AUA 2017: NHANES: Nearly Half of US Men Test Positive for HPV, Yet Vaccination Rates Lag and Recommendations Demur

Boston, MA (UroToday.com) In a recent nationwide sampling of the NHANES* database, almost half of men tested positive for human papilloma virus (HPV). Yet, only a small proportion of young men have received vaccination against HPV, a common sexually transmitted infection (STI) that can lead to genital warts and malignant disease. This underutilization exists despite its availability, a ‘permissive’ vaccination recommendation from the American Committee for Immunization Practices for boys aged 11 to 26 years, and a recently available vaccine against the 4 major strains of HPV.

Aiming to estimate the current prevalence of HPV infection, Robert E. Brannigan, MD, reporting at the May 2017 American Urological Association meeting in Boston, described findings from an analysis of data from the National Health and Nutrition Examination Survey NHANES*, a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations.

The investigators queried the NHANES database for all men aged 18 to 59 years during the years 2013 and 2014. The survey included polymerase chain reaction (PCR) testing of penile swabs against 37 strains of HPV infection. The investigators also collected information about other STIs, HPV vaccination, and circumcision status. HPV infection status was also stratified into those strains known to cause genital warts, (HPV 6 and 11 (LRHPV), and those known to be high-risk, and implicated in penile cancer—namely HPV 16 and 18 (HRHPV). Further, logistic regression analysis was used to evaluate circumcision status with HRHPV, when excluding those subjects who had received HPV vaccination.

The large study involved 1,520 men who provided the requested information on HPV infection and circumcision status. Among the findings: a total of 45.2% of men were positive any strain of HPV infection. LRHPV was present in 2.9% of men, and HRHPV was found in 5.8% of men in the analysis. However, only 7.8% of all men, and 13.4% of men aged 18 to 29 years had received HPV vaccination. And, more than three-quarters of men under analysis – 77.8% -- had been circumcised. (Circumcised men had an increased risk of HRHPV (OR 2.0, p=0.03) but no increased risk of LRHPV (OR 1.05, p=0.9).

The authors’ findings and conclusion point to a possible shortcoming in public health messaging, as although almost half of men tested positive for HPV on penile swab in this nationwide sample, only a small proportion of young men at risk had received vaccination against HPV. And, more men tested positive for the HPV strains that are associated with penile cancer than HPV strains linked to genital warts. 

Interestingly, the researchers pointed out that circumcised men had a two-fold increased risk of high-risk HPV infections.

Daugherty M, et al. HPV prevalence in males in the United States from penile swabs: results from NHANES. 2017 American Urological Association, May 12-16, 2017. Publication MP11-03

* National Health and Nutrition Examination Survey NHANES: a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey combines interviews and physical examinations.

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA



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