Despite the availability of primary prevention of HPV in men, Mexico has not yet introduced vaccination in the male population, focusing exclusively on girls 9-10 years old. The burden of condyloma (genital warts) in Mexico is not quantified; however, it may be as important as it is in other low- or middle-income countries.Assess the incidence of histopathologically confirmed condyloma and penile intraepithelial neoplasia (PeIN) and the HPV genotypes detected within these lesions.
HIM Study participants from Mexico were included in this country specific analyses. Participants were men aged 18-70 years living in Cuernavaca (central Mexico), enrolled between July 2005 and June 2009. Every six months beginning in 2009, participants underwent an interview, a physical exam, and laboratory analysis. Men who had two or more study visits after implementation of the protocol were included in this analysis (n=954). We collected a tissue sample from each external genital lesion (EGL) by shave excision. EGLs were categorized as condyloma, suggestive of condyloma, low- and high-grade squamous intraepithelial lesion (penile intraepithelial neoplasm, PeIN), or not HPV-related lesions. The Linear Array genotyping method was used to identify HPV genotypes from genital swabs, while the INNO-LiPA HPV Genotyping Extra method was used for biopsy tissue specimens.EGL incidence was computed among men free of EGL at baseline. Kaplan–Meier curves for EGL incidence were generated. Cumulative incidence of EGL within the first 12 months of follow-up was also estimated using Kaplan–Meier method.
The EGL incidence rate (95% CI) was 1.84 (1.42-2.39) per 100 person-years; the cumulative risk of EGL at 12-months was 2.9% (1.9-4.2). The highest incidence of EGL was observed in the age group 18-30 years: 1.99 (1.22-3.25) per 100 person-years.
HPV-6 was the most common HPV genotype in condylomas (62.7%). Seven subjects developed PeIN 1-3, four of which contained HPV-16. Forty-four percent (14.3%-137.8%) of HPV 11 infections progressed to condyloma within 6-months after infection.
We found statistically significant differences in high-risk sexual behaviors between men that did developed an EGL compared to men that did not develop an EGL such as having sex with other men or having sex with both men and women were found, as well as total number of female and male partners.
HPV-related EGLs among men is very common in Mexico with 10% developing an EGL during follow-up. The burden of disease is similar in three geographical areas that have been studied (Cuernavaca, Tampa and Sao Paulo).