Clinical relevance and evaluation of genitoanal papilloma virus infection in the male.

In the light of current epidemiological data, demonstrating a high prevalence of genitoanal papilloma virus infection (GPVI) existing merely in a subclinical or latent form, ambiguity has emanated on the level of ambition that should be considered optimal for the management of GPVI in the male. This review addresses a pragmatic approach to the problem, with an emphasis on diagnosing and treating overt condylomas causing psychosexual disturbance because of the growth of disfiguring but medically rather innocent condylomas, and of flat acetowhite lesions that cause symptoms such as itching, burning, and dyspareunia. The evaluation of children afflicted with genitoanal warts is elucidated. The significance of intraepithelial neoplastic transformation associated with high-risk human papillomavirus (HPV) types such as HPV 16 is discussed, with reference to immunocompetent and immunosuppressed men. Although unequivocal histopathological signs of HPV influence often are absent, conventional light microscopy is usually adequate for differential diagnostic evaluation in clinical routine. In situ hybridization for the detection of HPV DNA may improve histopathologic accuracy.