World Journal of Urology

, Volume 31, Issue 6, pp 1389–1394

Prevalence of the human papillomavirus (HPV) expression of the inner prepuce in asymptomatic boys and men

  • Gerald Klinglmair
  • Renate Pichler
  • Bettina Zelger
  • Hasan Serkan Dogan
  • Tanja Becker
  • Johannes Esterbauer
  • Markus Riccabona
  • Wolfgang Loidl
  • Wolfgang Horninger
  • Josef Oswald
Original Article



To investigate the prevalence of high-risk (HR) and low-risk (LR) human papillomavirus (HPV) in prepuces of boys and men without any HPV related lesions.

Patients and methods

Between 2009 and 2011, a total collective of 250 boys and men were investigated in this prospective study. The samples were subdivided into 3 groups regarding their age, consisting of 125 (50 %) children (0–10 years), 38 (15.2 %) adolescents (11–20 years) and 87 (34.8 %) adults (>20 years). In situ hybridization (ISH) was performed to detect HR and LR virus types within the epithelium, followed by microscopic interpretation and determination between episomal and integrative signal pattern.


Our results revealed high levels of HPV concentration (HR and LR) in all age groups: HR versus LR positivity was seen in 45.5 versus 35 % (children), 60.6 versus 63.6 % (adolescents) and 58.3 versus 48.6 % (adults). The topmost rate of HR (59.8 %)- and LR (50.6 %)-positive probes was found in the group with high estimated sexual activity (>14 years).


Concerning the high prevalence of male HPV infection even in children, indicating non-sexual transmission pathways, inclusion of boys in the vaccination program seems to be required reducing their burden of HPV related disease.


HPV Circumcision STD Prepuce Vaccination 


  1. 1.
    Shikary T, Bernstein DI, Jin Y, Zimet GD, Rosenthal SL, Kahn JA (2009) Epidemiology and risk factors for human papillomavirus infection in a diverse sample of low-income young women. J Clin Virol 46(2):107–111 Epub 8 Aug 2009PubMedCrossRefGoogle Scholar
  2. 2.
    Castellsagué X, Bosch FX, Muñoz N et al (2002) International Agency for Research on Cancer Multicenter Cervical Cancer Study Group. Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med 346:1105–1112PubMedCrossRefGoogle Scholar
  3. 3.
    Boccalini S, Tiscione E, Bechini A, Levi M, Mencacci M, Petrucci F, Bani Assad G, Santini MG, Bonanni P (2012) Sexual behavior, use of contraceptive methods and risk factors for HPV infections of students living in central Italy: implications for vaccination strategies. J Prev Med Hyg 53(1):24–29PubMedGoogle Scholar
  4. 4.
    Procedure: ISH BlueMap XT (Summary); Discovery XT StainingmoduleGoogle Scholar
  5. 5.
    Thomas M Grogan, Hiro Nitta, Lidija Pestic-Dragovich, Lizhen Pang, Jay Li (2005) Interpretation guide for Ventana INFORM® HPV II Probes In Situ Hybridization (ISH), Staining of Cervical Tissue. Ventana Medical Systems, Inc.Google Scholar
  6. 6.
    Muñoz N, Kjaer SK, Sigurdsson K et al (2010) Impact of HPV 6/11/16/18 vaccine on all HPV associated genital diseases in young women. J Natl Cancer Inst 102(5):325–339 Epub 5 Feb 2010PubMedCrossRefGoogle Scholar
  7. 7.
    Anic GM, Giuliano AR (2011) Genital HPV infection and related lesions in men. Prev Med 53(Suppl 1):S36–S41PubMedCrossRefGoogle Scholar
  8. 8.
    Larke N, Thomas SL, Dos Santos Silva I, Weiss HA (2011) Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis. J Infect Dis 204(9):1375–1390PubMedCrossRefGoogle Scholar
  9. 9.
    Albero G, Castellsague X, Giuliano AR, Bosch FX (2012) Male circumcision and genital papillomavirus: a systematic review and meta-analysis. Sex Transm Dis 39(2):104–113PubMedCrossRefGoogle Scholar
  10. 10.
    Tobian AA, Gray RH (2011) Male foreskin and oncogenic human papillomavirus infection in men and their female partners. Future Microbiol 6(7):739–745PubMedCrossRefGoogle Scholar
  11. 11.
    Wawer MJ, Tobian AA, Kigozi G et al (2011) Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomized trial in Rakai, Uganda. Lancet 377(9761):209–218 Epub 6 Jan 2011PubMedCrossRefGoogle Scholar
  12. 12.
    Tobian AA, Serwadda D, Quinn TC et al (2009) Male Circumcision for the Prevention of HSV-2 and HPV infections and Syphilis. N Engl J Med 360:1298–1309PubMedCrossRefGoogle Scholar
  13. 13.
    Smith JS, Backes DM, Hudgens MG et al (2010) Prevalence and risk factors of human papillomavirus infection by penile site in uncircumcised Kenyan men. Int J Cancer 126(2):572–577PubMedCrossRefGoogle Scholar
  14. 14.
    Backes DM, Bleeker MC, Meijer CJ et al (2011) Male circumcision is associated with a lower prevalence of human papillomavirus-associated penile lesions among Kenyan men. Int J Cancer 130(8):1888–1897Google Scholar
  15. 15.
    Gupta A, Arora R, Gupta S, Prusty BK, Kailash U, Batra S, Das BC (2006) Human papillomavirus DNA in urine samples of women with or without cervical cancer and their male partners compared with simultaneously collected cervical/penile smear or biopsy specimens. J Clin Virol 37(3):190–194Google Scholar
  16. 16.
    Bleeker MC, Hogewoning CJ, Van Den Brule AJ et al. (2002) Penile lesions and human papillomavirus in male sexual partners of women with cervical intraepithelial neoplasia. J Am Acad Dermatol 49(1):50–54Google Scholar
  17. 17.
    de Lima Rocha MG, Faria FL, Souza Mdo C, Vago AR, Fernandes AP, Fernandes PA (2008) Detection of human papillomavirus infection in penile samples through liquid-based cytology and polymerase chain reaction. Cancer (Cancer Cytopathol) 114:489–493Google Scholar
  18. 18.
    Morris Bj, Gray RH, Castellsague X, Bosch FX et al (2011) The strong protective effect of circumcision against cancer of the penis. Adv Urol 2011:812368 Epub 22 May 2011PubMedCrossRefGoogle Scholar
  19. 19.
    Mammas IN, Sourvinos G, Spandidos DA (2009) Human papillomavirus (HPV) infection in children and adolescents. Eur J Pediatr 168:267–273PubMedCrossRefGoogle Scholar
  20. 20.
    Doerfler D, Bernhaus A, Kottmel A, Sam C, Koelle D, Joura EA (2009) Human papillomavirus infection prior to coitarche. Am J Obstet Gynecol 200:487PubMedCrossRefGoogle Scholar
  21. 21.
    Tarnaud C, Lissouba P, Cutler E, Puren A, Taljaard D, Auvert B (2011) Association of low-risk human papillomavirus infection with male circumcision in young men: results from a longitudinal study conducted in Orange Farm (South Africa). Infect Dis Onstet Gynecol 2011:567408 Epub 7 Apr 2011Google Scholar
  22. 22.
    Guo M, Gong Y, Deavers M et al. (2008) Evaluation of a commercialized In Situ hybridization assay for detecting human papillomavirus DNA in tissue specimens from patients with cervical intraepithelial neoplasia and cervical carcinoma. JCM, p 274–280Google Scholar
  23. 23.
    Smith EM, Swarnavel S, Ritchie JM, Wang D, Haugen TH, Turek LP (2007) Prevalence of human papillomavirus in the oral cavity/oropharynx in a large population of children and adolescents. Pediatr Infect Dis J 26:836–840PubMedCrossRefGoogle Scholar
  24. 24.
    Marshall H, Ryan P, Roberton D, Baghurst P (2007) A cross-sectional survey to assess community attitudes to introduction of human papillomavirus vaccine. Aust N Z J Public Health 31:235–242PubMedCrossRefGoogle Scholar
  25. 25.
    Kim J, Goldie S (2009) Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States. BMJ 339:b3884PubMedCrossRefGoogle Scholar
  26. 26.
    Impfplan 2011 Österreich: evidenz-basierte empfehlungen des Obersten Sanitätsrates (Impfausschuss: 12. Oktober 2010), p 14–15.
  27. 27.
    Österreichische Krebshilfe. “Impfung gegen HPV”.

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Gerald Klinglmair
    • 1
  • Renate Pichler
    • 1
  • Bettina Zelger
    • 2
  • Hasan Serkan Dogan
    • 3
  • Tanja Becker
    • 4
  • Johannes Esterbauer
    • 5
  • Markus Riccabona
    • 4
  • Wolfgang Loidl
    • 5
  • Wolfgang Horninger
    • 1
  • Josef Oswald
    • 1
  1. 1.Department of UrologyMedical University of InnsbruckInnsbruckAustria
  2. 2.Department of PathologyMedical University of InnsbruckInnsbruckAustria
  3. 3.Department of Urology, Faculty of MedicineUludag UniversityGorukle, BursaTurkey
  4. 4.Department of Pediatric UrologySt. Vincent’s HospitalLinzAustria
  5. 5.Department of UrologySt. Vincent’s HospitalLinzAustria

Personalised recommendations