Prevalence and concordance of high-risk papillomavirus infection in male sexual partners of women diagnosed with high grade cervical lesions | Enfermedades Infecciosas y Microbiología Clínica (English Edition)

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array:1 [ 0 => "elena.lopez.diez@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Sonia" "apellidos" => "Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Amparo" "apellidos" => "Iñarrea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Angel" "apellidos" => "de la Orden" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Máximo" "apellidos" => "Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Sheila" "apellidos" => "Almuster" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 6 => array:3 [ "nombre" => "Leonardo" "apellidos" => "Tortolero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 7 => array:3 [ "nombre" => "Moises" "apellidos" => "Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 8 => array:3 [ "nombre" => "Ruben" "apellidos" => "Montero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 9 => array:3 [ "nombre" => "Antonio" "apellidos" => "Ojea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Urology, University Hospital of Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Microbiology, University Hospital of Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Obstetrics and Gynecology, University Hospital of Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prevalencia y concordancia de infección por papilomavirus de alto riesgo en las parejas sexuales masculinas de mujeres diagnosticadas de lesiones cervicales de alto grado" ] ] "textoCompleto" => "BackgroundHuman papillomavirus infection (HPV) is estimated to be the most common sexual transmitted infection.<a class="elsevierStyleCrossRef" href="#bib0185">1</a> Although these infections are typically transient and asymptomatic, some of them will result in anogenital warts, dysplastic and/or neoplastic lesions, which cause a substantial disease burden in both sexes and generate a considerable economic distress within societies.<a class="elsevierStyleCrossRef" href="#bib0190">2</a> Most infections are asymptomatic or subclinical and become undetectable over time.<a class="elsevierStyleCrossRef" href="#bib0195">3</a>There has been immense progress in understanding the natural history of HPV infection in women disease. Recently there has been an interest in understanding the relationship between HPV infection and disease in men.<a class="elsevierStyleCrossRef" href="#bib0200">4</a>Epidemiological studies show that high-risk (HR) HPV infection is necessarily the sexual transmitted cause of invasive cervical cancer and its precursor lesion, cervical intraepithelial neoplasia (CIN).<a class="elsevierStyleCrossRef" href="#bib0205">5</a> There are no consistent data on the natural history of HPV in the male population even though these viruses are prevalent in males.<a class="elsevierStyleCrossRef" href="#bib0210">6</a> Bosch et al.<a class="elsevierStyleCrossRef" href="#bib0215">7</a> assessed the contribution of the males’ genital HPV DNA status to the risk of development cervical neoplasia in their sexual partners, confirming their hypothesis that men could be vectors of HPV types typically found in cervical cancer. Presence of HR-HPV in the husbands’ penis conveys a 5-fold risk of cervical cancer to their wives.<a class="elsevierStyleCrossRef" href="#bib0220">8</a> Some studies have demonstrated a higher risk of cervical cancer among second wives of men whose previous wife died of cervical cancer.<a class="elsevierStyleCrossRef" href="#bib0225">9</a> It has been recognized widely that the risk of infection is associated with sexual behavior.<a class="elsevierStyleCrossRef" href="#bib0230">10</a> Nevertheless, the biology and dynamics of HPV transmission among sexual partners (SP) is still a cause for debate and have not already been completely established. The gap may be due to the limited number of studies on HPV male genital infections. A better understanding of HPV infection in men is an essential component of prevention programs aimed to reduce cervical cancer and other HPV related diseases.<a class="elsevierStyleCrossRef" href="#bib0235">11</a>Earlier studies of HPV infection in men used a variety of clinical and histological techniques to establish a diagnosis, but polymerase chain reaction (PCR) has emerged as the most sensitive available method for the detection of latent HPV infection.<a class="elsevierStyleCrossRef" href="#bib0240">12</a> The infectious diseases literature supports the lack of the Food and Drug Administration (FDA) approval of HPV tests for HPV detection in men and the absence of adequate therapy for established HPV infection in this population.<a class="elsevierStyleCrossRef" href="#bib0245">13</a> Although routine HPV testing is not necessary for men in general population, findings from emerging research in high-risk population suggest that HPV infection is pervasive and persistent in these groups, warranting the adoption of additional screening measures.<a class="elsevierStyleCrossRef" href="#bib0195">3</a>The aims of the present study were: (a) to investigate HR-HPV prevalence and genotype distribution in men, sexual partners of women presenting high-grade cervical intraepithelial neoplasia (HG-CIN) according to several epidemiological characteristics and (b) to assess type-specific concordance between partners.Materials and methodsPopulationA cross-sectional study was conducted by the Urology Department of the University Hospital of Vigo, Spain from January 2013 to June 2015. We recruited 125 asymptomatic men, more than 18 years old, whose SP (regular sexual intercourse for more than 1 year) had presented high grade squamous cervical lesions (cervical intraepithelial neoplasia (CIN) grade 2 (n=55) or CIN grade 3-carcinoma in situ (n=70)) in the previous 6 months. A stable relationship was defined as a duration of longer than 6 months, regardless of sexual intercourse with other partners. Women were diagnosed by cytology, colposcopy and histological examination in this time and HPV detection was performed when possible (n=120). Men were invited to fill in a questionnaire on life-style habits, including sexual behavior (SB). The delay between treatment (conization) of high grade cervical lesions and sampling of men for virological studies was less than 3 months. Penile scraping was obtained and submitted to the PCR assay in order to identify HPV carriers although there are no licensed tests for HPV detection in men and there are no recommendations for male screening. The study protocol (cod. 2013/470) received approval from the ethics committee of clinical investigation of Galicia (Santiago de Compostela, Spain). Information concerning the research project was provided to all participants. Because the significance of a positive HPV test in men is unknown, study personnel spent a considerable amount of time educating men about HPV. We explained that a positive test for the virus do not necessarily put them at risk for disease. Written informed consent was obtained from all patients (male and female partner). Participants did not receive incentive for study involvement. Women and men were not vaccinated against HPV previously to the inclusion in this study.Specimen collectionThree dry cytobrush for each male were used to scrape the genitalia in order to collect exfoliated cells from different penile areas: the dorsal and ventral area of the penile, external and internal surface of prepuce, coronal sulcus, glans and distal urethra. The three samples were combined and collected into one single vial containing TE buffer pH 8.0 Molecular Biology grade (AppliChem GmbH, Darmstadt, Germany). Samples were maintained at 2–8°C and processed within 24–72h after collection.Epidemiological surveyThe following variables were obtained by questionnaire in male: age, age at first sexual intercourse (FSI), number of SP in the year preceding the study, number of SP up to date of the study and tobacco use.HPV DNA detection and genotypingDNA was isolated using QIAamp MinElute Media Kit (Qiagen, Hilden, Germany). The extracted nucleic acids were stored at −20°C. An aliquot of the original sample was also stored at −20°C. Amplification and detection were carried out using the Linear Array HPV Genotyping Test (Linear Array. Roche Diagnostics, Mannheim, Germany) according to the manufacturer's instructions. We described the distribution of 21 HR-HPV genotypes classified as HR (HR-HPV, IARC Group 1 carcinogens) or probable/possible HR (pHR-HPV, IARC Group 2A/B carcinogens) by the International Agency for Research on Cancer Monograph Working Group<a class="elsevierStyleCrossRef" href="#bib0250">14</a> (HPV16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 67, 68, 69, 70, 73, 82 – including IS39 subtype). This test also detects human beta-globin in order to control the sample adequacy and quality as well as success in DNA extraction and PCR (internal control). Linear array does not have individual probe for HPV52 but uses a probe that simultaneously detects HPV52, 33, 35 and 58. Additional specific PCR was performed in case of HPV33, 35 and/or 58 infection in order to properly detect confection of these three genotypes with HPV52.<a class="elsevierStyleCrossRef" href="#bib0255">15</a>Data analysisEpidemiological men characteristics were described overall, stratified by HPV infection and histological diagnosis of their partner. For all calculations of means, standard deviation was calculated. The association between age at first sexual intercourse and HPV infection was evaluated using t-Student test. Qualitative variables were compared using the chi-square test. Multivariate logistic regression analysis was used to evaluate the factors independently associated with the detection of HR-HPV infection in male by use Step-Wise Logistic regression models. Only variables with p≤0.1 in the bivariate analysis were included in the multivariate analysis. Odds ratio (OR) and their 95% confidence interval (CI) were calculated. Type specific concordance analysis among the couples in which both partners were HPV positive was performed and kappa value was calculated. Data were analyzed using SPSS version 19.0 for Windows IBM, Chicago, USA. A p value <0.05 were considered statistically significant.ResultsA total of 125 men were included. Average age of men was 38.2±8.9 years old; 80% were younger than 45 years old. Human beta-globin was detected in all cases. Prevalence of HR-HPV infection in men was 50.4% (63/125). Multiple HR-HPV infections were detected in 30.4% (38/125) of this population. HPV16 was detected in 47.6% (30/63) of infected men. The most frequently detected genotypes were HPV16, HPV53, HPV52, HPV51, HPV66 and HPV31. Their prevalence is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Average age of woman was 35.3±8.4. The 87.2% were younger than 45 years old. Histological diagnoses of women were: CIN2 (n=55), CIN3-CIS (n=70). Data of HPV genotype were available in 120 women. HPV16 was detected in 67.5% (81/120) women. HR-HPV infection was detected in both partners in 50% (60/120). Among these infected couples, 62% (37/60) harbored at least one genotype in common. The HPV16 specific concordance was: 41.7% (25/60) couples were concordantly HPV16 positive and 18.3% (11/60) were concordantly HPV16 negative (kappa value: 0.21).The proportion of women with the same genotype as their male partner was 58.7% (37/63). The proportion of men sharing the same genotype as their female partner was 30.8% (37/120), p<0.0001.Epidemiological characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Current smoking status was associated with an increased risk for HR-HPV infection in men: 38.2% (21/55) vs 60% (42/70), OR 2.3 (95% CI 1.1–4.7), p=0.016.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionThe hypothesis of this study was that men sexual partners of women presenting HG-CIN may be at high risk for HPV infection; therefore this population could be an important HR-HPV reservoir. HR-HPV infection was prevalent in half male partners in this study. This data falls within the range reported in other studies for sexual partners of women with CIN (30–68%).<a class="elsevierStyleCrossRefs" href="#bib0220">8,16–19</a> Bosch et al. have reported 20 years before a low HPV prevalence (17.5%)<a class="elsevierStyleCrossRef" href="#bib0215">7</a> in a similar population, that could be related with different sampling or HPV detection methods.<a class="elsevierStyleCrossRef" href="#bib0280">20</a> Franceschi et al.<a class="elsevierStyleCrossRef" href="#bib0285">21</a> showed the strongest variation by countries, with a higher prevalence of HPV infection among Brazilian SP of woman with CIN compared with those detected in other countries (Colombia, Mexico, Spain). Differences in HPV prevalence by population and country reported in review articles<a class="elsevierStyleCrossRefs" href="#bib0280">20,22</a> support that local epidemiological studies are necessary.As found in previous reports<a class="elsevierStyleCrossRefs" href="#bib0290">22–24</a> age did not influence genital HR-HPV prevalence in this population of men younger than 45 years old.In the present study, HPV16 was the most frequent genotype as found in men in literature.<a class="elsevierStyleCrossRefs" href="#bib0215">7,19,20,24–26</a> The most prevalent genotype in women was also HPV16, as reported in women with diagnosis of high-grade squamous intraepithelial cervical lesions, especially in women younger than 45 years old.<a class="elsevierStyleCrossRefs" href="#bib0315">27,28</a> Among HR-HPV, HPV52 was the second most frequent genotype in this population of women.In terms of HR-HPV detection, the percentage of couples (50%) harboring HR-HPV is similar to that reported by others (32–65%).<a class="elsevierStyleCrossRefs" href="#bib0275">19,25,29,30</a> In couples where both members were HPV-positive, more than 60% were infected with one or more of the same HPV types. This level of concordance was observed before, independently of HPV prevalence and is consistent with the high transmissibility of HPV.<a class="elsevierStyleCrossRefs" href="#bib0295">23,25,29–31</a> Although HPV16 was detected in a high proportion of infected couples (more than 40%), it is remarkable that HPV16 specific concordance was weak, mainly due to other HPV genotypes detected in partners of women infected by HPV16. The proportion of women with the same genotype as their male partner was higher (almost double) than the proportion of men sharing the same genotype as their female partner. These findings suggest that the epithelial cells of the penile skin are more resistant to HPV infection than the cervical epithelium and the duration of HPV infection is shorter in men than in women.<a class="elsevierStyleCrossRefs" href="#bib0295">23,29</a>Limited data exist on the association between HPV infection and smoking in men. In this study current smoking could increase 2.3-fold the risk of HPV prevalent infection in males. These results are similar to the HIM study.<a class="elsevierStyleCrossRef" href="#bib0185">1</a> At present, it is unclear how smoking may influence HPV infection in men, but many possible mechanisms exist. Smoking could potentially increase viral load by weakening the cellular immune response.<a class="elsevierStyleCrossRef" href="#bib0340">32</a>Sexual behavior has been strongly associated with HPV infection and seropositivity in men.<a class="elsevierStyleCrossRef" href="#bib0245">13</a> Features previously associated with HR-HPV were: young age at first sexual intercourse (FSI), a higher number of lifetime sexual partners (LSP) and a higher number of recent SP. In the National Questionnaire of Sexual Health, published by Spanish Government in 2009, it was found that mean age of FSI was 17–18 years old (29.3%) for Spanish men. In this study, younger age at FSI was not a risk factor for HPV infection as other authors have previously reported.<a class="elsevierStyleCrossRef" href="#bib0270">18</a> There are contradictory data that could be attributable not only to the range of birth year of men but also to geographical characteristics.<a class="elsevierStyleCrossRef" href="#bib0345">33</a>Having one or more SP in the preceding year was not related to HPV infection. This variable has been poorly evaluated. The risk of HPV reinfection between a monogamous couple is still a matter of debate.<a class="elsevierStyleCrossRef" href="#bib0350">34</a> In contrast, Rombaldi et al.<a class="elsevierStyleCrossRef" href="#bib0270">18</a> found a high association between both variables. Our data indicate that in this group a risk factor for HPV infection was not lifetime number of SP. Contradictory results about this association were reported.<a class="elsevierStyleCrossRefs" href="#bib0235">11,21,31</a>When lesions are not visible, sampling at multiple penile sites could increase the sensitivity of the HPV.<a class="elsevierStyleCrossRefs" href="#bib0235">11,30</a> Our sampling method, which involved the collection of cells from de skin of the glans penis, coronal sulcus and distal urethra was adequate for HPV identification and yielded a high proportion of beta-globin detection (100%).Research has demonstrated that nonavalent, quadrivalent and bivalent HPV vaccines stimulate immunogenicity in males and females.<a class="elsevierStyleCrossRef" href="#bib0355">35</a> On October 16, 2009, the US Food and Drug Administration (FDA) approved the use of quadrivalent vaccine in males 9–26 years old for the prevention of genital warts. Subsequently, the Advisory Committee on immunization Practices (ACID) declined to recommend the quadrivalent vaccine for routine immunization in men.<a class="elsevierStyleCrossRef" href="#bib0360">36</a> Until 2009 HPV-vaccine programs have not been incorporated for girls and young women in Spain. No vaccinated women were included in this study. We assume that the faster way to achieve greatest protection for cervical cancer and its precursors is to vaccinate males as well as female because both genders contribute to the transmission of HPV-infection. Regardless of vaccination strategies adopted, efforts should be made to educate males about HPV and its health implications.A limitation of the present study is the sample size. Unfortunately, no epidemiological data were provided for the female partners. Thus, we did not know life style habits of women (including sexual behavior) and the history of other sexually transmitted diseases which may influence the risk of infecting their male partners. At the moment, we have not results of the follow-up of the patients and their partners for their HPV status.Further prospective and controlled studies are needed to know how to control viral transmission and to provide adequate counseling to HPV infected SP.ConclusionsThe results of the present study suggest that, within healthy male population, sexual partners of women with high grade cervical lesions have a high prevalence of HR-HPV. Therefore this subpopulation could be maintaining the risk of viral transmission and consequently the risk of recurrence of cervical lesions in their couples. Additional studies focused on the relationship between HPV infected male and HPV reinfection and CIN relapse in their partners are necessary to support the introduction of preventive strategies as men follow up or men vaccination.Authors’ contributionsELD carried out the collection in male, design of study data and drafted the manuscript. SPC performed HPV detection and participated in the study design. AIF carried out the collection in female. All authors read and approved the final manuscript.Conflict of interestThe authors declare no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres838130" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec833867" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec833869" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres838131" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec833868" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Background" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Population" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Specimen collection" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Epidemiological survey" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "HPV DNA detection and genotyping" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Data analysis" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Authors’ contributions" ] 11 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of interest" ] 12 => array:2 [ "identificador" => "xack281669" "titulo" => "Acknowledgements" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-28" "fechaAceptado" => "2016-02-08" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec833867" "palabras" => array:6 [ 0 => "Human papillomavirus DNA test" 1 => "Couples" 2 => "Epidemiology" 3 => "Cervical intraepithelial neoplasia" 4 => "Male" 5 => "Mass screening" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec833869" "palabras" => array:7 [ 0 => "HR-HPV" 1 => "CIN2" 2 => "CIN3-CIS" 3 => "LSP" 4 => "FSI" 5 => "SP" 6 => "SB" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec833868" "palabras" => array:6 [ 0 => "Test VPH-ADN" 1 => "Parejas" 2 => "Epidemiología" 3 => "Neoplasia cervical intraepitelial" 4 => "Varón" 5 => "Cribado poblacional" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundLittle is known about the characteristics of high-risk papillomavirus (HR-HPV) infection in men. The aims of this cross-sectional study were: (a) to investigate HR-HPV prevalence and genotype distribution in men, sexual partners of women presenting with high-grade cervical intraepithelial neoplasia (HG-CIN), according to epidemiological characteristics, and (b) to assess type-specific concordance between partners. MethodsA total of 125 men were recruited within the first 6 months after HG-CIN diagnosis of their partner. Samples from the coronal sulcus, glans penis shaft, and scrotum were tested with linear array HPV genotyping assay (Roche Diagnostics, Mannheim, Germany). Type-specific concordance within 120 couples was studied. Epidemiological factors were evaluated by multivariate logistic regression analysis. SPSS 19 (IBM, Chicago, USA). ResultsThe prevalence of HR-HPV infection in males was 50.4% (63/125). HPV16/53/52/51/66/31 were the most frequent genotypes (24/10.4/9.6/8.8/8/7.2%, respectively). Current smoking was associated with an increased risk for HR-HPV infection in men (38.2% (21/55) vs 60% (42/70), OR 2.4, p=0.025). Among 60 infected couples, 62% shared at least one genotype: 41.7% couples were concordantly HPV16 positive and 18.3% were HPV16 negative (kappa value: 0.21). The proportion of women with the same genotype as their male partner was higher than the proportion of men sharing the same genotype as their female partner: 58.7% (37/63) vs 30.8% (37/120), p<0.0001. ConclusionsSexual partners of women with HG-CIN are a significant reservoir and vector of HPV infection, a fact that could contribute to making viral clearance more difficult to achieve in their partners after treatment of their HG-CIN lesions." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLas características de la infección por papilomavirus de alto riesgo (VPH-AR) en el varón apenas se conocen. Los objetivos de este estudio transversal fueron: (a) investigar la prevalencia de VPH-AR y la distribución de genotipos en varón pareja sexual de mujer con neoplasia intraepitelial cervical de alto grado (CIN-AG) y su epidemiología, y (b) evaluar la concordancia tipo-específica entre parejas. MétodosSe seleccionaron hombres (n=125) en los primeros 6 meses tras el diagnóstico de CIN-AG de su pareja. Se genotiparon muestras del surco coronario, base del glande y escroto (Linear Array, Roche Diagnostics, Mannheim, Alemania). Se estudió la concordancia tipo-específica entre parejas (n=120). Los factores epidemiológicos se evaluaron mediante regresión logística multivariante, SPSS 19 (IBM, Chicago, USA). ResultadosLa prevalencia de VPH-AR en el hombre fue del 50,4% (63/125). VPH16/53/52/51/66/31 fueron los genotipos más frecuentes (24/10,4/9,6/8,8/8/7,2%, respectivamente). El tabaquismo se asoció con un mayor riesgo de infección por VPH-AR en el hombre (38,2% [21/55] vs 60% [42/70], OR 2,4, p=0,025). Entre 60 parejas infectadas, el 62% compartieron al menos un genotipo: el 41,7% fueron concordantes VPH16 positivas y el 18,3% VPH16 negativas (valor kappa: 0,21). La proporción de mujeres con el mismo genotipo que su pareja fue mayor que la de hombres con el mismo genotipo que su pareja: 58,7% (37/63) vs 30,8% (37/120), p<0,0001. ConclusionesLas parejas sexuales de mujeres con CIN-AG constituyen un importante reservorio y vector de infección por VPH; esto podría contribuir a que el aclaramiento viral de sus parejas tras el tratamiento de CIN-AG fuese más difícil de alcanzar." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "HR-HPV, high-risk HPV genotypes; pHR, probable/possible high-risk genotypes; IARC, International Agency for Research on Cancer. Crude HPV prevalence calculated in 63 HPV positive patients: 25 single and 38 multiple infections." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IARC classification \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Genotype \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalence in total population (N=125) % \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalence in HPV positive men (N=63) % \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="11" align="left" valign="top">HR-HPV</td><td class="td" title="table-entry " align="left" valign="top">HPV16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV31 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV52 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="7" align="left" valign="top">pHR-HPV</td><td class="td" title="table-entry " align="left" valign="top">HPV53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV70 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414610.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Type-specific prevalence in HPV positive men." ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "FSI, first sexual intercourse; SP, sexual partners; CIN: cervical intraepithelial neoplasia; CIS, carcinoma in situ.Age was expressed as mean±standard deviation." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HPV detection (n=125)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">p-Value</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Negative \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bivariate analysis \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age at FSI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.9±2.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.4±2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.382 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Lifetime SP</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1–5 SP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (34.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (65.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="middle">0.050</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>5 SP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (55.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (44.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Recent SP</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1 SP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 (49.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (51.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="middle">0.498</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>1 SP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (57.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (42.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">Current smoking</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (60.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (40.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="middle">0.015<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a></td><td class="td" title="table-entry " align="left" valign="top">0.016<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (38.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (61.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(OR 2.3, 95% CI: 1.1–4.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top">CIN grade in partner</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CIN 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (54.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (45.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " rowspan="2" align="char" valign="middle">0.411</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">CIN 3-CIS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (47.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (52.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1414609.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "p<0.05, statistically significant." ] ] ] "descripcion" => array:1 [ "en" => "HPV detection in men according to epidemiological characteristics." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0185" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Smoking and human papillomavirus (HPV) infection in the HPV in men (HIM) study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. 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Prevalence and concordance of high-risk papillomavirus infection in male sexual partners of women diagnosed with high grade cervical lesions

Prevalencia y concordancia de infección por papilomavirus de alto riesgo en las parejas sexuales masculinas de mujeres diagnosticadas de lesiones cervicales de alto grado

Elena López Dieza,

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elena.lopez.diez@sergas.es

Corresponding author.

, Sonia Pérezb, Amparo Iñarreac, Angel de la Ordenc, Máximo Castroa, Sheila Almustera, Leonardo Tortoleroa, Moises Rodrígueza, Ruben Monteroa, Antonio Ojeaa

a Department of Urology, University Hospital of Vigo, Vigo, Pontevedra, Spain

b Department of Microbiology, University Hospital of Vigo, Vigo, Pontevedra, Spain

c Department of Obstetrics and Gynecology, University Hospital of Vigo, Vigo, Pontevedra, Spain

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Human papillomavirus infection &#40;HPV&#41; is estimated to be the most common sexual transmitted infection&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a> Although these infections are typically transient and asymptomatic&#44; some of them will result in anogenital warts&#44; dysplastic and&#47;or neoplastic lesions&#44; which cause a substantial disease burden in both sexes and generate a considerable economic distress within societies&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">2</span></a> Most infections are asymptomatic or subclinical and become undetectable over time&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There has been immense progress in understanding the natural history of HPV infection in women disease&#46; Recently there has been an interest in understanding the relationship between HPV infection and disease in men&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Epidemiological studies show that high-risk &#40;HR&#41; HPV infection is necessarily the sexual transmitted cause of invasive cervical cancer and its precursor lesion&#44; cervical intraepithelial neoplasia &#40;CIN&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a> There are no consistent data on the natural history of HPV in the male population even though these viruses are prevalent in males&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">6</span></a> Bosch et al&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> assessed the contribution of the males&#8217; genital HPV DNA status to the risk of development cervical neoplasia in their sexual partners&#44; confirming their hypothesis that men could be vectors of HPV types typically found in cervical cancer&#46; Presence of HR-HPV in the husbands&#8217; penis conveys a 5-fold risk of cervical cancer to their wives&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">8</span></a> Some studies have demonstrated a higher risk of cervical cancer among second wives of men whose previous wife died of cervical cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">9</span></a> It has been recognized widely that the risk of infection is associated with sexual behavior&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">10</span></a> Nevertheless&#44; the biology and dynamics of HPV transmission among sexual partners &#40;SP&#41; is still a cause for debate and have not already been completely established&#46; The gap may be due to the limited number of studies on HPV male genital infections&#46; A better understanding of HPV infection in men is an essential component of prevention programs aimed to reduce cervical cancer and other HPV related diseases&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Earlier studies of HPV infection in men used a variety of clinical and histological techniques to establish a diagnosis&#44; but polymerase chain reaction &#40;PCR&#41; has emerged as the most sensitive available method for the detection of latent HPV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> The infectious diseases literature supports the lack of the Food and Drug Administration &#40;FDA&#41; approval of HPV tests for HPV detection in men and the absence of adequate therapy for established HPV infection in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a> Although routine HPV testing is not necessary for men in general population&#44; findings from emerging research in high-risk population suggest that HPV infection is pervasive and persistent in these groups&#44; warranting the adoption of additional screening measures&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The aims of the present study were&#58; &#40;a&#41; to investigate HR-HPV prevalence and genotype distribution in men&#44; sexual partners of women presenting high-grade cervical intraepithelial neoplasia &#40;HG-CIN&#41; according to several epidemiological characteristics and &#40;b&#41; to assess type-specific concordance between partners&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Population</span><p id="par0030" class="elsevierStylePara elsevierViewall">A cross-sectional study was conducted by the Urology Department of the University Hospital of Vigo&#44; Spain from January 2013 to June 2015&#46; We recruited 125 asymptomatic men&#44; more than 18 years old&#44; whose SP &#40;regular sexual intercourse for more than 1 year&#41; had presented high grade squamous cervical lesions &#40;cervical intraepithelial neoplasia &#40;CIN&#41; grade 2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41; or CIN grade 3-carcinoma <span class="elsevierStyleItalic">in situ</span> &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;&#41; in the previous 6 months&#46; A stable relationship was defined as a duration of longer than 6 months&#44; regardless of sexual intercourse with other partners&#46; Women were diagnosed by cytology&#44; colposcopy and histological examination in this time and HPV detection was performed when possible &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>120&#41;&#46; Men were invited to fill in a questionnaire on life-style habits&#44; including sexual behavior &#40;SB&#41;&#46; The delay between treatment &#40;conization&#41; of high grade cervical lesions and sampling of men for virological studies was less than 3 months&#46; Penile scraping was obtained and submitted to the PCR assay in order to identify HPV carriers although there are no licensed tests for HPV detection in men and there are no recommendations for male screening&#46; The study protocol &#40;cod&#46; 2013&#47;470&#41; received approval from the ethics committee of clinical investigation of Galicia &#40;Santiago de Compostela&#44; Spain&#41;&#46; Information concerning the research project was provided to all participants&#46; Because the significance of a positive HPV test in men is unknown&#44; study personnel spent a considerable amount of time educating men about HPV&#46; We explained that a positive test for the virus do not necessarily put them at risk for disease&#46; Written informed consent was obtained from all patients &#40;male and female partner&#41;&#46; Participants did not receive incentive for study involvement&#46; Women and men were not vaccinated against HPV previously to the inclusion in this study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Specimen collection</span><p id="par0035" class="elsevierStylePara elsevierViewall">Three dry cytobrush for each male were used to scrape the genitalia in order to collect exfoliated cells from different penile areas&#58; the dorsal and ventral area of the penile&#44; external and internal surface of prepuce&#44; coronal sulcus&#44; glans and distal urethra&#46; The three samples were combined and collected into one single vial containing TE buffer pH 8&#46;0 Molecular Biology grade &#40;AppliChem GmbH&#44; Darmstadt&#44; Germany&#41;&#46; Samples were maintained at 2&#8211;8<span class="elsevierStyleHsp" style=""></span>&#176;C and processed within 24&#8211;72<span class="elsevierStyleHsp" style=""></span>h after collection&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Epidemiological survey</span><p id="par0040" class="elsevierStylePara elsevierViewall">The following variables were obtained by questionnaire in male&#58; age&#44; age at first sexual intercourse &#40;FSI&#41;&#44; number of SP in the year preceding the study&#44; number of SP up to date of the study and tobacco use&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">HPV DNA detection and genotyping</span><p id="par0045" class="elsevierStylePara elsevierViewall">DNA was isolated using QIAamp MinElute Media Kit &#40;Qiagen&#44; Hilden&#44; Germany&#41;&#46; The extracted nucleic acids were stored at &#8722;20<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; An aliquot of the original sample was also stored at &#8722;20<span class="elsevierStyleHsp" style=""></span>&#176;C&#46; Amplification and detection were carried out using the Linear Array HPV Genotyping Test &#40;Linear Array&#46; Roche Diagnostics&#44; Mannheim&#44; Germany&#41; according to the manufacturer&#39;s instructions&#46; We described the distribution of 21 HR-HPV genotypes classified as HR &#40;HR-HPV&#44; IARC Group 1 carcinogens&#41; or probable&#47;possible HR &#40;pHR-HPV&#44; IARC Group 2A&#47;B carcinogens&#41; by the International Agency for Research on Cancer Monograph Working Group<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> &#40;HPV16&#44; 18&#44; 26&#44; 31&#44; 33&#44; 35&#44; 39&#44; 45&#44; 51&#44; 52&#44; 53&#44; 56&#44; 58&#44; 59&#44; 66&#44; 67&#44; 68&#44; 69&#44; 70&#44; 73&#44; 82 &#8211; including IS39 subtype&#41;&#46; This test also detects human beta-globin in order to control the sample adequacy and quality as well as success in DNA extraction and PCR &#40;internal control&#41;&#46; Linear array does not have individual probe for HPV52 but uses a probe that simultaneously detects HPV52&#44; 33&#44; 35 and 58&#46; Additional specific PCR was performed in case of HPV33&#44; 35 and&#47;or 58 infection in order to properly detect confection of these three genotypes with HPV52&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">15</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data analysis</span><p id="par0050" class="elsevierStylePara elsevierViewall">Epidemiological men characteristics were described overall&#44; stratified by HPV infection and histological diagnosis of their partner&#46; For all calculations of means&#44; standard deviation was calculated&#46; The association between age at first sexual intercourse and HPV infection was evaluated using <span class="elsevierStyleItalic">t</span>-Student test&#46; Qualitative variables were compared using the chi-square test&#46; Multivariate logistic regression analysis was used to evaluate the factors independently associated with the detection of HR-HPV infection in male by use Step-Wise Logistic regression models&#46; Only variables with <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;1 in the bivariate analysis were included in the multivariate analysis&#46; Odds ratio &#40;OR&#41; and their 95&#37; confidence interval &#40;CI&#41; were calculated&#46; Type specific concordance analysis among the couples in which both partners were HPV positive was performed and kappa value was calculated&#46; Data were analyzed using SPSS version 19&#46;0 for Windows IBM&#44; Chicago&#44; USA&#46; A <span class="elsevierStyleItalic">p</span> value &#60;0&#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 125 men were included&#46; Average age of men was 38&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;9 years old&#59; 80&#37; were younger than 45 years old&#46; Human beta-globin was detected in all cases&#46; Prevalence of HR-HPV infection in men was 50&#46;4&#37; &#40;63&#47;125&#41;&#46; Multiple HR-HPV infections were detected in 30&#46;4&#37; &#40;38&#47;125&#41; of this population&#46; HPV16 was detected in 47&#46;6&#37; &#40;30&#47;63&#41; of infected men&#46; The most frequently detected genotypes were HPV16&#44; HPV53&#44; HPV52&#44; HPV51&#44; HPV66 and HPV31&#46; Their prevalence is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Average age of woman was 35&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;4&#46; The 87&#46;2&#37; were younger than 45 years old&#46; Histological diagnoses of women were&#58; CIN2 &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#41;&#44; CIN3-CIS &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>70&#41;&#46; Data of HPV genotype were available in 120 women&#46; HPV16 was detected in 67&#46;5&#37; &#40;81&#47;120&#41; women&#46; HR-HPV infection was detected in both partners in 50&#37; &#40;60&#47;120&#41;&#46; Among these infected couples&#44; 62&#37; &#40;37&#47;60&#41; harbored at least one genotype in common&#46; The HPV16 specific concordance was&#58; 41&#46;7&#37; &#40;25&#47;60&#41; couples were concordantly HPV16 positive and 18&#46;3&#37; &#40;11&#47;60&#41; were concordantly HPV16 negative &#40;kappa value&#58; 0&#46;21&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The proportion of women with the same genotype as their male partner was 58&#46;7&#37; &#40;37&#47;63&#41;&#46; The proportion of men sharing the same genotype as their female partner was 30&#46;8&#37; &#40;37&#47;120&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Epidemiological characteristics are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Current smoking status was associated with an increased risk for HR-HPV infection in men&#58; 38&#46;2&#37; &#40;21&#47;55&#41; <span class="elsevierStyleItalic">vs</span> 60&#37; &#40;42&#47;70&#41;&#44; OR 2&#46;3 &#40;95&#37; CI 1&#46;1&#8211;4&#46;7&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;016&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">The hypothesis of this study was that men sexual partners of women presenting HG-CIN may be at high risk for HPV infection&#59; therefore this population could be an important HR-HPV reservoir&#46; HR-HPV infection was prevalent in half male partners in this study&#46; This data falls within the range reported in other studies for sexual partners of women with CIN &#40;30&#8211;68&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;16&#8211;19</span></a> Bosch et al&#46; have reported 20 years before a low HPV prevalence &#40;17&#46;5&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">7</span></a> in a similar population&#44; that could be related with different sampling or HPV detection methods&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">20</span></a> Franceschi et al<span class="elsevierStyleItalic">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> showed the strongest variation by countries&#44; with a higher prevalence of HPV infection among Brazilian SP of woman with CIN compared with those detected in other countries &#40;Colombia&#44; Mexico&#44; Spain&#41;&#46; Differences in HPV prevalence by population and country reported in review articles<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">20&#44;22</span></a> support that local epidemiological studies are necessary&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">As found in previous reports<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">22&#8211;24</span></a> age did not influence genital HR-HPV prevalence in this population of men younger than 45 years old&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In the present study&#44; HPV16 was the most frequent genotype as found in men in literature&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">7&#44;19&#44;20&#44;24&#8211;26</span></a> The most prevalent genotype in women was also HPV16&#44; as reported in women with diagnosis of high-grade squamous intraepithelial cervical lesions&#44; especially in women younger than 45 years old&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">27&#44;28</span></a> Among HR-HPV&#44; HPV52 was the second most frequent genotype in this population of women&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">In terms of HR-HPV detection&#44; the percentage of couples &#40;50&#37;&#41; harboring HR-HPV is similar to that reported by others &#40;32&#8211;65&#37;&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">19&#44;25&#44;29&#44;30</span></a> In couples where both members were HPV-positive&#44; more than 60&#37; were infected with one or more of the same HPV types&#46; This level of concordance was observed before&#44; independently of HPV prevalence and is consistent with the high transmissibility of HPV&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">23&#44;25&#44;29&#8211;31</span></a> Although HPV16 was detected in a high proportion of infected couples &#40;more than 40&#37;&#41;&#44; it is remarkable that HPV16 specific concordance was weak&#44; mainly due to other HPV genotypes detected in partners of women infected by HPV16&#46; The proportion of women with the same genotype as their male partner was higher &#40;almost double&#41; than the proportion of men sharing the same genotype as their female partner&#46; These findings suggest that the epithelial cells of the penile skin are more resistant to HPV infection than the cervical epithelium and the duration of HPV infection is shorter in men than in women&#46;<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">23&#44;29</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Limited data exist on the association between HPV infection and smoking in men&#46; In this study current smoking could increase 2&#46;3-fold the risk of HPV prevalent infection in males&#46; These results are similar to the HIM study&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a> At present&#44; it is unclear how smoking may influence HPV infection in men&#44; but many possible mechanisms exist&#46; Smoking could potentially increase viral load by weakening the cellular immune response&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">32</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Sexual behavior has been strongly associated with HPV infection and seropositivity in men&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a> Features previously associated with HR-HPV were&#58; young age at first sexual intercourse &#40;FSI&#41;&#44; a higher number of lifetime sexual partners &#40;LSP&#41; and a higher number of recent SP&#46; In <span class="elsevierStyleItalic">the National Questionnaire of Sexual</span> Health&#44; published by Spanish Government in 2009&#44; it was found that mean age of FSI was 17&#8211;18 years old &#40;29&#46;3&#37;&#41; for Spanish men&#46; In this study&#44; younger age at FSI was not a risk factor for HPV infection as other authors have previously reported&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> There are contradictory data that could be attributable not only to the range of birth year of men but also to geographical characteristics&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">33</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Having one or more SP in the preceding year was not related to HPV infection&#46; This variable has been poorly evaluated&#46; The risk of HPV reinfection between a monogamous couple is still a matter of debate&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">34</span></a> In contrast&#44; Rombaldi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a> found a high association between both variables&#46; Our data indicate that in this group a risk factor for HPV infection was not lifetime number of SP&#46; Contradictory results about this association were reported&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">11&#44;21&#44;31</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">When lesions are not visible&#44; sampling at multiple penile sites could increase the sensitivity of the HPV&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">11&#44;30</span></a> Our sampling method&#44; which involved the collection of cells from de skin of the glans penis&#44; coronal sulcus and distal urethra was adequate for HPV identification and yielded a high proportion of beta-globin detection &#40;100&#37;&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Research has demonstrated that nonavalent&#44; quadrivalent and bivalent HPV vaccines stimulate immunogenicity in males and females&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a> On October 16&#44; 2009&#44; the US Food and Drug Administration &#40;FDA&#41; approved the use of quadrivalent vaccine in males 9&#8211;26 years old for the prevention of genital warts&#46; Subsequently&#44; the Advisory Committee on immunization Practices &#40;ACID&#41; declined to recommend the quadrivalent vaccine for routine immunization in men&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a> Until 2009 HPV-vaccine programs have not been incorporated for girls and young women in Spain&#46; No vaccinated women were included in this study&#46; We assume that the faster way to achieve greatest protection for cervical cancer and its precursors is to vaccinate males as well as female because both genders contribute to the transmission of HPV-infection&#46; Regardless of vaccination strategies adopted&#44; efforts should be made to educate males about HPV and its health implications&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">A limitation of the present study is the sample size&#46; Unfortunately&#44; no epidemiological data were provided for the female partners&#46; Thus&#44; we did not know life style habits of women &#40;including sexual behavior&#41; and the history of other sexually transmitted diseases which may influence the risk of infecting their male partners&#46; At the moment&#44; we have not results of the follow-up of the patients and their partners for their HPV status&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Further prospective and controlled studies are needed to know how to control viral transmission and to provide adequate counseling to HPV infected SP&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">The results of the present study suggest that&#44; within healthy male population&#44; sexual partners of women with high grade cervical lesions have a high prevalence of HR-HPV&#46; Therefore this subpopulation could be maintaining the risk of viral transmission and consequently the risk of recurrence of cervical lesions in their couples&#46; Additional studies focused on the relationship between HPV infected male and HPV reinfection and CIN relapse in their partners are necessary to support the introduction of preventive strategies as men follow up or men vaccination&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Authors&#8217; contributions</span><p id="par0135" class="elsevierStylePara elsevierViewall">ELD carried out the collection in male&#44; design of study data and drafted the manuscript&#46; SPC performed HPV detection and participated in the study design&#46; AIF carried out the collection in female&#46; All authors read and approved the final manuscript&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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            1 => "CIN2"
            2 => "CIN3-CIS"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Little is known about the characteristics of high-risk papillomavirus &#40;HR-HPV&#41; infection in men&#46; The aims of this cross-sectional study were&#58; &#40;a&#41; to investigate HR-HPV prevalence and genotype distribution in men&#44; sexual partners of women presenting with high-grade cervical intraepithelial neoplasia &#40;HG-CIN&#41;&#44; according to epidemiological characteristics&#44; and &#40;b&#41; to assess type-specific concordance between partners&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 125 men were recruited within the first 6 months after HG-CIN diagnosis of their partner&#46; Samples from the coronal sulcus&#44; glans penis shaft&#44; and scrotum were tested with linear array HPV genotyping assay &#40;Roche Diagnostics&#44; Mannheim&#44; Germany&#41;&#46; Type-specific concordance within 120 couples was studied&#46; Epidemiological factors were evaluated by multivariate logistic regression analysis&#46; SPSS 19 &#40;IBM&#44; Chicago&#44; USA&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The prevalence of HR-HPV infection in males was 50&#46;4&#37; &#40;63&#47;125&#41;&#46; HPV16&#47;53&#47;52&#47;51&#47;66&#47;31 were the most frequent genotypes &#40;24&#47;10&#46;4&#47;9&#46;6&#47;8&#46;8&#47;8&#47;7&#46;2&#37;&#44; respectively&#41;&#46; Current smoking was associated with an increased risk for HR-HPV infection in men &#40;38&#46;2&#37; &#40;21&#47;55&#41; <span class="elsevierStyleItalic">vs</span> 60&#37; &#40;42&#47;70&#41;&#44; OR 2&#46;4&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;025&#41;&#46; Among 60 infected couples&#44; 62&#37; shared at least one genotype&#58; 41&#46;7&#37; couples were concordantly HPV16 positive and 18&#46;3&#37; were HPV16 negative &#40;kappa value&#58; 0&#46;21&#41;&#46; The proportion of women with the same genotype as their male partner was higher than the proportion of men sharing the same genotype as their female partner&#58; 58&#46;7&#37; &#40;37&#47;63&#41; <span class="elsevierStyleItalic">vs</span> 30&#46;8&#37; &#40;37&#47;120&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Sexual partners of women with HG-CIN are a significant reservoir and vector of HPV infection&#44; a fact that could contribute to making viral clearance more difficult to achieve in their partners after treatment of their HG-CIN lesions&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Las caracter&#237;sticas de la infecci&#243;n por papilomavirus de alto riesgo &#40;VPH-AR&#41; en el var&#243;n apenas se conocen&#46; Los objetivos de este estudio transversal fueron&#58; &#40;a&#41; investigar la prevalencia de VPH-AR y la distribuci&#243;n de genotipos en var&#243;n pareja sexual de mujer con neoplasia intraepitelial cervical de alto grado &#40;CIN-AG&#41; y su epidemiolog&#237;a&#44; y &#40;b&#41; evaluar la concordancia tipo-espec&#237;fica entre parejas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se seleccionaron hombres &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>125&#41; en los primeros 6 meses tras el diagn&#243;stico de CIN-AG de su pareja&#46; Se genotiparon muestras del surco coronario&#44; base del glande y escroto &#40;Linear Array&#44; Roche Diagnostics&#44; Mannheim&#44; Alemania&#41;&#46; Se estudi&#243; la concordancia tipo-espec&#237;fica entre parejas &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>120&#41;&#46; Los factores epidemiol&#243;gicos se evaluaron mediante regresi&#243;n log&#237;stica multivariante&#44; SPSS 19 &#40;IBM&#44; Chicago&#44; USA&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de VPH-AR en el hombre fue del 50&#44;4&#37; &#40;63&#47;125&#41;&#46; VPH16&#47;53&#47;52&#47;51&#47;66&#47;31 fueron los genotipos m&#225;s frecuentes &#40;24&#47;10&#44;4&#47;9&#44;6&#47;8&#44;8&#47;8&#47;7&#44;2&#37;&#44; respectivamente&#41;&#46; El tabaquismo se asoci&#243; con un mayor riesgo de infecci&#243;n por VPH-AR en el hombre &#40;38&#44;2&#37; &#91;21&#47;55&#93; <span class="elsevierStyleItalic">vs</span> 60&#37; &#91;42&#47;70&#93;&#44; OR 2&#44;4&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;025&#41;&#46; Entre 60 parejas infectadas&#44; el 62&#37; compartieron al menos un genotipo&#58; el 41&#44;7&#37; fueron concordantes VPH16 positivas y el 18&#44;3&#37; VPH16 negativas &#40;valor kappa&#58; 0&#44;21&#41;&#46; La proporci&#243;n de mujeres con el mismo genotipo que su pareja fue mayor que la de hombres con el mismo genotipo que su pareja&#58; 58&#44;7&#37; &#40;37&#47;63&#41; <span class="elsevierStyleItalic">vs</span> 30&#44;8&#37; &#40;37&#47;120&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Las parejas sexuales de mujeres con CIN-AG constituyen un importante reservorio y vector de infecci&#243;n por VPH&#59; esto podr&#237;a contribuir a que el aclaramiento viral de sus parejas tras el tratamiento de CIN-AG fuese m&#225;s dif&#237;cil de alcanzar&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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        ]
      ]
    ]
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      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HR-HPV&#44; high-risk HPV genotypes&#59; pHR&#44; probable&#47;possible high-risk genotypes&#59; IARC&#44; International Agency for Research on Cancer&#46; Crude HPV prevalence calculated in 63 HPV positive patients&#58; 25 single and 38 multiple infections&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">IARC classification&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Genotype&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalence in total population &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>125&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prevalence in HPV positive men &#40;<span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>63&#41; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="11" align="left" valign="top">HR-HPV</td><td class="td" title="table-entry  " align="left" valign="top">HPV16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">47&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="7" align="left" valign="top">pHR-HPV</td><td class="td" title="table-entry  " align="left" valign="top">HPV53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">HPV73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Type-specific prevalence in HPV positive men&#46;</p>"
        ]
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      1 => array:8 [
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        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">FSI&#44; first sexual intercourse&#59; SP&#44; sexual partners&#59; CIN&#58; cervical intraepithelial neoplasia&#59; CIS&#44; carcinoma <span class="elsevierStyleItalic">in situ</span>&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Age was expressed as mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">HPV detection &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>125&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bivariate analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate analysis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age at FSI</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;382&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Lifetime SP</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#8211;5 SP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;34&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19 &#40;65&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43 &#40;44&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53 &#40;51&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="middle">0&#46;498</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;1 SP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;OR 2&#46;3&#44; 95&#37; CI&#58; 1&#46;1&#8211;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="middle">0&#46;411</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 3-CIS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">33 &#40;47&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">37 &#40;52&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "texto" => "<p id="par0150" class="elsevierStylePara elsevierViewall">We thank Vigo&#44; Spain Research Unit for the statistical analysis and review of the manuscript&#46; We also thank nursery team&#44; especially Carmen Garcia and Carmen Lago&#44; from the Urology Department of the University Hospital of Vigo&#44; for their excellent help in this research&#44; collecting patients&#46; We thank M Consuelo Reboredo from the Gynecology Department and the laboratory technicians of the Microbiology Department of the University Hospital of Vigo&#44; for their support of the study&#46;</p>"
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Article information

ISSN: 2529993X
Original language: English

DOI:10.1016/j.eimce.2017.03.019

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Year/Month	Html	Pdf	Total

2024 November	2	1	3
2024 October	7	3	10
2024 September	16	1	17
2024 August	15	4	19
2024 July	8	4	12
2024 June	9	3	12
2024 May	7	3	10
2024 April	14	13	27
2024 March	14	5	19
2024 February	17	0	17
2024 January	34	2	36
2023 December	15	6	21
2023 November	20	11	31
2023 October	15	1	16
2023 September	17	0	17
2023 August	21	0	21
2023 July	6	3	9
2023 June	8	0	8
2023 May	8	8	16
2023 April	7	0	7
2023 March	11	3	14
2023 February	11	10	21
2023 January	16	3	19
2022 December	25	8	33
2022 November	23	7	30
2022 October	20	6	26
2022 September	16	10	26
2022 August	9	6	15
2022 July	14	3	17
2022 June	8	4	12
2022 May	10	8	18
2022 April	9	5	14
2022 March	12	10	22
2022 February	11	6	17
2022 January	13	11	24
2021 December	13	18	31
2021 November	14	16	30
2021 October	17	13	30
2021 September	9	9	18
2021 August	7	6	13
2021 July	12	10	22
2021 June	21	14	35
2021 May	14	9	23
2021 April	26	11	37
2021 March	11	9	20
2021 February	10	5	15
2021 January	8	10	18
2020 December	10	6	16
2020 November	11	4	15
2020 October	9	5	14
2020 September	13	15	28
2020 August	14	9	23
2020 July	5	7	12
2020 June	6	11	17
2020 May	9	8	17
2020 April	6	5	11
2020 March	7	3	10
2020 February	7	2	9
2020 January	6	2	8
2019 December	15	10	25
2019 November	3	5	8
2019 October	14	5	19
2019 September	5	4	9
2019 August	1	1	2
2019 July	9	7	16
2019 June	15	16	31
2019 May	20	42	62
2019 April	7	25	32
2019 March	1	5	6
2019 February	5	2	7
2019 January	2	5	7
2018 December	1	6	7
2018 November	7	3	10
2018 October	2	5	7
2018 September	12	0	12
2018 August	2	3	5
2018 July	5	4	9
2018 June	4	1	5
2018 May	4	5	9
2018 April	6	3	9
2018 March	5	1	6
2018 February	1	0	1
2018 January	7	1	8
2017 December	6	0	6
2017 November	3	2	5
2017 October	7	0	7

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