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.

[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.

[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.