HPV-related external genital lesions among men residing in Brazil

Application of the theoretical domains framework to identify factors influencing catch-up HPV vaccinations among male college students in the United States: A review of evidence and recommendations

BACKGROUND

Genital human papillomavirus (HPV) infection is the most prevalent sexually transmitted infection among young adults ages 15-25 years in the United States (US). Although HPV vaccines are recommended for individuals ages through 26 years, vaccine completion rates remain substantially low.

METHODS

Accordingly, our study utilized a comprehensive - Theoretical Domains Framework (TDF) of behavior change to systematically identify facilitators and barriers to catch-up HPV vaccinations. Five databases - Medline, Embase, CINAHL, ERIC, and PsycINFO were searched from January 2009 to July 2019 for empirical studies using quantitative and qualitative methods to assess HPV vaccine uptake among males ages 18-26 years within US college and university settings. The TDF analytic process included a content analysis using the mixed deductive-inductive approach to extract, analyze and categorize data into TDF domains/themes and sub-themes.

RESULTS

Overall, 17 studies were selected for data extraction. We identified eleven key TDF domains that influenced HPV vaccination behavior among college male students: 'knowledge' (82% of included studies), 'environmental context and resources' (53%), 'beliefs about consequences' (53%), 'unrealistic optimism' (50%) and 'pessimism' (6%), 'emotion' (50%), 'social influences' (50%), 'beliefs about capabilities' (41%), 'intention' (24%), 'reinforcement' (18%), 'social professional role and identity'(12%), and 'behavioral regulation' (12%). Barriers influencing HPV vaccine uptake included lack of knowledge and awareness regarding HPV infections, HPV vaccine safety, effectiveness, side effects, and costs; absence of health providers' recommendations; lack of healthcare and health insurance; low levels of perceived susceptibility and severity for HPV infections; HPV vaccine misinformation; as well as social stigma and peer influences regarding HPV vaccinations. Enablers for HPV vaccine uptake included high levels of perceived benefits for HPV vaccines.

DISCUSSION

Our study theoretically identified factors influencing HPV vaccinations. This could inform the efficient planning, support, and implementation of interventions that facilitate catch-up HPV vaccination practices among high-risk males within college/university settings.

Sex differences in the prevalence and determinants of HPV-related external genital lesions in young adults: a national cross-sectional survey in Brazil

Background

External genital lesions (EGL) are the most common sexually transmitted infections (STIs). We aimed to evaluate the prevalence, determinants and sex differences in EGL among young adults from Brazil.

Methods

Overall, 7694 participants (aged 16 to 25 years) underwent an interview, genital examination and sampling for HPV genotyping.

Results

The prevalence of EGL was 4.08% (234) and is more frequent in men (5.72%) than women (2.31%) (p <  0.001). Genital lesions were significantly associated with male sex, infection by high-risk and multiple HPV types, having more than two sexual partners in the last year, smoking status and the presence of other STI. While alcohol use was associated with a higher prevalence of EGL in women, same-sex sexual relationship increase the prevalence in men. In the EGL group, 67.79% (p = 0.032) were positive for HPV infection and the types HPV6 and HPV11 were the most prevalent ones.

Conclusion

The prevalence of EGL in young adults was consistently high, and most cases were associated with genital HPV infection and STIs. Although men have a higher prevalence, both sexes share most genital lesion determinants. The promotion of sexual education and vaccination especially focus in young men, who are usually outside the targets of primary health care programmes, can prevent EGL in Brazilian young adults.

Awareness and Knowledge Levels of 18-Year-Old and Older Individuals Regarding Human Papillomavirus (HPV) and HPV Vaccine in Hatay, Turkey

The aim of this study was to evaluate the knowledge and awareness levels of 18-year-old and older women and men on HPV infection, HPV vaccine, and the potential risk factors in Hatay, Turkey. In our study, it was found that overall 27.0 and 23.2% of the participants reported having heard of HPV infection and HPV vaccine. The rate of participants who had heard of HPV infection and HPV vaccine was higher in women than in men (p < 0.000). Thirteen percent of the participants was aware of the fact that HPV triggers cervical cancer, 10.2% penile cancer, and 16.7% genital warts, respectively. The overall vaccination rate of the participants was 2.7%. When the total knowledge score of the participants about HPV infection and HPV vaccine was evaluated according to independent variables, it was found that being a woman, urbanization, and having a high level of education had a positive effect on knowledge score, while never having heard of HPV infection and HPV vaccine had a negative effect on knowledge score (p < 0.000). It was determined in the linear regression model that gender, educational status, residential area, and having heard of HPV infection before influenced knowledge levels. It was determined that the relation between these variables and the total knowledge scores of the participants was statistically significant (p < 0.05). It was also determined that women who had higher educational levels, those who were living in urban areas, and those who had heard HPV infection before had higher knowledge levels. The level of knowledge of the participants about HPV infection and HPV vaccine was found to be very low. Having adequate knowledge about HPV infection and increasing the acceptance of HPV vaccination in public will play an important role in decreasing the rate of mortality and morbidity of the different HPV-associated cancers in women and men.

Human Papillomavirus and Genital Disease in Men: What We Have Learned from the HIM Study

It is currently recognized that in addition to the major impact of human papillomavirus (HPV) infection in females, HPV causes considerable disease in men at the genitals, anal canal, and oropharynx. Specifically, genital HPV infections may progress to genital warts and penile carcinoma. Although studies concerning the natural history of HPV infections and associated neoplasias have mainly focused on women, during the last 2 decades considerable attention has been given in further understanding these infections in men. The HIM (HPV infection in men) Study, the only prospective multicenter study of male HPV natural history, consisted of a large prospective international cohort study in which men from Brazil, the United States, and Mexico were enrolled. The design and protocols of this study allowed unraveling crucial information regarding the relationship between HPV infection and clinical consequences in men, and associated risk factors at each of the anatomic sites where HPV is known to cause cancer in men.

Improvement in dietary intake estimates through the combined use of different approaches

ABSTRACT Objective This study aimed to compare dietary intake estimates using two different methodological approaches: use of new portions obtained with the 24-Hour Diet Recall, which was applied in the current study population, and the application of calibration equations, which were estimated using the same 24h-recalls. Methods Calibration equations were estimated using linear regression. The medians and confidence intervals of energy and nutrient intakes were assessed using all the approaches. The U Mann Whitney test was applied to verify differences among dietary intakes obtained with the 24 Hour Recall and Food Frequency Questionnaire-based methods. The correlation between different measures was assessed with Spearman coefficient. Weighted Kappa was used to verify the capability of the Food Frequency Questionnaire -based methods to classify individuals in the same intake levels of the 24 Hour Recall. Results Nine of the eleven components that were analyzed using the Food Frequency Questionnaire with standard portions and calibrated had medians significantly different from those obtained using the 24 Hour Recall; only the measurements of vitamin E and energy were statistically equal. For the Food Frequency Questionnaire with 24 Hour Recall portions, only the medians of vitamin D and B12 did not significantly differ from the 24 Hour Recall medians. Finally, for the Food Frequency Questionnaire with 24 Hour Recall portions and calibrated, all components, except folate and iron, had medians statistically equal to those obtained using the 24 Hour Recall. Spearman correlation coefficients were higher for the Food Frequency Questionnaire with 24 Hour Recall portions calibrated for all the assessed components, and the values ranged from 0.27 (total fat) to 0.57 (iron). Higher Kappa correlation coefficients were found for the Food Frequency Questionnaire 24 Hour Recall portions calibrated. Conclusion Calibrated FFQ with portions estimated from the own target population obtained better estimates of dietary intake, with values considerably more similar to those obtained with the reference method.

Human papillomavirus (HPV) genotype distribution in penile carcinoma: Association with clinic pathological factors

Background

Penile carcinoma (PC) is a rare, highly mutilating disease, common in developing countries. The evolution of penile cancer includes at least two independent carcinogenic pathways, related or unrelated to HPV infection.

Objectives

To estimate the prevalence, identify HPV genotypes, and correlate with clinicopathological data on penile cancer.

Methods

A retrospective cohort study involving 183 patients with PC undergoing treatment in a referral hospital in Goiânia, Goiás, in Midwestern Brazil, from 2003 to 2015. Samples containing paraffin embedded tumor fragments were subjected to detection and genotyping by INNO-LiPA HPV. The clinicopathological variables were subjected to analysis with respect to HPV positivity and used prevalence ratio (PR), adjusted prevalence ratio (PRa) and 95% confidence interval (CI) as statistical measures.

Results

The prevalence of HPV DNA in PC was 30.6% (95% CI: 24.4 to 37.6), high-risk HPV 24.9% (95% CI: 18.9 to 31.3), and 62.5% were HPV 16. There was a statistical association between the endpoints HPV infection and HPV high risk, and the variable tumor grade II-III (p = 0.025) (p = 0.040), respectively. There was no statistical difference in disease specific survival at 10 years between the HPV positive and negative patients (p = 0.143), and high and low risk HPV (p = 0.325).

Conclusions

The prevalence of HPV infection was 30.6%, and 80.3% of the genotypes were identified as preventable by anti-HPV quadrivalent or nonavalent vaccine. HPV infections and high-risk HPV were not associated with penile carcinoma prognosis in this study.