Status of High-risk Oncogenic Human Papillomavirus Subtypes Harbored in the Prepuce of Prepubertal Boys

Detection of human papillomavirus subtypes harbored in the foreskin of asymptomatic boys: Controlled study

INTRODUCTION

Human papillomavirus infection (HPV) is one of the most common sexually transmitted infections and can cause penile and anal cancer in men, and invasive cervical cancer in women.

OBJECTIVE

To evaulate the colonization of 32 HPV subtypes in the foreskin of boys.

STUDY DESIGN

A prospective analysis was made of the data of 62 healthy boys who had undergone standard circumcision. Deoxyribonucleic acid (DNA) was isolated from the foreskin tissues, and the integrity of DNA was tested. The DNA of each patient was further assessed with real-time polymerase chain reaction (PCR) and the presence of 32 subtypes of HPV was explored. To confirm the results, melting curve analysis and agarose gel electrophoresis (AGE) were performed for all samples. Further analysis was made using LCD-array on six randomly selected samples to confirm the results together with negative and positive controls.

RESULTS

The mean age of the boys was 6.8 ± 2 years at the time of surgery. All positive controls and samples were positive, all negative controls were negative in the first HPV amplification assay. All positive controls had typical melting curve peaks, whereas all sample amplifications had non-specific, atypical melting curves not fitting with those of the positive controls. Two bands of expected sizes (124 and 405 bp) were only observed in positive controls, but not in negative controls or samples on AGE. The same results were observed on the 6 randomly selected samples using LCD-array. Consequently, all the foreskin samples were evaluated as negative for the 32 HPV types investigated in the study.

DISCUSSION

Literature shows a high prevalence of genital HPV in newborns, in early infancy, late adolescence and adulthood. However there is a lack of data in literature on the prevalence in early and late childhood. The negative results of HPV colonization on the foreskin in the current study may be attributed to the conservative and mostly monogamous nature of most family structures in Turkey.

CONCLUSION

The results of the present study have shown that foreskin tissue is not a natural reservoir for HPV and subclinical HPV infection is not likely in the absence of suspected sexual contact.

Microbiology of smegma: Prospective comparative control study

Purpose

The aim of the study was to investigate the common bacteria found in the smegma in the subpreputial space of asymptomatic boys prospectively, and to determine the difference of those bacteria according to the presence of smegma.

Materials and Methods

In our institution, 40 boys who performed penoplasty were recruited into the study. Swab was done using aseptic techniques on smegma and glans in the operation room. According to the presence of smegma in the subpreputial space, we classified glans as a group S (with smegma, n=20) and group C (without smegma, n=20). The swabs were immediately sent to microbiology laboratory for microscopy, culture, and sensitivity tests.

Results

The mean age was 30.4±26.4 months. Thirty-one bacteria were isolated from smegma, comprising 15 gram-positive species (48.4%) and 16 gram-negative species (51.6%). The most commonly isolated gram-negative bacterium was Escherichia coli (25.8%), while the commonly isolated gram-positive bacteria were Enterococcus faecalis (19.4%) and Enterococcus avium (12.9%). Most of the bacterial isolates were multi-drug-resistant (61.3%). In group S, 12 boys had 22 bacterial isolates in the glans. The commonly isolated bacteria were E. coli (27.3%), E. avium (22.7%) and E. faecalis (18.2%). In group C, 13 boys had 21 bacterial isolates in the glans. The most commonly isolated bacterium was E. faecalis (28.6%).

Conclusions

Smegma in the subpreputial space of children was colonized by many kinds of uropathogen.

HPV prevalence in the foreskins of asymptomatic healthy infants and children: Systematic review and meta-analysis

The true HPV prevalence in the foreskins of infants and children has been little documented, but reporting on this prevalence is of great importance given its impact on the rationale for treating asymptomatic boys. We searched multiple databases from 1960 to 2016 for observational or prospective studies that reported on HPV prevalence in foreskins. We conducted a meta-analysis using a random-effects model to pool for HPV prevalence in the foreskins of infants and children. Eight studies, with a total of 556 infants and children with phimosis, were eligible for the meta-analysis. The pooled overall prevalence of general HPV, high-risk HPV, low-risk HPV, HPV 16/18, HPV 16, and HPV 18 were 17.3 (95%CI: 0.8-46.3), 12.1 (95% CI: 0.9-31.5), 2.4 (95% CI: 0.0-11.2), 4.8 (95% CI: 0.0-16.8), 1.7 (95% CI: 0.0-5.1), and 0 (95% CI: 0-0.5), respectively. The estimated HPV prevalence in foreskins was not zero among infants and children, which implies HPV transmission other than by sexual contact. Considering that high-risk HPV is detected in asymptomatic infants and children, future studies are warranted to determine whether preventive treatments in asymptomatic infants and children could be effective in preventing persistence or transmission of high-risk HPV.

High-risk Oncogenic Human Papilloma Virus Infection of the Foreskin and Microbiology of Smegma in Prepubertal Boys

OBJECTIVE

To evaluate the prevalence and genotypes of human papillomavirus (HPV) infection and microbiological status of the foreskin in asymptomatic prepubertal boys.

METHODS

A total of 100 prepubertal healthy boys who underwent a standard circumcision procedure were included in the study. High-risk HPV status was determined by real-time polymerase chain reaction for the genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The swabs were immediately sent to microbiology laboratory for culture and sensitivity tests.

RESULTS

The median age at the time of surgery was 5.7 years (range, 2 months-9 years). High-risk HPV was detected in 9 foreskins (9%). Positive samples showed are HPV16 (n = 3), 31 (n = 2), 39 (n = 3), and 51 (n = 1). There were a total of 72 organism isolates: 54 gram-positive (75%) and 17 gram-negative (23.6%) bacteria and 1 (1.4%) Candida. The most commonly isolated gram-negative bacterium was Escherichia coli (41.2%), whereas the commonly isolated gram-positive bacterium was Enterecoccus sp. (57.4%).

CONCLUSION

Our results showed that subclinical high-risk HPV infections are found in the foreskin, which could be a reservoir for HPV-associated diseases, and smegma seems not to be a risk factor for drug-resistant infection in children.