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Human papillomavirus (HPV) infection in heterosexual South African men attending sexual health services: associations between HPV and HIV serostatus
  1. Etienne E Muller1,*,
  2. Tobias F Chirwa2,
  3. David A Lewis1
  1. 1 National Institute for Communicable Diseases, South Africa;
  2. 2 University of the Witwatersrand, South Africa
  1. Correspondence to: Etienne E Muller, STI Reference Centre, National Institute for Communicable Diseases, STI Reference Centre, NICD, Private Bag X4, Sandringham, Johannesburg, 2131, South Africa; etiennem{at}


Objectives: To investigate the distribution of HPV genotypes and determine the associations between HPV infection and HIV co-infection in sexually active heterosexual men with anogenital warts, male urethral discharge or asymptomatic men.

Methods: Valid specimens for HPV genotyping were obtained from three patient groups consisting of 108 men with anogenital warts (GW), 56 men with urethral discharge syndrome (MUS) and 50 asymptomatic men attending for HIV voluntary counselling and testing (VCT). The Linear Array HPV Genotyping Test was used to determine the HPV genotype distribution among study participants. Sera were tested for HIV antibodies using two commercial rapid tests.

Results: The prevalence of anogenital HPV among study participants was 78% (166). HPV DNA was detected in 100% (108) of GW, 48% (27) of MUS and 62% (31) of VCT participants. HPV types 6, 11, 16 and 18 were prevalent either as single or combined infections in 81% (134) of all HPV-positive study participants. HPV types 6 and/or 11 were significantly higher among GW patients (p<0.001). After adjusting for patient groups, HIV seropositivity was significantly associated with multiple HPV infections (OR=3.98, 95% CI: 1.58, 10.03) but not with presence of a foreskin (OR=0.67, 95% CI: 0.32, 1.40).

Conclusions: Infections with HPV were prevalent among sexually active heterosexual men attending the men’s sexual health clinic. Associations were observed between HIV co-infection and multiple HPV infections. Further population-based studies on the prevalence of HPV genotypes are required to determine if men should be included in any future national HPV vaccination programme in South Africa.

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