This cross-sectional study was carried out on 22 heterosexual men with AGWs with involvement of the UM and 22 heterosexual men with AGWs without involvement of the UM at the Hajdaie Dermatology Clinic in Kermanshah, Iran, over a period of 3 years (2013-2016).
Tissue samples of AGWs were collected with a shave biopsy, fixed in 10% formalin, and subjected to HPV type microarray detection by PCR and subsequent reverse dot-blot hybridization with sequence-specific oligonucleotide probes.
To the best of our knowledge, this is the first study to evaluate the risk factors and HPV types in patients with AGWs in the UM region and those with AGWs in other genital areas.
Most studies (4, 5, 10, 11) have reported external AGWs to frequently occur in the third and early fourth decades, which is compatible with the results of our study.
Shorter duration of lesions and earlier attendance of patients affected with AGWs with UM involvement may be related to tumoral mass sensation in the urethra, dysuria, urethral discharge (12), change in the urine stream (13), and concern for malignancy.
The most important risk factor for AGWs is the number of lifetime multiple sexual partners (10, 14-19).
In most studies, unprotected sexual contact has been reported as an important factor in AGWs (10, 13, 18, 19).
In our study, there was no difference in the detection of HPV types between the group of patients with AGWs that involved the UM and those that had AGWs at other locations.
In 2008, of the estimated 22 000 new penile cancer cases, half were attributable to HPV, with much higher rates observed in regions with a low human development index. Data from Zimbabwe suggest that southern Africa has higher incidence rates, and a recently published report of HPV detection in cancerous and precancerous penile lesions from men in South Africa demonstrated multiple HPV infections, with high rates of HPV-16. Risk factors for penile cancer include: a lack of MC; phimosis and/or poor genital hygiene; AGWs; and HIV infection.
An RCT involving 4 065 men from 18 countries aged 16 - 26 years showed that the quadrivalent vaccine was 90% effective in preventing infection with vaccine-specific types in the per protocol analysis, and 89% effective in preventing AGWs in the same population. In 602 MSM aged 16 - 26 years, the quadrivalent vaccine was 77.5% effective in preventing HPV-6-, -11-, -16- and -18-associated AIN. The bivalent vaccine is not currently registered for use in men.