title: Is real-time PCR the correct method to evaluate the incidence of human papillomavirus in prepuces of asymptomatic boys and men?
abstract: OBJECTIVE
  To investigate the prevalence of human papillomavirus (HPV) in prepuces of asymptomatic boys and men, the present study was designed.
  
  
  METHODS
  Two hundred and fifty male prepuce specimens who underwent circumcision due to phimosis were collected. Samples were subdivided into groups regarding their age: children (group I, 0-10 years), adolescents (group II, 11-20 years) and adults (group III, >20 years). HPV High Screen Real-TM Quant 2x kit detecting HPV 6 and 11 (low risk) as well as another kit for identification of HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59 (high risk) were used. Additionally, a Taq Man assay has been designed targeting the L1 gene of HPV 6, 11, 16 and 18.
  
  
  RESULTS
  Evaluating the number of low-risk HPV subtypes, we found HPV 6 and 11 in 5.3 % of samples (n = 12/226). Concerning high-risk HPV, we found a positivity in 4 % of samples (n = 9/224). In contrast to low-risk data where no age distribution was observed, we found an age-specific accumulation of high-risk HPV subtypes in the children group (n = 6/9). A second independent assay (Taq Man PCR assay) measuring HPV 6, 11, 16 and 18 of all positive samples confirmed only the high-risk HPV subtypes of the Real-TM Quant 2x assay.
  
  
  CONCLUSIONS
  Our study provides evidence that qPCR estimation for HPV infection obviously underestimates the incidence rate of infected prepuces in boys and men with phimosis. Contrary, an overestimation of the HPV infection rate with the in situ hybridization method of phimotic prepuces cannot be excluded.
authors.affiliation: Department of Urology, Medical University of Innsbruck, Seilerstätte 4, 4010, Linz, Austria, isabel-maria.heidegger@i-med.ac.at.
authors.forename: Isabel
authors.initials: I
authors.lastname: Heidegger
authors.forename: Renate
authors.initials: R
authors.lastname: Pichler
authors.forename: Barbara
authors.initials: B
authors.lastname: Müller
authors.forename: Helmut
authors.initials: H
authors.lastname: Klocker
authors.forename: David
authors.initials: D
authors.lastname: Oswald
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haid
authors.forename: Bettina
authors.initials: B
authors.lastname: Zelger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Josef
authors.initials: J
authors.lastname: Oswald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D052816:Foreskin / Q000821:virology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology*; D010688:Phimosis / Q000601:surgery / Q000821:virology; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D055815:Young Adult