title: Prevalence, Incidence, and Clearance of Anogenital Warts in Kenyan Men Reporting High-Risk Sexual Behavior, Including Men Who Have Sex With Men.
abstract: Background.  Human papillomavirus (HPV) causes a spectrum of disease, ranging from warts to cancer. Prevalence, incidence, and factors associated with anogenital warts in East African men are unknown. Methods.  Kenyan men reporting high-risk sexual behavior were inspected for anogenital warts at enrollment and follow-up visits. Logistic regression was performed to identify associations with anogenital warts at baseline. Cox regression was performed to analyze predictors of incident anogenital warts, and Kaplan-Meier curves were used to estimate clearance. Results.  Baseline anogenital wart prevalence in 1137 men was 2.9% (95% confidence interval [CI], 2.0%-4.0%) overall, 2.0% in human immunodeficiency virus (HIV)-uninfected men, and 9.4% in HIV-1-infected men (adjusted odds ratio, 5.43; 95% CI, 2.03-11.29). Over a median of 1.4 years, anogenital wart incidence among 1104 men was 5.3 (95% CI, 4.3-6.5) per 100 person-years. Having HIV-1 infection at baseline (adjusted hazard ratio [aHR], 1.66; 95% CI, 1.01-2.72) or a genital syndrome during follow-up (aHR, 4.78; 95% CI, 3.03-7.56) was associated with increased wart incidence. Wart clearance was lower in HIV-1-infected men (log-rank P<.001). Conclusions.  Anogenital wart prevalence and incidence were increased in HIV-1-infected men, and anogenital warts co-occurred with other genital syndromes. Quadrivalent HPV vaccination should be recommended for young men in settings with high HIV-1 prevalence.
authors.affiliation: Department of Medicine.
authors.forename: Santiago
authors.initials: S
authors.lastname: Neme
authors.affiliation: Centre for Geographic Medicine Research - Coast , Kenya Medical Research Institute , Kilifi.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wahome
authors.affiliation: Centre for Geographic Medicine Research - Coast , Kenya Medical Research Institute , Kilifi.
authors.forename: Grace
authors.initials: G
authors.lastname: Mwashigadi
authors.affiliation: Centre for Geographic Medicine Research - Coast , Kenya Medical Research Institute , Kilifi.
authors.forename: Alexander N
authors.initials: AN
authors.lastname: Thiong'o
authors.affiliation: Department of Medicine.
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Stekler
authors.affiliation: Departments of Epidemiology, Laboratory Medicine, and Medicine ; Vaccine and Infectious Disease Division , Fred Hutchinson Cancer Research Center , Seattle, Washington.
authors.forename: Anna
authors.initials: A
authors.lastname: Wald
authors.affiliation: Centre for Geographic Medicine Research - Coast , Kenya Medical Research Institute , Kilifi ; Nuffield Department of Clinical Medicine , University of Oxford , Headington , United Kingdom.
authors.forename: Eduard J
authors.initials: EJ
authors.lastname: Sanders
authors.affiliation: Departments of Medicine, Epidemiology, and Global Health , University of Washington , Seattle ; Centre for Geographic Medicine Research - Coast , Kenya Medical Research Institute , Kilifi.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
keywords: HIV-1; HPV; Kenya; MSM; condylomata acuminata; genital warts; incidence; men