Comparison of nylon-flocked swabs and cotton swabs in the detection of human papillomavirus infection in men.

BACKGROUND: Human papillomavirus (HPV) is an oncogenic virus and the commonest sexually transmitted pathogen worldwide. Appropriate sampling is an important factor in infection management. This study aimed to compare the efficacy of cotton swabs (CS) and nylon-flocked swabs (NFS) in sampling for HPV-DNA PCR testing in male patients with genital warts. METHODS: The study included men with genital warts who presented to the urology outpatient clinic of Antalya Medical Park Hospital. Before wart treatment, multisite sampling of the penis and genital area was performed separately with CS and NFS. The samples were analyzed for HPV-DNA using real-time PCR. RESULTS: The study included 45 men with a mean age of 32.1 ± 8.6 years. At least one HPV type was detected in all 45 patients with NFS sampling and 44 patients with CS sampling (total HPV types detected: 106 and 84, respectively). NFS sampling detected 52 high-risk HPV types in 37 of the 45 patients, while CS sampling detected 37 high-risk types in 19 patients (p = 0.029). NFS sampling also detected a total of 54 low-risk HPV types in all 45 patients, versus 47 low-risk HPV types in 41 patients with CS sampling. Multiple HPV types were detected in 30 patients with NFS and 17 patients with CS (p = 0.001). CONCLUSION: NFS were more effective than CS for HPV-DNA testing in men with genital warts. NFS were superior to CS in detecting multiple-type HPV infection and high-risk HPV types. The use of NFS should be recommended for HPV-DNA PCR testing in men.

Evaluation of the optimal sampling approach for HPV genotyping in circumcised heterosexual men with genital warts.

BACKGROUND: Human papillomavirus (HPV) causes a serious socioeconomic burden globally. However, there is currently no consensus on the optimal sampling method for HPVDNA genotyping in circumcised heterosexual men. This study aimed to determine the diagnostic efficacy of 6 different anatomic sampling sites in HPV DNA polymerase chain reaction (PCR) testing of circumcised heterosexual men with genital warts. METHODS: The study included circumcised heterosexual men who presented to our clinic with complaints of genital warts. Swab samples were obtained from the penile shaft (PS), scrotum, coronal sulcus (CS), and external urethral meatus (EUM). First-void urine (FVU) and genital wart biopsy (GWB) were also tested for HPV DNA by PCR. RESULTS: A total of 32 patients (mean age: 36.9 ± 6.9 years) were included. None of the six samples studied was sufficient on its own to reveal all HPV types detected in a patient. When the samples were analyzed individually, GWB detected an average of 49.5% of total HPV types in a patient. This rate was 50.5% for PS, 40.4% for CS, 31.6% for scrotum, 26.3% for EUM, and 15.8% for FVU samples. The detection rate increased to 75.8% with combined testing of GWB and PS samples, 83.2% with GWB/PS/CS, 90.5% with GWB/PS/CS/scrotum, and 98.9% with GWB/PS/CS/scrotum/EUM samples. CONCLUSION: No single anatomic region or sample type can detect all HPV types present in circumcised heterosexual men by PCR assay. The detection rate approaches 99% when wart biopsy is combined with swab sampling of the penile shaft, coronal sulcus, scrotum, and external urethral meatus.

Evaluating the utility of the A.F. Genital System test for pathogen diagnosis in acute male urethritis.

This study evaluated the effectiveness of the A.F. Genital System (Liofilchem® , Italy) in detecting pathogens compared with multiplex real-time polymerase chain reaction (PCR) in men with acute urethritis. Men diagnosed as having acute urethritis between 1 April 2021 and 31 December 2021 were included. Urethral swab samples were obtained for A.F. Genital System and PCR testing in a randomly determined order. The efficacy of the A.F. Genital System was analysed by comparing the results of the two tests. The study included 83 patients (mean age 34.1 ± 11.3 years). A urethritis pathogen was detected in 69 patients (83.1%) by PCR and only 15 patients (18.1%) with the A.F. Genital System. The sensitivity of the A.F. Genital System in detecting acute urethritis pathogens was 21.7% (95% confidence interval [CI]: 13.6-32.8), and the specificity was 100% (95% CI: 78.5-100). Its sensitivity was 20% (95% CI: 7.1-45.2) in the diagnosis of gonococcal urethritis and 19.1% (95% CI: 11.2-30.4) in the diagnosis of non-gonococcal urethritis. PCR detected two or more urethritis pathogens in 9 patients (13.0%), while no polymicrobial infection was detected with the A.F. Genital System. Based on the results of multiplex real-time PCR, the A.F. Genital System had very low sensitivity in the detection of pathogens in acute male urethritis. It should be kept in mind that using this test in patients with acute urethritis may result in a high missed diagnosis rate for urethritis pathogens.

Prognostic value of HPV DNA in Urothelial Carcinoma of the Bladder: A Preliminary Report of 2-Year Follow-up Results.

PURPOSE: The association between the human papillomavirus (HPV) and anogenital carcinomas is well established. However, despite its anatomic adjacency, the relationship between HPV and urothelial carcinoma of the bladder (UCB) is less clear. Recent meta-analysis and case-control studies demonstrated a significant relationship between the presence of HPV DNA and UCB. The aim of this clinical study was to compare the 2-year follow-up results of HPV-positive and HPV-negative UCB patients to evaluate the prognostic value of HPV DNA positivity in UCB. METHODS: The study included patients with stage pTa and pT1 UCB who underwent polymerase chain reaction (PCR) analysis of HPV DNA between January 1 and November 30, 2018. Based on their PCR results, 19 HPV-positive and 38 HPV-negative UCB patients who had regular follow-up in our clinic were evaluated in terms of tumor recurrence and disease progression over a 2-year follow-up period. RESULTS: There was no significant difference between the groups in terms of age, follow-up time, smoking, or tumor grade (P= .576, P= .368, P= .080, and P= .454). Tumor recurrence was observed at least once in 47.3% (n=9) of the 19 HPV-positive patients and 36.8% (n=14) of the 38 HPV-negative patients (P= .445). There was no difference in disease progression between the groups during follow-up. CONCLUSION: In our sample of UCB patients, the presence of HPV DNA was associated with a trend toward higher recurrence rate during the 2-year follow-up, though the difference was not statistically significant. No difference in disease progression was observed based on HPV DNA positivity.

New Approach to Microscopy of Gram-Stained Urethral Smear: The Kissing Slide Method.

BACKGROUND: The effectiveness of microscopy of Gram-stained smear (GSS) for the detection of male urethral infection is debatable, especially in cases with low inflammation and no visible urethral discharge. This clinical study compared GSS samples collected with the conventional swab method and our new technique, the kissing slide method, together with polymerase chain reaction results to demonstrate the effectiveness of this new method in men with acute urethritis. METHODS: The study included 64 men who presented to the urology outpatient clinic with complaints of acute urethritis between October 2019 and January 2020. Two GSS samples were collected from each patient, first using the kissing slide method (applying the slide directly to the urethral mucosa), followed by the conventional method. The results were compared with polymerase chain reaction findings. RESULTS: The patients' mean age was 37.4 ± 7.8 years, and 68.7% had no visible urethral discharge on physical examination. At a GSS threshold of ≥5 polymorphonuclear leukocytes/high-power field, sensitivity values were 60% (95% confidence interval [CI], 42.32%-75.41%) for the kissing slide method and 23.33% (95% CI, 11.79%-40.93%) for the conventional method. At a threshold of ≥2 polymorphonuclear leukocytes/high-power field, sensitivity values with the kissing slide and conventional methods were 80% (95% CI, 62.69%-90.5%) and 50% (95% CI, 33.15%-66.85%) in all patients, and 66.67% (95% CI, 41.71%-84.82%) and 20% (95% CI, 7.047%-45.19%) in cases without visible urethral discharge, respectively. CONCLUSION: The new kissing slide method is a noninvasive alternative method that may have better sensitivity than the conventional GSS sampling method in the diagnosis of male acute urethritis. Randomized studies are needed to verify these findings.

Is There any Association between Urothelial Carcinoma of the Bladder and Human Papillomavirus? A Case-Control Study.

OBJECTIVES: Human papillomavirus (HPV) is a well-known oncogenic virus associated with anogenital carcinomas. Despite the anatomical proximity of the bladder and the anogenital region, the relationship between HPV and urothelial carcinoma of the bladder (UCB) is still a controversial issue. This study aimed to test the urethral swabs and first-void urine samples of patients with UCB for HPV-Deoxyribonucleic acid (DNA) using polymerase chain reaction (PCR) assay and to compare the results with a control group. MATERIALS AND METHODS: Sixty-nine patients who were diagnosed with UCB between January and December 2018 were included in this case-control study. Sixty-nine patients who visited the urology outpatient clinic for non-oncological reasons within the study period were designated as the control group. Urethral swab and first-void morning urine samples were collected from each patient. HPV-DNA presence was investigated using a PCR kit that can detect a total of 22 HPV genotypes, of which 18 are high-risk and 3 are low-risk genotypes. RESULTS: The mean age of the patients included in the study was 63.2 ± 12.6 years and the male to female ratio was 5.3. HPV-DNA was detected in 28.9% (20/69) of the patients in the case group and in 8.7% (6/69) of the patients in the control group. HPV-DNA positivity was significantly higher in the case group (OR 4.24; 95% CI 1.63-12.34). No statistically significant relationship was found between HPV-DNA positivity and tumor grade (p = 0.36). CONCLUSION: A statistically significant relationship exists between HPV infection and UCB, regardless of the tumor grade.

HPV infection in urology practice.

Human papillomavirus (HPV) is the most common pathogen of sexually transmitted disease worldwide. While HPV is responsible for low-grade benign lesions in the anogenital area such as condyloma acuminatum, it is also strongly associated with cervical, anal, vulvar/vaginal, and penile carcinomas. In addition to being an oncogenic virus, HPV causes a substantial socioeconomic burden due to the recurrence of benign lesions, the lack of a definitive treatment option that provides a complete cure, and the high cost of treatment. The global incidence of HPV infection is rising, especially among young and sexually active individuals; as a result, in recent years these infections have also become increasingly conspicuous in urology practice, both as incidental findings and primary complaints. The aim of this review is to evaluate the pathogenesis, diagnosis, and treatment modalities of HPV infections in light of the current literature from the urologist's perspective.

Microscopy of Gram-stained urethral smear in the diagnosis of urethritis: Which threshold value should be selected?

The aim of this study was to investigate the sensitivity of GSS in the diagnosis of urethritis in patients who present to the outpatient clinic with symptoms of urethritis. Sixty-three male patients who presented to our outpatient clinic with symptoms of urethritis between January and March 2018 were evaluated. Urethral smear samples obtained from patients were evaluated both by GSS examination and by Real-time Multiplex Polymerase Chain Reaction (rt-MPCR) assay. The sensitivity and specificity of GSS in detecting gonococcal urethritis (GU) and nongonococcal urethritis (NGU) were calculated for threshold values of ≥5 and ≥2 PMNL/HPF. The mean age was 33.2 ± 7.1 years. According to the rt-MPCR results, 14 patients had GU and 27 patients had NGU. A threshold value of ≥5 PMNL/HPF in the GSS demonstrated 92.9% sensitivity in the diagnosis of GU and 55.6% sensitivity in the diagnosis of NGU. A threshold value of ≥2 PMNL/HPF reached 100% sensitivity for GU and 92.6% sensitivity for NGU. A cut-off value of ≥5 PMNL/HPF in the GSS has low sensitivity in the diagnosis of NGU. On the other hand, a threshold value of ≥2 PMNL/HPF seems to have higher sensitivity in the diagnosis of both GU and NGU.