INTRODUCTION--A recent study comparing heterosexual men with and without confirmed sexually transmitted diseases (STDs) in an urban STD clinic showed that uncircumcised men were less likely than circumcised men to have genital warts detectable by clinical examination (adjusted odds ratio 0.7, 95% confidence interval 0.4, 0.9). Based on these initial findings we hypothesised that the appearance and anatomic distribution of genital warts, and possibly treatment response, may be different for circumcised and uncircumcised men. METHODS--The anatomic location, appearance, number of warts, and response to treatment was investigated through review of medical records of 459 heterosexual men with genital warts detected in 1988. RESULTS--Age- and race-adjusted estimates indicated that among men with genital warts, warts were detected much more commonly on the distal penis--that is, the corona, frenulum, glans or urethral meatus-, among uncircumcised men (26%) than among circumcised men (3%) (OR 10.0, 95% CI 3.9, 25.7). Where the appearance was specified, warts were more often described as condylomatous in uncircumcised men and slightly more often as papular in circumcised men. No significant difference between circumcised and uncircumcised men was seen in the number of return visits to the clinic for persistent warts after treatment with liquid nitrogen: 2.2 visits for 19 uncircumcised men and 2.3 visits for 149 circumcised men. CONCLUSION--Circumcised men were more likely than uncircumcised men to have genital warts, but when present, warts were more often located on the distal portion of the penis among uncircumcised men. This paradox is not understood, but could reflect either nonspecific resistance to proximal penile warts conferred by the foreskin, or heightened susceptibility to various HPV types in uncircumcised men, some of which may confer subsequent immunity to genital warts.
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机译:简介-一项近期研究比较了城市性病诊所中有无确诊为性传播疾病(STD)的异性恋男性,结果表明,未割包皮的男性比割包皮的男性更容易通过临床检查发现生殖器疣(校正比值比为0.7,95%置信区间0.4、0.9)。基于这些初步发现,我们假设割包皮和未割包皮的男性的生殖器疣的外观和解剖分布以及可能的治疗反应可能有所不同。方法–通过回顾1988年检测到的459名异性生殖器疣的异性恋男性的病历,调查了解剖学的位置,外观,疣的数量以及对治疗的反应。结果–年龄和种族调整后的估计值表明,生殖器疣,在未割包皮的男性(26%)中比在割包皮的男性(3%)中,更常见于远端阴茎(即电晕,系带,龟头或尿道口)上的疣(OR 10.0,95% CI 3.9,25.7)。在明确外观的地方,疣在未割包皮的男性中更常见为con突,在割包皮的男性中更常见为丘疹。割包皮和未割包皮的男性在用液氮治疗后回诊持久性疣的次数无明显差异:19例未割包皮的男性为2.2次,149例割礼的男性为2.3个。结论:割礼的男性比割礼的男性更容易患生殖器疣,但是,割礼的男性中,割礼的男性更多地位于阴茎的远端。这种悖论尚不明确,但可能反映了包皮对近端阴茎疣的非特异性抵抗,或未割包皮的男性对各种HPV类型的敏感性增加,其中一些可能会导致随后的生殖器疣免疫力。
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