MALE SEXUAL-BEHAVIOR AND HUMAN PAPILLOMAVIRUS DNA - KEY RISK-FACTORS FOR CERVICAL-CANCER IN SPAIN

Background: It is now established that certain types of human papillom aviruses (HPVs) are the sexually transmitted agents etiologically link ed to cervical cancer. Studies assessing the contribution of the male' s sexual behavior and genital HPV DNA status to the risk of developmen t of cervical neoplasia in sexual partners have yielded inconsistent r esults, Purpose: This study evaluates the role of men's sexual behavio r and the presence of HPV DNA in the penis on the development of cervi cal cancer in their sexual partners in Spain, a low-risk area for cerv ical neoplasia, Methods: Husbands (n = 633) of women participating in two case-control studies of cervical neoplasia were interviewed to obt ain information on lifestyle habits, including sexual practices, Cytol ogic samples were taken from the distal urethra and the surface of the glans penis of 183 husbands of case women and of 171 husbands of cont rol women. These samples were analyzed by a polymerase chain reaction- based system using a generic probe and 25 type-specific probes for the detection and typing of HPV DNA. Serologic specimens were also obtain ed and analyzed for antibodies to Chlamydia trachomatis, Treponema pal lidum, herpes simplex virus type II, and Neisseria gonorrhoeae, Result s: The presence of HPV DNA in the husbands' penis conveyed a fivefold risk of cervical cancer to their wives (adjusted odds ratio [OR] for H PV DNA positivity = 4.9; 95% confidence interval [CI] = 1.9-12.6), The risk of cervical cancer was strongly related to HPV type (adjusted OR for HPV type 16 = 9.0; 95% CI = 1.1-77.5), to the husbands' number of extramarital partners (adjusted OR = 11.0; 95% CI = 3.0-30.0; for gre ater than or equal to 21 women versus one), and to the number of prost itutes as extramarital sexual partners (adjusted OR = 8.0; 95% CI = 2. 9-22.2; for greater than or equal to 10 women versus none), Presence o f antibodies to C. trachomatis (adjusted OR = 2.6; 95% CI = 1.4-4.6) a nd an early age at first sexual intercourse of the husband (adjusted O R = 3.2; 95% CI = 1.7-5.9; for less than or equal to 15 years versus g reater than or equal to 21 years) were also associated with cervical n eoplasia in the wife, After adjustment for these variables and for the wife's pack-years of smoking, the husband's smoking was moderately as sociated with cervical cancer in his wife (adjusted OR = 2.5; 95% CI = 1.4-4. 1; for greater than or equal to 26.2 pack-years versus none), Conclusions: The study supports the role of men as vectors of the HPV types that are related to cervical cancer, Lifetime number of female s exual partners, number of female prostitutes as sexual partners, and d etection of HPV DNA in the penis of husbands are all surrogate markers of exposure to HPV during marriage, Implications: Men who report mult iple sexual partners or who are carriers of HPV DNA may be vectors of high-risk HPV types and may place their wives at high risk of developi ng cervical cancer, Prostitutes are an important reservoir of high-ris k HPVs.