Elsevier

Urology

Volume 86, Issue 2, August 2015, Pages 368-372
Urology

Pediatric Urology
High-risk Oncogenic Human Papilloma Virus Infection of the Foreskin and Microbiology of Smegma in Prepubertal Boys

https://doi.org/10.1016/j.urology.2015.04.034Get rights and content

Objective

To evaluate the prevalence and genotypes of human papillomavirus (HPV) infection and microbiological status of the foreskin in asymptomatic prepubertal boys.

Methods

A total of 100 prepubertal healthy boys who underwent a standard circumcision procedure were included in the study. High-risk HPV status was determined by real-time polymerase chain reaction for the genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. The swabs were immediately sent to microbiology laboratory for culture and sensitivity tests.

Results

The median age at the time of surgery was 5.7 years (range, 2 months-9 years). High-risk HPV was detected in 9 foreskins (9%). Positive samples showed are HPV16 (n = 3), 31 (n = 2), 39 (n = 3), and 51 (n = 1). There were a total of 72 organism isolates: 54 gram-positive (75%) and 17 gram-negative (23.6%) bacteria and 1 (1.4%) Candida. The most commonly isolated gram-negative bacterium was Escherichia coli (41.2%), whereas the commonly isolated gram-positive bacterium was Enterecoccus sp. (57.4%).

Conclusion

Our results showed that subclinical high-risk HPV infections are found in the foreskin, which could be a reservoir for HPV-associated diseases, and smegma seems not to be a risk factor for drug-resistant infection in children.

Section snippets

Methods

This study was approved by the local institutional review board. All parents of the subjects provided informed consent. Between 2013 and 2014, 100 healthy boys who had undergone standard circumcision under local or general anesthesia enrolled in the study. The reasons for circumcision were primary phimosis and religious. A detailed physical examination was performed for all. The boys who were proved to have experienced sexual abuse were excluded from the present study. During the surgery, the

Results

The median age at the time of surgery was 5.7 years (range, 2 months-9 years). Three (3%) of them were aged <6 months. There were no pathologic features in the anogenital region of any of the subjects during their genital examination. Phimosis was detected in 55 (55%) of the children. High-risk HPV was detected in 9 foreskins (9%). Positive samples showed are HPV16 (n = 3), 31 (n = 2), 39 (n = 3), and 51 (n = 1; Table 1). No associations of high-risk HPV infection with age were found.

Smegma

Comment

In this study, we found high-risk HPV infection of the foreskin in 9% of boys. There are 2 same-age study groups in the international literature. In the study by Verit et al,12 there were 30 foreskins from boys with a mean age of 8.1 years (range, 4-11 years) who underwent circumcision. High-risk HPV was reported in 25 (83.3%) of the 30 subjects. HPV genotypes were stratified in 3 groups. None of the patients was positive for group 2 genotypes (HPV31, 33, 45, 52, and 58); 1 (3%) was positive

Conclusion

Our results showed that subclinical infection with high-risk HPV is found in the foreskin of some boys, which could be a reservoir for HPV-associated diseases, and circumcision reduced this risk. Because the human foreskin seems to be an HPV reservoir, vaccination may be also advised in uncircumcised boys. Further study is needed to determine how male circumcision affects HPV incidence and clearance by specific anatomic subsite and HPV types. On the other hand, smegma in the preputial space of

References (24)

  • D.M. Backes et al.

    Systematic review of human papillomavirus prevalence in invasive penile cancer

    Cancer Causes Control

    (2009)
  • A.L. Cubilla et al.

    The basaloid cell is the best tissue marker for human papillomavirus in invasive penile squamous cell carcinoma: a study of 202 cases from Paraguay

    Am J Surg Pathol

    (2010)
  • Cited by (0)

    Financial Disclosure: The authors declare that they have no relevant financial interests.

    View full text