Sexual behaviour and less frequent bathing are associated with higher human papillomavirus incidence in a cohort study of uncircumcised Kenyan men
- Danielle M Backes1,
- Peter J F Snijders2,
- Michael G Hudgens3,
- Robert C Bailey4,
- Martijn Bogaarts2,
- Kawango Agot5,
- Walter Agingu5,
- Stephen Moses6,
- Chris J L M Meijer2,
- Jennifer S Smith1
- 1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- 2Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
- 3Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- 4Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
- 5Impact Research and Development Organization, Kisumu, Kenya
- 6Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
- Correspondence to Dr Danielle M Backes, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 2101 McGavran-Greenberg Hall, CB #7435, Chapel Hill, NC 27599, USA;
- Received 8 February 2012
- Revised 24 July 2012
- Accepted 30 July 2012
- Published Online First 1 September 2012
Objectives Data on the acquisition of human papillomavirus (HPV) infection in men are limited, especially from developing regions including Africa. The objective of this study was to characterise and determine the risk factors of HPV acquisition among a cohort of uncircumcised men participating in a randomised controlled trial (RCT) of male circumcision in Kisumu, Kenya.
Methods Penile exfoliated cell specimens were collected at baseline, 6- and 12-month follow-up visits from the glans/coronal sulcus and shaft of men enrolled in the control arm of the RCT between 2002 and 2005. All participants were HIV seronegative, aged 17–24 years at baseline and remained uncircumcised over follow-up. Specimens were tested with GP5+/6+ PCR to detect 44 HPV types. Parametric frailty models were used to assess risk factors of HPV incidence.
Results The median age of 966 participants was 20 years. The median follow-up time was 12.1 months. The incidence rate (IR) of any HPV infection was 49.3/1000 person-months with HPV16 having the highest IR (10.9/1000 person-months). The strongest risk factors for overall HPV incidence were bathing less frequently than daily (adjusted HR=2.6; 95% CI 1.0 to 6.5) and having ≥2 female sexual partners in the past year (adjusted HR=1.6; 95% CI 1.2 to 2.1).
Conclusions HPV IRs were notably high in this cohort of high-risk, uncircumcised men from Kisumu, Kenya, with the number of sexual partners and bathing frequency being the strongest risk factors.