Bosch F X, Castellsagué X, Muñoz N, de Sanjosé S, Ghaffari A M, González L C, Gili M, Izarzugaza I, Viladiu P, Navarro C, Vergara A, Ascunce N, Guerrero E, Shah K V
Servei d'Epidemiologia i Registre del Càncer, L'Hospitalet de Llobregat, Barcelona, Spain.
J Natl Cancer Inst. 1996 Aug 7;88(15):1060-7. doi: 10.1093/jnci/88.15.1060.
It is now established that certain types of human papillomaviruses (HPVs) are the sexually transmitted agents etiologically linked to cervical cancer. Studies assessing the contribution of the male's sexual behavior and genital HPV DNA status to the risk of development of cervical neoplasia in sexual partners have yielded inconsistent results.
This study evaluates the role of men's sexual behavior and the presence of HPV DNA in the penis on the development of cervical cancer in their sexual partners in Spain, a low-risk area for cervical neoplasia.
Husbands (n = 633) of women participating in two case-control studies of cervical neoplasia were interviewed to obtain information on lifestyle habits, including sexual practices. Cytologic samples were taken from the distal urethra and the surface of the glans penis of 183 husbands of case women and of 171 husbands of control women. These samples were analyzed by a polymerase chain reaction-based system using a generic probe and 25 type-specific probes for the detection and typing of HPV DNA. Serologic specimens were also obtained and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae.
The presence of HPV DNA in the husbands' penis conveyed a fivefold risk of cervical cancer to their wives (adjusted odds ratio [OR] for HPV DNA positivity = 4.9; 95% confidence interval [CI] = 1.9-12.6). The risk of cervical cancer was strongly related to HPV type (adjusted OR for HPV type 16 = 9.0; 95% CI = 1.1-77.5), to the husbands' number of extramarital partners (adjusted OR = 11.0; 95% CI = 3.0-40.0; for > or = 21 women versus one), and to the number of prostitutes as extramarital sexual partners (adjusted OR = 8.0; 95% CI = 2.9-22.2; for > or = 10 women versus none). Presence of antibodies to C. trachomatis (adjusted OR = 2.6; 95% CI = 1.4-4.6) and an early age at first sexual intercourse of the husband (adjusted OR = 3.2; 95% CI = 1.7-5.9; for < or = 15 years versus > or = 21 years) were also associated with cervical neoplasia in the wife. After adjustment for these variables and for the wife's pack-years of smoking, the husband's smoking was moderately associated with cervical cancer in his wife (adjusted OR = 2.5; 95% CI = 1.4-4.4; for > or = 26.2 pack-years versus none).
The study supports the role of men as vectors of the HPV types that are related to cervical cancer. Life-time number of female sexual partners, number of female prostitutes as sexual partners, and detection of HPV DNA in the penis of husbands are all surrogate markers of exposure to HPV during marriage.
Men who report multiple sexual partners or who are carriers of HPV DNA may be vectors of high-risk HPV types and may place their wives at high risk of developing cervical cancer. Prostitutes are an important reservoir of high-risk HPVs.
现已确定，某些类型的人乳头瘤病毒（HPV）是与宫颈癌病因相关的性传播病原体。评估男性性行为和生殖器HPV DNA状态对性伴侣宫颈肿瘤发生风险影响的研究结果并不一致。
本研究评估在西班牙这个宫颈肿瘤低风险地区，男性性行为及阴茎中HPV DNA的存在对其性伴侣宫颈癌发生的作用。
对参与两项宫颈肿瘤病例对照研究的女性的丈夫（n = 633）进行访谈，以获取包括性行为在内的生活习惯信息。从183例病例女性的丈夫和171例对照女性的丈夫的尿道远端和阴茎龟头表面采集细胞学样本。使用通用探针和25种型特异性探针，通过基于聚合酶链反应的系统对这些样本进行分析，以检测HPV DNA并进行分型。还采集了血清学标本，并分析了沙眼衣原体、梅毒螺旋体、单纯疱疹病毒II型和淋病奈瑟菌的抗体。
丈夫阴茎中存在HPV DNA使其妻子患宫颈癌的风险增加了五倍（HPV DNA阳性的校正比值比[OR] = 4.9；95%置信区间[CI] = 1.9 - 12.6）。宫颈癌风险与HPV类型密切相关（HPV 16型的校正OR = 9.0；95% CI = 1.1 - 77.5），与丈夫的婚外性伴侣数量有关（校正OR = 11.0；95% CI = 3.0 - 40.0；21名及以上女性性伴侣与1名相比），与作为婚外性伴侣的妓女数量有关（校正OR = 8.0；95% CI = 2.9 - 22.2；10名及以上女性性伴侣与无相比）。沙眼衣原体抗体的存在（校正OR = 2.6；95% CI = 1.4 - 4.6）以及丈夫首次性交的年龄较小（校正OR = 3.2；95% CI = 1.7 - 5.9；15岁及以下与21岁及以上相比）也与妻子的宫颈肿瘤有关。在对这些变量以及妻子的吸烟包年数进行校正后，丈夫的吸烟与妻子患宫颈癌有中度关联（校正OR = 2.5；95% CI = 1.4 - 4.4；26.2包年及以上与无相比）。
该研究支持男性作为与宫颈癌相关的HPV类型载体的作用。女性性伴侣的终生数量、作为性伴侣的女性妓女数量以及丈夫阴茎中HPV DNA的检测都是婚姻期间接触HPV的替代标志物。
报告有多个性伴侣或为HPV DNA携带者的男性可能是高危HPV类型的载体，并可能使其妻子患宫颈癌的风险增加。妓女是高危HPV的重要储存宿主。
