Penile HPV prevalence and associated factors among 20-70-year-old men from Gampaha district in Sri Lanka: a community-based study in a lower middle-income country.

BACKGROUND

Human Papillomavirus (HPV) is the leading cause of sexually transmitted infections worldwide. Male HPV infection contributes towards disease burden in males and plays a crucial role in transmission to females. This is especially significant in Lower Middle-Income Countries (LMICs) which bear 90% of the global cervical cancer burden. Most existing data on male HPV prevalence come from high-income countries, yet evidence from LMICs is crucial for informing cost-effective male HPV vaccination and targeted prevention strategies. Present study was conducted to estimate the prevalence of penile HPV infection and to identify factors associated with HPV infection among 20–70-year-old men in Sri Lanka. METHOD: A community-based cross-sectional study was conducted using multi-stage probability-proportionate cluster sampling to recruit 579 participants. Consented study participants were referred to the identified clinic for data and penile swab collection. HPV was detected using PCR with GP5+/GP6 + primers, and positives were confirmed by Sanger sequencing. Chi-square test was used with a significance level of p < 0.05, and bivariable analysis followed by multivariable logistic regression model was conducted to explore possible determinants of HPV infection and calculate Adjusted Odds Ratios (AORs).

RESULTS

Mean age of the study participants was 39.7 years (± SD = 12.5) while mean age of sexual debut was 22.3 years (± SD = 5) and 76.3% (n = 442) were legally or customarily married. Majority were heterosexual (99.1%, n = 574) with 0.9% (n = 5) identifying as bisexual. Prevalence of any HPV genotype was 5.7% (n = 33, 95%CI:3.9–7.9) while high-risk genotype prevalence was 1.7% (n = 10, 95% CI:0.3–3.1) among clinically asymptomatic men. Identified high-risk HPV genotypes included HPV59 (n = 4), HPV16 (n = 3), HPV45 (n = 2) and HPV33 (n = 1). However, HPV18 was not detected. Factors associated with HPV infection after adjusting for confounding factors included having > 1 female partner/s in their lifetime (p = 0.02; AOR: 2.4, 95%CI:1.1–4.9) and pre-marital sexual relationships (p = 0.04; AOR:3.5, 95%CI:1.04–12.1).

CONCLUSION

High-risk sexual behaviours are contributed with HPV infection among males in Sri Lanka. Promoting safe sex practices, along with detection and monitoring of vaccine-preventable HPV genotypes among males, are vital for decision-making for HPV preventive strategies.