Epidemiology of human papillomavirus on anogenital warts in Portugal – The HERCOLES study

• Published in: Journal of the European Academy of Dermatology and Venereology 2017-08, Vol.31 (8), p.1342-1348
• Main Authors: Azevedo, J., Pista, A., Lisboa, C., Santo, I., Azevedo, L., Cunha, M.J., Marcelino, M, Reis, JP, Gameiro, A, Cabral, AR, Coutinho, MI, Gouveia, M, Teixeira, VB, Brito, C, Fernandes, JC, Araújo, C, Resende, C, Ferreira, O, Cardoso, J, Fernandes, C, Rodrigues, A, aureano, A, Fernandes, PV, Mestre, T, Bártolo, E, Matos, D, Barreiros, H, Alves, J, Coelho, R, Moreira, C, Borges‐Costa, J, Gouveia, AI, Teixeira, A, Lopes, L, Uva, L, Dias, C, Machado, JC, Cirnes, L, Faustino, A, Santos, S
• Format: Article
• Language: English
• Subjects: Adult; Anus Diseases - epidemiology; Anus Diseases - virology; Condylomata Acuminata - epidemiology; Condylomata Acuminata - virology; Female; Genital Diseases, Female - epidemiology; Genital Diseases, Female - virology; Genital Diseases, Male - epidemiology; Genital Diseases, Male - virology; Humans; Male; Middle Aged; Papillomaviridae - isolation & purification; Portugal - epidemiology; Prospective Studies
• ISSN: 0926-9959; 1468-3083
• DOI: 10.1111/jdv.14311

Background Anogenital warts (AGW) are one of the most prevalent sexually transmitted disease worldwide. Approximately, 90% of AGWs are related to infection by HPV 6 and 11. However, AGW have been associated with infection by multiple genotypes, including HR‐HPV, which may be associated with a long‐term increased risk of anogenital cancer. Objective This observational prospective epidemiological study aims to estimate the type‐specific HPV distribution on incident AGWs in both genders, and additionally to assess the frequency of anal and oral HPV infection in patients with AGWs. Methods According to defined inclusion criteria, individuals with incident clinical diagnosis of AGWs were recruited in seven Portuguese Centres. HPV genotyping was performed using CLART HPV2 test. Results Between November 2012 and March 2014, 162 women and 400 men (mean age: 34 years), were enrolled. After exclusion of patients with unqualified AGW samples, HPV was detected in 95.3% (505/530) AGW patients, 96.8% males and 91.6% females. Among men who have sex with men, HPV was detected in 98.5% patients. HPV 6 and/or HPV 11 were the most frequent genotypes (87.5%), and HPV 16 the most common HR‐HPV (9.2%). Infection with HPV 6/11 and any HR‐HPV was observed in 35.8% patients. HPV prevalence on the anal canal and oral mucosa was 83.1% and 15.0%, respectively. Conclusion Incident AGWs were more frequent in males than in females. LR‐HPVs were more common among males and HR‐HPVs among females. HPV 6 and 11 were the most common genotypes on both genders. However, there was also a high prevalence of HR‐HPVs, particularly of HPV 16. AGWs represent a clinical marker of both anal and oral HPV infections, including anal HR‐HPV infections in women and men who have sex with men. The HERCOLES study could be a clue to further investigations concerning HPV burden of disease by gender and sexual behaviour.