled trial (RCT) of male circumcision in Kisumu, Kenya.
  
  
  METHODS
  Penile exfoliated cell specimens were collected at baseline, 6- and 12-month follow-up visits from the glans/coronal sulcus and shaft of men enrolled in the control arm of the RCT between 2002 and 2005. All participants were HIV seronegative, aged 17-24 years at baseline and remained uncircumcised over follow-up. Specimens were tested with GP5+/6+ PCR to detect 44 HPV types. Parametric frailty models were used to assess risk factors of HPV incidence.
  
  
  RESULTS
  The median age of 966 participants was 20 years. The median follow-up time was 12.1 months. The incidence rate (IR) of any HPV infection was 49.3/1000 person-months with HPV16 having the highest IR (10.9/1000 person-months). The strongest risk factors for overall HPV incidence were bathing less frequently than daily (adjusted HR=2.6; 95% CI 1.0 to 6.5) and having ≥ 2 female sexual partners in the past year (adjusted HR=1.6; 95% CI 1.2 to 2.1).
  
  
  CONCLUSIONS
  HPV IRs were notably high in this cohort of high-risk, uncircumcised men from Kisumu, Kenya, with the number of sexual partners and bathing frequency being the strongest risk factors.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA. backes@email.unc.edu
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Backes
authors.forename: Peter J F
authors.initials: PJ
authors.lastname: Snijders
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hudgens
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
authors.forename: Martijn
authors.initials: M
authors.lastname: Bogaarts
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.forename: Walter
authors.initials: W
authors.lastname: Agingu
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D002944:Circumcision, Male; D015331:Cohort Studies; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control*; D010413:Penis / Q000821:virology*; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012725:Sexual Behavior; D055815:Young Adult
chemical_list: D004279:DNA, Viral