Muñoz N, Castellsagué X, Bosch F X, Tafur L, de Sanjosé S, Aristizabal N, Ghaffari A M, Shah K V
Unit of Field and Intervention Studies, International Agency for Research on Cancer, Lyon, France.
J Natl Cancer Inst. 1996 Aug 7;88(15):1068-75. doi: 10.1093/jnci/88.15.1068.
Epidemiologic evidence has been inconclusive in linking men's sexual behavior and genital human papillomaviruses (HPVs) with cervical cancer risk in their sexual partners in areas with a high incidence of cervical cancer.
This study assesses the role of men's sexual behavior and the presence of penile HPV DNA on the risk of their wives' developing cervical neoplasia in an area in Colombia with a high incidence of cervical cancer.
A total of 210 husbands of women with cervical intraepithelial neoplasia grade III (n = 118) or invasive squamous cell carcinoma of the cervix (n = 92) and a total of 262 husbands of women recruited as control subjects (173 and 89, respectively) were interviewed. Questionnaires included detailed information on sexual behavior. Exfoliated cells were obtained from the glans penis and from the distal urethra of the penis. The specimens were analyzed for HPV DNA by use of a polymerase chain reaction-based assay that included a generic probe and 25 type-specific probes. Serum specimens were collected and analyzed for antibodies to Chlamydia trachomatis, Treponema pallidum, herpes simplex virus type II, and Neisseria gonorrhoeae.
Limited education (adjusted odds ratio [OR] = 4.4; 95% confidence interval [CI] = 1.9-9.8; for no schooling versus secondary or higher education) and presence of antibodies to C. trachomatis (adjusted OR = 2.5; 95% CI = 1.5-4.4) in husbands were the only identified risk factors for cervical neoplasia in their wives. The prevalence of HPV DNA in the penis was 25.7% among husbands of case women and 18.9% among husbands of control women (adjusted OR = 1.2; 95% CI = 0.6-2.3). Neither the lifetime number of female sexual partners (adjusted OR = 1.0; 95% CI = 0.4-2.6; for > 50 partners versus one to five) nor the lifetime number of female prostitutes as sexual partners (adjusted OR = 1.2; 95% CI = 0.7-2.0; for > or = 21 prostitutes versus one to five) was associated with the risk of cervical cancer.
Our results are compatible with the hypothesis that in the population of Cali, whose women are at high risk of developing cervical cancer, exposure to HPV among young men is a common occurrence and is mediated by contacts with large numbers of female sexual partners and prostitutes. These widespread sexual practices limit the power of case-control studies to detect significant associations between men's sexual behavior and the cervical cancer risk in their sexual partners. HPV DNA detection in the penis of adult men is a poor reflection of lifetime exposure or of etiologically relevant exposure to HPV. The role of C. trachomatis in cervical carcinogenesis deserves further investigation.
Further research is needed to elucidate the male's role in cervical carcinogenesis in populations at high risk for cervical cancer. HPV DNA prevalence surveys and studies of the natural history of HPV in young men will be of great value.
在宫颈癌高发地区，关于男性性行为和生殖器人乳头瘤病毒（HPV）与性伴侣患宫颈癌风险之间的流行病学证据尚无定论。
本研究评估在哥伦比亚宫颈癌高发地区，男性性行为及阴茎HPV DNA的存在对其妻子发生宫颈肿瘤风险的作用。
共访谈了210名患有宫颈上皮内瘤变III级（n = 118）或宫颈浸润性鳞状细胞癌（n = 92）女性的丈夫，以及262名作为对照受试者女性的丈夫（分别为173名和89名）。问卷包含性行为的详细信息。从阴茎龟头和阴茎远端尿道获取脱落细胞。使用基于聚合酶链反应的检测方法对标本进行HPV DNA分析，该方法包括一个通用探针和25个型特异性探针。收集血清标本并分析沙眼衣原体、梅毒螺旋体、单纯疱疹病毒II型和淋病奈瑟菌的抗体。
丈夫受教育程度有限（调整优势比[OR] = 4.4；95%置信区间[CI] = 1.9 - 9.8；未受过教育与受过中等或更高教育相比）以及丈夫体内存在沙眼衣原体抗体（调整OR = 2.5；95% CI = 1.5 - 4.4）是其妻子发生宫颈肿瘤的仅有的已确定风险因素。病例组女性丈夫阴茎中HPV DNA的患病率为25.7%，对照组女性丈夫为18.9%（调整OR = 1.2；95% CI = 0.6 - 2.3）。女性性伴侣的终生数量（调整OR = 1.0；95% CI = 0.4 - 2.6；> 50个伴侣与1 - 5个相比）以及作为性伴侣的女性妓女的终生数量（调整OR = 1.2；95% CI = 0.7 - 2.0；≥ 21个妓女与1 - 5个相比）均与宫颈癌风险无关。
我们的结果与以下假设相符：在卡利市人群中，其女性患宫颈癌风险较高，年轻男性感染HPV很常见，且是由与大量女性性伴侣和妓女的接触介导的。这些广泛的性行为限制了病例对照研究检测男性性行为与性伴侣患宫颈癌风险之间显著关联的能力。成年男性阴茎中HPV DNA检测并不能很好地反映终生暴露情况或与病因相关的HPV暴露情况。沙眼衣原体在宫颈癌发生中的作用值得进一步研究。
需要进一步研究以阐明在宫颈癌高危人群中男性在宫颈癌发生中的作用。HPV DNA患病率调查以及对年轻男性HPV自然史的研究将具有重要价值。
