Pediatric UrologyHigh-risk Oncogenic Human Papilloma Virus Infection of the Foreskin and Microbiology of Smegma in Prepubertal Boys
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
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Financial Disclosure: The authors declare that they have no relevant financial interests.