[Prevalence of HPV-induced lesions in men: a study from 246 heterosexual couples]. / Prévalence de lésions HPV-induites chez les hommes : étude à partir de 246 couples hétérosexuels.

OBJECTIVES: Human Papillomaviruses (HPV) infection is high in heterosexual couples. We have evaluated clinically the frequency and the histological type of genital lesions in men whose partners have an HPV cervical and/or external genital lesion. PATIENTS AND METHODS: We conducted a cross-sectional study; we examined 246 men whose partner was referred for HPV lesions treatment of either the external genital tract or the cervix. All clinical HPV lesions detected in the men then underwent histological examination. RESULTS: In 72% of cases, the couples were 18 to 35 years old. We detected HPV clinical lesions, confirmed histologically in 43% (106/246) of men. Warts and high-grade intraepithelial neoplasia were diagnosed in 83 (78%) and 23 (22%) of cases, respectively. The prevalence of clinical HPV lesions in men ranged from 34% in case of HG CIN to 80% when the female partner suffered from genital warts. DISCUSSION AND CONCLUSIONS: The high frequency of clinical HPV lesions in men whose the partner has warts should lead to a peniscopy of the partner in these cases. Similarly, the peniscopy detects an HPV lesion in a third of men of which the partner gets a HG CIN. It is necessary to realize prospective studies to reevaluate the impact of diagnosing and treating male lesions with regard to the evolution of HG CIN in their partner.

[Intraepithelial carcinoma and invasive carcinoma of the vulva, vagina and penis in Ile-de-france. Enquete PETRI on 423 cases]. / Carcinomes intraépithéliaux et carcinomes invasifs de la vulve, du vagin et du pénis en Ile-de-France. Enquête PETRI portant sur 423 cas.

OBJECTIVE: Precancerous and invasive carcinoma of the external genitalia and of the vagina are rare tumors and their incidence is not very well known in the Paris region. The objective of this study was to evaluate the frequency of precancerous and invasive lesions of the vulva, the vagina and the penis as well as their variation according to age. METHODS: A prospective study was conducted implicating private and public pathology laboratories in Paris and the seven departments around. Four hundred and twenty three genital biopsies have been analyzed: 160 from the vulva, 151 from the vagina and 112 from the penis. RESULTS: The mean age of the patients was 45 years. The highest frequency of genital biopsies was similar for the three anatomical sites and concerned patients of 25-34 years old. intraepithelial neoplasias represented 77p. 100 of the biopsies (32p. 100 of low grade and 45p. 100 of high grade), invasive squamous carcinoma and adenocarcinoma represented 21p. 100 and 2p. 100 of cases, respectively. The mean age of the patients with low grade vulvar intraepithelial neoplasia, low grade vaginal intraepithelial neoplasia and low grade penile intraepithelial were 34, 40 and 33 years old, respectively. An interval of three to seven years separates the mean age of low grade intraepithelial neoplasia from the mean age of high grade. High grade intraepithelial neoplasia present a peak of frequency in the same class of age for the three localizations (25-34 years) and the risk of developing a high grade intraepithelial neoplasia of the external genital was higher between 25 and 35 years and between 35-45 years of the vagina. The mean age of invasive vulvar carcinoma, vagina carcinoma and penile carcinoma was 62, 59 and 68 years old, respectively. CONCLUSIONS: The correlation between the development of intraepithelial neoplasia of the vulva and the penis supposes a common aetiologic factor in the majority of the cases. The diagnosis of a intraepithelial neoplasia implies a clinical, colposcopic and follow-up of the entire genital area.

Incidence of preputial lichen sclerosus in adults: histologic study of circumcision specimens.

BACKGROUND: Narrowing of the prepuce in men is poorly documented, and the causes are often unknown, except in the case of clinical infections or skin diseases such as lichen sclerosus (LS). OBJECTIVE: We conducted a histologic study of circumcision specimens with phimosis or paraphimosis. METHODS: This prospective study included 43 men with contraction referred for circumcision. RESULTS: LS was present in 32% of cases, but only 12% of these cases of LS had not been diagnosed before circumcision. In 31% of cases the histologic findings were normal. Subacute nonspecific inflammatory changes were diagnosed in 37% of all cases, and secondary narrowing of the prepuce in 62% of cases. It is probable that this histologic modification of the preputial mucosa is involved in narrowing of the prepuce. CONCLUSION: Phimosis in young adults is usually not associated with LS (only 14%). In contrast, most older patients had secondary phimosis caused by progressive LS (40%) or subacute nonspecific inflammatory changes (40%). Although all cases of phimosis in men should be treated by complete circumcision to prevent penile cancer, paraphimosis associated with preputial dyspareunia, with the exception of cases associated with LS, can be treated by corrective surgery.

Developmental factors of urethral human papillomavirus lesions: correlation with circumcision.

OBJECTIVE: To assess the relationship between circumcision and urethral human papillomavirus (HPV) lesions, and the influence of urethritis on the development of urethral HPV infections on inducing squamous metaplasia of the urethral epithelium. PATIENTS AND METHODS: The study included 210 heterosexual, HIV-negative men (median age 29 years) who all had female partners with genital HPV infection. The patients were divided into three groups according to clinical findings, i.e. 97 patients with no clinical HPV lesions on peniscopy and urethroscopy, 70 patients with balanopreputial lesions but no urethral lesions, and 43 patients with urethral HPV lesions, including 17 who had associated penile lesions. They all underwent meatopeniscopy for HPV screening, urethral biopsy for histological analysis, and bacterial cultures were taken. The results in each subgroup were compared between circumcised and uncircumcised men. RESULTS: There was no significant difference in the incidence of HPV infection (58% vs 42%, odds ratio, OR, 1.8; 95% confidence interval, CI, 0.98-3.62) between uncircumcised and circumcised men, but this relationship differed with the developmental site of HPV lesions (shaft-foreskin, P<0.02; urethra, not significant). There was also a significant difference in the prevalence of urethritis between uncircumcised and circumcised men (34.5% vs 19%, OR 2.35, 95% CI 1. 08-5.11), and between HPV-infected and uninfected men (41.5% vs 18%, OR 3.17, 95% CI 1.71-5.83). This positive relationship of the prevalence of urethritis for both factors (circumcision and HPV) depended on the type of organism (sexually transmitted disease, not significant; common organism, P<0.02). The frequency of urethritis was related to the site of HPV lesions; urethritis was present in 36% of the patients with preputial HPV lesions, compared with 51% of those with urethral HPV lesions. Chlamydia trachomatis was detected in 1% of the patients without and in 7% of those with HPV lesions. In 68% of the patients, histological analysis of the urethral mucosa showed a squamous metaplasia of the urethral epithelium associated with urethritis. CONCLUSIONS: Being uncircumcised did not seem to increase the risk of HPV urethral infection in young men. Genital bacterial infections and urethral HPV lesions appear to be linked. Urethritis can induce squamous metaplasia of the urethral epithelium, which appears to favour the colonization of the anterior urethra by HPVs.

Comparison of clinical, histological, and virological symptoms of HPV in HIV-1 infected men and immunocompetent subjects.

OBJECTIVE: We assessed the clinical, histological, and virological features of anogenital human papillomavirus (HPV) infection, according to their immune status in HIV-1 infected men, referred for an anogenital examination or treatment, in comparison with immunocompetent patients. METHODS: The study population comprised 33 HIV-1 infected heterosexual or homosexual men and 38 HIV negative men seen in a screening and treatment centre for anogenital HPV infections. All patients were examined with a colposcope. Biopsies were carried out on all subjects with anogenital lesions for histological studies and HPV detection by Southern blot. RESULTS: The HIV infected patients had a balanopreputial HPV infection in 70%, anal in 30%, and urethral in 37%, while HIV negative patients had balanopreputial lesion in 72%, anal in 26%, and urethral in 16%. Diffuse anogenital lesions were present in 33% of the HIV infected cases and in 10.5% of HIV negative cases (p < 0.02). Among the HIV infected patients, the genital HPV lesions were condylomatous in 67.5% of the cases and dysplastic in 57%. HIV negative patients had condylomatous lesions in 86% of the cases and dysplasic in 14%. The condylomatous lesions of HIV infected patients had a low grade malignant histological aspect in 36% of the cases and high grade histological criteria were found in 22% of the dysplasias. Oncogenic HPVs were detected more frequently in HIV infected patients (35% v 12%) and more than one HPV type was found in 21.5% of cases. Neither the anogenital diffusion of the HPV lesions nor their morphological, histological, and virological features differed significantly in patient with CD4 cell counts > or < 200 x 10(6)/l. In contrast, patients with CD4 cell counts < 50 x 10(6)/l had a higher risk of several types of HPVs and of developing a diffuse anogenital infection. CONCLUSION: HIV-1 infected patients had an increased frequency of high grade anogenital dysplastic lesions and a higher frequency of HPV infection with multiple and diffuse sites of involvement. These characteristics of HPV infection were independent of the patients' immune status up to CD4 cell counts > 50 x 10(6)/l but showed an increased risk when the CD4 cell count was < 50 x 10(6)/l. The higher frequency of diffuse anogenital infections among HIV infected men calls for rapid treatment, laser or surgery, given the association of histological features of intraepithelial neoplasia and the presence of multiple HPV infection sites which may be the consequence of immune disturbances, most of which are transmissible potentially oncogenic HPVs.

Lack of evidence for a role of human papillomaviruses in transitional cell carcinoma of the bladder.

PURPOSE: In view of the conflicting results reported in the literature, we assessed the involvement of human papillomaviruses (HPV) in the development of transitional cell carcinoma of the bladder. MATERIALS AND METHODS: A total of 58 bladder papillomatous proliferations was histologically examined and analyzed for the presence of HPV deoxyribonucleic acid (DNA) sequences by Southern blot hybridization and the polymerase chain reaction (PCR) method. RESULTS: Typical features of condyloma acuminatum were observed in the bladder specimen of a patient with urethral condylomatosis. Of the specimens 57 had histological features of transitional cell carcinoma but no known signs of HPV infection. HPV-6 DNA was detected in the condylomatous tumor. However, no HPV DNA was detected in the 57 bladder cancers by Southern blot hybridization and polymerase chain reaction. CONCLUSIONS: These findings do not support an etiological role of HPV in the development of transitional cell bladder cancer.

[Sex behavior of patients attending a free, anonymous HIV screening center in Paris]. / Les comportements sexuels des consultants d'un centre de dépistage anonyme et gratuit du VIH à Paris.

People's sexual behavior changes as they acquire knowledge od HIV infection. During a 10-week period (September-November 1994), we analysed the results of interviews conducted prior to free, anonymous tests in the Figuier HIV screening center (CDAG, Paris). Men accounted for 61% of the 1275 attendees, and 62% were aged between 20 and 29 years (both sexes). Consultants were homo/bisexuals in 26% cases and 23% had an HIV-infected partner. Male and female hetero-sexual represented respectively 35 and 38% of attendees, and 1.7% had an HIV-infected partner. Most of the subjects (76%) had had more than one sexual partner in the last 12 months. 72% of the homo/bisexuals of all ages stated that they used condoms systematically during sexual penetration, compared to 35% of the heterosexuals. In contrast, only 3.9% of homo/bisexual used condoms during oral intercourse. 12% of the subjects (21% of homo/bisexuals, and 8.5% of heterosexuals) stated that they had been treated for an STD during the previous year, and most were aged between 25 and 34 years. The most frequent stated STDs were anogenital papillomavirus and herpes virus infections, and chlamydial infections. 80% of the homo/bisexual considered they "too a risk" (oral intercourse), compared to 47% of heterosexuals. 10% of the subjects did not collect their result. In this study the seroprevalence of HIV was 1%, with the highest values in the 25-34 year age group and among homo/bisexuals (3%), and the lowest values among male and female heterosexuals (0.4% and 0.2%, respectively). Most of the subjects, on the basis of their stated sexual behavior, were aware of the risk of HIV infection, but the high frequency of STDs shows that prevention campaigns must be reinforced. Practician must offer advice on prevention and screening in order to reduce the frequency of infective and tumoral diseases due to sexually transmitted pathogens.

[Prevalence of Chlamydia trachomatis among men consulting in urology. Comparative study between cell culture and sperm PCR]. / Prévalence de Chlamydia trachomatis parmi les hommes consultant en Andrologie. Etude comparative entre la culture cellulaire et la PCR sur le sperme.

OBJECTIVE: Genital Chlamydia trachomatis infection can be difficult to diagnose, depending on the precise site of infection. Given the lack of major clinical signs and symptoms in many cases and the risk of male and female infertility. Chlamydia trachomatis is a public health problem. It can be difficult to detect this pathogen in sperm by means of cell culture, because of seminal fluid toxicity for cell lines. New techniques such as the polymerase chain reaction (PCR) can be used to detect genomic DNA. STUDY DESIGN: We studies 81 patients by applying the Amplicor CT PCR test to sperm, in comparison with cell culture on sperm and urethral samples. RESULTS: The prevalence of Chlamydia trachomatis infection was not significantly different (3.7% vs 5%) in the urethral cell culture and PCR methods, respectively (p > 0.05). In contrast, PCR was significantly more sensitive than sperm cell culture (5% vs 1.2%; p < 0.03). Moreover, we have not detected of genital chlamydiose among the infertile men. CONCLUSION: These findings suggest that PCR detection of Chlamydia trachomatis can dispense with the need for urethral sampling and cell culture in selected male patients.

[Treatment of external ano-genital condylomata with 0.5% podophyllotoxin]. / Traitement des condylomes ano-génitaux externes par podophyllotoxine à 0.5%.

There are several possible protocols for the treatment of ano-genital condylomata. In this study, the efficacy of podophyllotoxin (0.5%) was assessed. The authors observed a recovery rate at 1 month of 81% in cases of condylomata of the balano-preputial and vulvar mucous membranes, a rate of 67% in condylomata of the keratinized tissues and 63% in those of the anal margin. Response to treatment is also dependent on the morphology of the lesion; regression was observed in 78% of cases of condylomata acuminata and in 57% of cases of endophytic condylomata. The side effects were local and consisted of erosion in 20% of cases. The efficacy of treatment was, amongst other things, analysed according to the recurrence of the infection at one month, which occurred in 16% of cases affecting mucous membranes. In the therapeutic arsenal for the treatment of condylomata, podophyllotoxin 0.5% is a first line treatment for condylomata acuminata of the genital mucous membranes.

CO2 laser for therapeutic circumcision in adults.

The use of carbon dioxide laser for 38 posthetomies or therapeutic circumcisions in the treatment of phimosis, paraphimosis, balanitis of Zoon or a genital infection by the human papillomaviurs permits clean and hemostatic incisions. The clean and dry wound produced by the carbon dioxide beam offers several advantages. It reduces the surgeon's risk of contamination by the HIV virus and the subsequent sear is regular and without edema. In 57% of primary phimosis cases, the histological analysis showed a lichen sclerosus et atrophicus.

Penile intraepithelial neoplasia. Specific clinical features correlate with histologic and virologic findings.

BACKGROUND: To evaluate the existence of the morphologic features specific for penile intraepithelial neoplasia (PIN), 1000 male sexual partners of women with genital condyloma or intraepithelial neoplasia were studied. METHODS: Ninety-two patients who presented with lesions suggesting intraepithelial neoplasia (pigmented or leukoplastic papules, keratinized condylomata, or erythroplastic macules) underwent biopsy for histologic and virologic studies. RESULTS: Histologic results showed penile intraepithelial neoplasia in 93% of the specimens. Human papillomavirus (HPV) DNA from potentially oncogenic papillomaviruses was detected in 75% of patients with Grade I PIN, in 93% of patients with Grade II PIN, and in all patients with Grade III PIN: Uncircumcised and circumcised men showed the same rate (52% vs. 45%; odds ratio [OR] = 1.3; 95% confidence interval, 0.97-1.73) of HPV-associated lesions, whereas the rate of PIN was significantly higher in uncircumcised men than in circumcised men (10% vs. 6%; OR = 1.77; 95% confidence interval, 1.02-3.07). The mean age of patients with Grade III PIN was 7 years older then the mean age of patients with Grade I PIN, which suggests a step progression similar to that of cervical intraepithelial neoplasia. CONCLUSION: Morphology seems to be a specific-enough indicator of PIN. More data are needed to determine whether treatment of PIN may contribute to preventing cervical or penile cancer. If so, the morphologic criteria here described will be clinically useful.

[Genital herpes simplex virus infection among men screened for genital papillomavirus]. / L'infection génitale par les herpès simplex virus parmi des hommes consultant pour un dépistage des papillomavirus génitaux.

OBJECTIVE: Our aim was to assess the frequency of herpetic genital infection (HSV) among men attending a human papillomavirus (HPV) screening centre. Clinical screening of a herpetic lesion was completed with biological detection of HSV by cell culture and by polymerase chain reaction (PCR). We also evaluated the role of the male viral factor on the female partners. METHOD: We performed a genital examination by colposcopy of 135 men whose female partners presented an HPV genital infection. The HPV lesions detected underwent biopsy by Southern blot viral analysis. The lesions which clinically appeared to be caused by HSV were removed for HSV detection and typing by cell culture and by PCR. Sperm was collected for viral detection by cell culture and PCR was collected for viral detection by cell culture and PCR from patients presenting a herpetic type urethral symptomatology. RESULTS: Peniscopy detected HPV lesions in 46 p. 100 of the men, in 88 p. 100 of cases in the balano-preputial zone and in 82 p. 100 of cases their morphology was exophytic. The other areas were in 14.5 p. 100 of cases urethral and 9 p. 100 anal. We detected a dysplasic lesion in 6 p. 100 of cases. In 74 p. 100 of cases molecular hybridization by Southern detected 6/11/42 type HPV and in 6.4 p. 100 of cases HPV 16. Clinical examination revealed the presence of genital herpetic infection in 15.5 p. 100 of cases, of these 76 p. 100 were preputial and 24 p. 100 meato-urethral. PCR detected HSV-2 in 88 p. 100 of the preputial lesions and in 86 p. 100 of the spermatic ejaculates from the meato-urethral lesions. The chi 2 test showed that no link exists between a herpetic genital infection and the presence of an HPV lesion, but that the risk is greater (OR = 2.15; IC 95 p. 100 = 0.84-5.49). We also observed that 50 p. 100 of the female partners of men with both HPV+HSV infections had high grade cervical lesions. CONCLUSION: This study shows that clinical examination in an HPV screening centre enabled detection of clinical HSV in 15.5 p. 100 of cases as opposed to 17 p. 100 biologically. Thus the good clinical-virological correlation shows that clinical criteria remain the principal elements for detecting viral genital infections, it therefore appears advantageous to only use the new HSV identification techniques for targeted detection. Also, herpetic genital infection is independent of human papillomavirus infection. When screening for HPV, herpetic genital infection should be taken into account as we have observed that the female partners of men with both HPV + HSV are at greater risk of presenting high grade cervical lesions.

[Genital bacterial infections associated with papillomavirus: value of screening and basis for treatment]. / Infections bactériennes génitales associées aux papillomavirus: intérêt du dépistage et base du traitement.

Genital bacterial and viral infections may be responsible of couple infertility and may be potentially oncogenic for genital lesions. Genital bacterial infection is associated with human papillomavirus infection in as much as 48% for men and 64% for women. The bacterias most frequently found are intracellular species (29%) and Gram-negative bacilli (14%). Treatment with specific antibiotics can reduce the frequency of infertility in both men and women. This treatment can also prevent therapeutic complications during treatment for papillomavirus infection.

[Male genital examination: the usefulness of penis endoscopy and the acetic acid test for the detection of papillomavirus lesions]. / Examen génital masculin: l'utilité de la péniscopie et du test à l'acid acétique pour le dépistage des lésions à papillomavirus.

This study was based on 2,400 genital examinations performed by means of the acetic acid test looking for human papillomavirus (HPV) lesions in the male partners of women with HPV genital lesions. These peniscopies demonstrated HPV lesions in 56% of the men examined. In 109 cases, histological and virological examination revealed that 30% of them had areas of intraepithelial neoplasia of the penis, associated with potentially oncogenic papillomavirus infection. The value of this examination is to detect HPV lesions and, in particular, dysplastic lesions. The treatment of these lesions appears to allow a reduction in the incidence of recurrence of HPV lesions in women after treatment.

[Value of therapeutic circumcision in diffuse condylomata acuminata]. / Intéret de la circoncision thérapeutique dans la condylomatose diffuse.

Therapeutical circumcision (posthectomy) in nine patients presenting with diffuse penile warts. CO2 laser circumcision resulted in a 100 p. 100 cure rate after a 3-month follow-up in patients with diffuse warts of recent onset, and a 75 p. 100 cure rate in patients with recalcitrant warts.

[New ambulatory techniques for the detection and treatment of urethral condyloma in men. Apropos of 2 cases]. / Nouvelles techniques ambulatoires de détection et de traitements des condylomes urétraux chez l'homme. A propos de 2 cas.

We have been looking for urethral condylomatous lesions during a screening genital examination of 2,000 male patients who were the partners of women presenting with a condylomatous infection. The use of a small speculum and of a retractor of our own design has allowed the out patient diagnosis and treatment of urethral lesions up to 20 mm deep in 26 (22%) of the 123 patients presenting with lesions of the urethral meatus. A follow-up urethroscopy demonstrated the presence of condylomatous lesions in the retrobalanic portion, up to the vicinity of the striated sphincter in 11 (8%) of these patients. The use of a novel retractor thus allows visualizing all the lesions located up to the great lacuna and treating them with a laser beam, with a healing rate of 93%. Urethroscopy must be reserved for recurrence of meatic condylomas after treatment.