Epidemiology of Human Papillomavirus Genital Lesions in Females and Their Male Partners

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Abstract
This study was undertaken to determine those factors that may be important in the development and natural history of human papillomavirus (HPV) infections in the genital tract epithelium of females and their male consorts. There has been a reluctance in this community to accept that a new disease entity and epidemic of HPV infections is important and that it is related to the development of dysplasia-neoplasia in both males and females. The main findings were a 25% false negative cytology screening rate, a poor correlation rate between cytology colposcopy and histology, a higher incidence of involvement of vagina, vulva, urethra, and anus than was anticipated on clinical impressions, and a low incidence of disease confined to cervix alone. Among the male cohort, diagnosis based on microscopy and biopsy alone showed that 75% of the males had proven HPV lesions, and 1 in 25 had carcinoma in situ of the penis at the time of initial diagnosis. The vast majority of the males were asymptomatic and there was no consistent link between consorts where both showed the same morphologic type HPV lesion. Reliance on colposcopy alone for classification of HPV lesions was unreliable, since from 1 in 5 to 1 in 3 colposcopically defined simple HPV lesions showed histologic changes from CIN I to CIN III. Because of the high incidence of changing sexual relationships among this study group, it is recommended that with every new sexual encounter, both parties should start from the beginning in terms of screening and follow-up. Cytology alone is far too unreliable even in the most expert hands to be used as the sole follow-up screening technique for those patients previously treated conservatively for noninvasive epithelial lesions. We believe that any program aimed at reducing the incidence of invasive cancer of the cervix that does not include screening and treating male sexual partners is doomed to failure. We believe also that it is highly likely, given the natural history of HPV infections of significance in females, that there is a large pool of undiagnosed males in the community who will probably ultimately develop invasive carcinoma of the penis.