Circumcision and Human Papillomavirus Infection in Men: A Site-Specific Comparison

(See the editorial commentary by Chin-Hong, on pages 781–3.) Background. Lack of circumcision has been identified as a risk factor for male genital human papillomavirus (HPV) infection, although this association has not been consistently supported. Methods. Specimens for HPV testing were collected from a cohort of 379 (primarily heterosexual) adult males. HPV prevalence in the glans penis and coronal sulcus, penile shaft, scrotum, semen, and urine was compared by circumcision status. Results. Overall, HPV DNA prevalence ranged from 6 % in semen to 52 % in the penile shaft. The prevalence of anyHPV infection in the glans/coronawas significantly higher in uncircumcisedmen (46%) than in circumcisedmen (29%) (odds ratio [OR], 1.96 [95 % confidence interval {CI}, 1.02–3.75], adjusted for demographic characteristics and sexual history). Uncircumcised men also had an increased risk of oncogenic HPV infection (adjusted OR, 2.51 [95% CI, 1.11-5.69]) and infection with multiple HPV types (adjusted OR, 3.56 [95 % CI, 1.50–8.50]). Among uncircum-cised men, HPV prevalence in the foreskin (44%) was comparable to that in the glans/corona, and type-specific positivity was observed between the 2 sites ( 0.52). Conclusions. Uncircumcised men have an increased risk of HPV infection, including with oncogenic HPV, specifically localized to the glans/corona, possibly because of its proximity to the foreskin, which may be particularl