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Detection of human papillomavirus in urine among heterosexual men in relation to location of genital warts and circumcision status
  1. Ei T Aung1,
  2. Christopher K Fairley1,2,
  3. Sepehr N Tabrizi3,4,5,
  4. Jennifer A Danielewski3,4,
  5. Jason J Ong1,2,
  6. Marcus Y Chen1,2,
  7. Catriona S Bradshaw1,2,
  8. Eric P F Chow1,2
  1. 1 Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
  2. 2 Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
  3. 3 Murdoch Childrens Research Institute, Parkville, Victoria, Australia
  4. 4 Department of Microbiology and Infectious Diseases, The Royal Women’s Hospital, Parkville, Victoria, Australia
  5. 5 Department of Obstetrics Gynaecology, University of Melbourne, Parkville, Victoria, Australia
  1. Correspondence to Dr Eric P F Chow, Melbourne Sexual Health Centre, Alfred Health, Carlton, VIC 3053, Australia; echow{at}


Objective Human papillomavirus (HPV) surveillance is important to monitor the effectiveness of national HPV vaccination programmes. Positivity of HPV in urine in men varies with different sampling methods. We aimed to determine the positivity for detection of HPV-6/11 in urine samples among men in relation to the position of genital warts and circumcision status.

Method We analysed stored chlamydia-positive urine specimens in young heterosexual men aged less than 25 years attending Melbourne Sexual Health Centre, Australia, between 2004 and 2015, for HPV genotypes. Positivity of HPV-6/11 and high-risk genotypes were stratified according to the position of genital warts and circumcision status. Positivity of HPV-6/11 was calculated using diagnosis of warts as the gold standard. Warts were classified as proximal penile warts from suprapubic area to midshaft of penis, and distal penile warts from distal shaft of penis to meatus.

Results Of the 934 specimens, 253 (27.1%) men were positive for any HPV and 82 men (8.8%) had genital warts. The ORs of HPV-6/11 detection in urine were 4.63 (95% CI: 1.68 to 12.78) and 40.20 (95% CI: 19.78 to 81.70) times higher among men who had proximal penile warts and distal penile warts, respectively, compared with men who did not have genital warts. Circumcised men were less likely to have high-risk HPV (OR 0.31; 95% CI: 0.14 to 0.65) than uncircumcised men. Uncircumcised men were more likely to have distal penile warts than circumcised men (OR 8.22; 95% CI: 1.34 to 337.46).

Conclusion Positivity of HPV-6/11 in urine increases greatly in men with distal penile warts. Circumcised men are less likely to have distal penile warts, any HPV or high-risk HPV detected. Urine is likely to be an alternative sampling method for HPV-6/11 surveillance programme in men in countries with low circumcision rates.

  • HPV
  • human papilloma virus
  • urine
  • men
  • genital warts
  • circumcision
  • surveillance

Statistics from


  • Handling editor Jackie A Cassell

  • Contributors ETA, CKF and EPFC conceived the study and design. JAD performed all HPV genotyping. ETA and EPFC performed data analyses. ETA conducted chart review and wrote the first draft of the manuscript. All authors helped with interpretation of data, manuscript editing and approved the final version.

  • Funding This work was supported by the National Health and Medical Research Council (NHMRC) programme grant (number 568971). EPFC and JJO are supported by the Early Career Fellowships from the Australian NHMRC (numbers 1091226 and 1104781, respectively).

  • Competing interests The authors do not have a commercial or other association that might pose a conflict of interest.

  • Patient consent Obtained.

  • Ethics approval The Alfred Hospital Ethics Committee, Melbourne, Australia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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