OBJECTIVE: To compare the accuracy of different diagnostic methods and their use in estimating the prevalence of genital human papillomavirus (HPV) infections in males attending a urological clinic. MATERIAL AND METHODS: The study population was derived from a series of 1,153 consecutive males attending a urological clinic in São Paulo between January 1996 and November 1998. Of these 1,153 males, 334 had clinically suspected genital HPV infection and comprised the study cohort. The diagnostic methods used included peniscopy, directed biopsy and HPV detection by means of the Hybrid Capture 2 (HC) assay for both oncogenic and non-oncogenic HPV types. RESULTS: Peniscopy was performed for 297 males, positive results being reported in 237 cases (79.8%). Directed biopsy was performed in 188 males, and histology suggested HPV in 140 of these cases (74.5%). HC confirmed the presence of HPV in only 35.2% of the histologically HPV-suggestive cases. Peniscopy has good sensitivity for identifying male carriers of genital HPV. However, the technique has an inherent low specificity, limiting its usefulness to the correct identification of those who never present with HPV infection. Characteristic histological alterations are useful in suggesting HPV infection, but their correlation with HPV detection using HC is not particularly good. CONCLUSIONS: These data suggest that both histology and peniscopy have low specificity in detecting male genital HPV. Accurate diagnosis of HPV infection can be confirmed by molecular detection methods only. Histology, however, plays an important role in the differential diagnosis. An appropriate diagnostic protocol for male genital HPV infections in a urological clinic should include peniscopy, histology and molecular diagnostic tools (HC or polymerase chain reaction).
OBJECTIVE: To compare the accuracy of different diagnostic methods and their use in estimating the prevalence of genital human papillomavirus (HPV) infections in males attending a urological clinic. MATERIAL AND METHODS: The study population was derived from a series of 1,153 consecutive males attending a urological clinic in São Paulo between January 1996 and November 1998. Of these 1,153 males, 334 had clinically suspected genital HPV infection and comprised the study cohort. The diagnostic methods used included peniscopy, directed biopsy and HPV detection by means of the Hybrid Capture 2 (HC) assay for both oncogenic and non-oncogenic HPV types. RESULTS: Peniscopy was performed for 297 males, positive results being reported in 237 cases (79.8%). Directed biopsy was performed in 188 males, and histology suggested HPV in 140 of these cases (74.5%). HC confirmed the presence of HPV in only 35.2% of the histologically HPV-suggestive cases. Peniscopy has good sensitivity for identifying male carriers of genital HPV. However, the technique has an inherent low specificity, limiting its usefulness to the correct identification of those who never present with HPV infection. Characteristic histological alterations are useful in suggesting HPV infection, but their correlation with HPV detection using HC is not particularly good. CONCLUSIONS: These data suggest that both histology and peniscopy have low specificity in detecting male genital HPV. Accurate diagnosis of HPV infection can be confirmed by molecular detection methods only. Histology, however, plays an important role in the differential diagnosis. An appropriate diagnostic protocol for male genital HPV infections in a urological clinic should include peniscopy, histology and molecular diagnostic tools (HC or polymerase chain reaction).