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.