Longitudinal patterns of penile human papillomavirus detection among Ugandan men: A prospective sampling study
Date:
08/25/2025
Locations:
Citation:
Feng X, Patel EU, Kigozi G, Gravitt PE, Galiwango RM, Petersen MR, Nalugoda F, Redd AD, Reynolds SJ, Quinn TC, Grabowski MK, Tobian AAR. Longitudinal patterns of penile human papillomavirus detection among Ugandan men: A prospective sampling study. Int J Cancer. 2025 Aug 25. doi: 10.1002/ijc.70107. Epub ahead of print. PMID: 40879263.
Abstract
Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection, yet data on HPV dynamics in African male populations remain limited. We conducted a prospective study of 300 human immunodeficiency virus-negative, sexually active Ugandan men enrolled at circumcision and followed every 6 weeks for 6 months. Penile swabs were collected by clinical staff, and HPV DNA was detected using the Roche polymerase chain reaction-based linear array assay at six time points. We estimated both point and cumulative prevalence of any and high-risk HPV, and assessed empirical and bootstrapped absolute and relative differences to quantify bias from relying solely on baseline testing. The baseline prevalence of any HPV was 49.7%, increasing to 66.0% when cumulative results were considered. Among 27 men with swabs with amplifiable viral or cellular DNA at all six visits, 100% tested positive at least once. HPV detection was often transient: only 6.1% of men with any HPV were consistently positive at all visits. Men who were ever HPV positive reported a younger age at first sex and more sexual partners. Single-timepoint testing significantly underestimated HPV prevalence, with relative biases of 24.7% for any HPV and 40.3% for high-risk HPV. Bootstrap analyses showed that reducing absolute bias to below 5% required two visits for any HPV and three for high-risk HPV, whereas achieving relative bias below 5% required three and five visits, respectively. The results remained consistent in sensitivity analyses that excluded pre-circumcision visits. These findings highlight the limitations of cross-sectional HPV testing and emphasize the importance of repeated sampling for accurate surveillance and vaccine impact assessments in male populations.