Objective-To assess whether there might be an association between geni
tal papillomavirus infection (GPVI) and balanoposthitis. Design-Retros
pective HPV DNA examination of biopsy specimens from 23 men suffering
from balanoposthitis and exhibiting acetowhite lesions that were penos
copically and histologically concurrent with HPV infection. Setting-Th
e STD clinics at Karolinska Hospital and South Hospital, Stockholm, Sw
eden. Participitants-Randomly selected men attending with long-lasting
and/or recurrent penile symptoms and exhibiting a clinical picture of
balanoposthitis, who revealed a penoscopical and histopathological pi
cture of epidermal lesions that were concordant with accepted criteria
for typical or conspicuous GPVI. Asymptomatic controls were selected
retrospectively on the basis of identical penoscopy and histology crit
eria. Results-A history of previous condylomata was obtained in eight
(35%) of 23 men. At penoscopic evaluation tiny condylomatous lesions w
ere observed in five (22%) patients. The in situ hybridisation (ISH) a
ssay using specific probes for the HPV types 6/11, 16/18, 31/33 and 42
was positive in 13/23 (56%) of the patient samples, but in only 26% o
f the 19 control samples. In patient biopsies the oncogenic HPV types
16/18 and/or 31/33 were found in 7/13 samples, whereas HPV 6/11 and/or
42 were present in another six cases. PCR performed on the ten ISH ne
gative patient biopsies, were negative in all cases. Conclusion-Sympto
ms included redness, itching, burning, tenderness, dyspareunia, fissur
ing and in two cases penile oedema and inguinal adenopathy. All patien
ts fulfilled penoscopical and histopathological criteria for HPV infec
tion. We demonstrate some tentative evidence that HPV might be associa
ted with long-lasting balanoposthitis, although our data still are cir
cumstantial for a causative association. The results also elucidate th
e diversity in clinical presentation of GPVI.