title: Acquisition and persistence of human papillomavirus 16 (HPV-16) and HPV-18 among men with high-HPV viral load infections in a circumcision trial in Kisumu, Kenya.
abstract: BACKGROUND
  Circumcision and lower human papillomavirus (HPV) viral loads in men are possibly associated with a reduced risk of HPV transmission to women. However, the association between male circumcision and HPV viral load remains unclear.
  
  
  METHODS
  Swab specimens from the glans and shaft of the penis were collected from men enrolled in a circumcision trial in Kisumu, Kenya. GP5+/6+ polymerase chain reaction (PCR) was used to identify HPV DNA types. HPV-16 and HPV-18 loads were measured with a LightCycler real-time PCR and classified as high (>250 copies/scrape) or low (≤250 copies/scrape).
  
  
  RESULTS
  A total of 1159 men were randomly assigned to undergo immediate circumcision, and 1140 men were randomly assigned to the control arm (these individuals were asked to remain uncircumcised until the study ended). The hazard of acquisition of high-viral load infections in the glans was lower in the circumcision arm, compared with the control arm, for HPV-16 (hazard ratio [HR], 0.32 [95% confidence interval {CI}, .20-.49]) and HPV-18 (HR, 0.34 [95% CI, .21-.54]). The 6-month risk of HPV persistence among men with high-viral load infections in the glans at baseline was lower in the circumcision arm, compared with the control arm, for HPV-16 (risk ratio [RR], 0.36 [95% CI, .18-.72]) and HPV-18 (RR 0.34 [95% CI, .13-.86]). Weaker and less precise results were obtained for shaft samples.
  
  
  CONCLUSIONS
  Male circumcision could potentially reduce the risk of HPV transmission to women by reducing the hazard of acquisition, and the risk of persistence of high-HPV viral load infections in the glans in men.
authors.affiliation: Department of Epidemiology.
authors.forename: Virginia
authors.initials: V
authors.lastname: Senkomago
authors.affiliation: Department of Epidemiology Department of Epidemiology, Brown Public Health, Brown University, Providence, Rhode Island.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Backes
authors.affiliation: Department of Biostatistics, Gillings School of Global Public Health.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Hudgens
authors.affiliation: Department of Epidemiology.
authors.forename: Charles
authors.initials: C
authors.lastname: Poole
authors.affiliation: Impact Research and Development Organization, Kisumu, Kenya.
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.affiliation: Centre for Global Public Health, University of Manitoba, Winnipeg, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Moses
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Peter J F
authors.initials: PJ
authors.lastname: Snijders
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Chris J L M
authors.initials: CJ
authors.lastname: Meijer
authors.affiliation: Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Albertus T
authors.initials: AT
authors.lastname: Hesselink
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York.
authors.forename: Nicolas F
authors.initials: NF
authors.lastname: Schlecht
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois, Chicago.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Bailey
authors.affiliation: Department of Epidemiology Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D052161:Human papillomavirus 18 / Q000302:isolation & purification*; D006801:Humans; D007630:Kenya; D008297:Male; D030361:Papillomavirus Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology*; D010413:Penis / Q000821:virology*; D016133:Polymerase Chain Reaction; D015995:Prevalence; D016896:Treatment Outcome; D019562:Viral Load; D055815:Young Adult
keywords: HPV-16; HPV-18; Kenya; human papillomavirus (HPV); male circumcision; men; persistence; randomized controlled trial (RCT), incidence; viral load