Clinical and serological manifestations of genital human papillomavirus infection.

Abstract

Efficacy of chemical and/or surgical treatment for penile and anal condylomata acuminata was investigated in two retrospective studies of hetero- and homosexual men. Variation in clinical features and symptomatology as well as the reliability of diagnostic criteria by different methods for acetowhite penile lesions was also studied. Furthermore, the antibody response in the course of penile wart disease as well as in asymptomatic genitoanal papillomavirus infection (GPVI) was analysed. In the first retrospective study, as much as 23% of patients still had condylomas after one year of chemical and/or surgical treatment. On the other hand, 38% were cured after a single treatment session. In the group mainly with anal warts, concurrent penile warts were significantly more common among heterosexual men compared to homosexual men (p < 0.001), while intra-anal wart growth was more common among the homosexual males (p < 0.001). When comparing diagnostic methods for subclinical penile HPV infection, conventional histopathology appeared to be the most valuable diagnostic aid to penoscopy, while the additional use of Southern blot, in situ hybridisation and PCR assays for HPV DNA detection did not increase the predictive value of GPVI. We also describe a new distinct clinical entity, HPV-associated balanoposthitis, comprising a wide range of often long-lasting symptoms, such as itching, burning and dyspareunia. A significant increase in the IgG antibody response against defined epitopes in the L1 and L2 capsid proteins of HPV 6, was found among men with previous condylomata. By following a cohort of STD clinic patients with multiple brush samples from the genitoanal region as well as serum samples taken at several consecutive clinical visits, we identified 16 patients who had seroconverted to HPV seropositivity during follow-up. Antibody responses to several HPV-derived peptide and protein antigens were induced at the same time. Seroconversions were usually seen concomitantly with HPV acquisition or at the visit after HPV DNA was first detected. The HPV antibody response was frequently transient and declined or disappeared after clearance of infection. The antibody responses were induced by several different HPV types, indicating limited type-specificity. The most type-restricted response was against HPV 16 capsids, where seroconversions to continuous seropositivity were induced by infection with HPV 16.