Kristiansen Sinja1, Bjartling Carina2, Svensson Åke1, Forslund Ola3, Torbrand Christian4
1Lund University, Skane University Hospital, Department of Dermatology and Venereology, Malmö Sweden. 2Lund University, Skane University Hospital, Department of Obstetrics and Gynecology, Malmö, Sweden. 3 Lund University, Department of Medical Microbiology, Laboratory Medicine, Lund, Sweden. 4 Department of Urology, Helsingborg Hospital, Helsingborg, Sweden; Institution of Translational Medicine, Lund University, Malmö, Sweden.
Excised foreskin is not routinely sent for histopathological examination in clinical practice. Studies have shown missed diagnosis of LS in up to 62%. LS can develop into penile cancer in up to 13% of cases. High risk (HR) HPV can develop into PeIN and penile cancer. The aims of this study were to investigate prevalence of pathological diseases and spectrum of HPV types among excised foreskin tissue. Our intention was to analyse the diagnoses that histopathology revealed in circumcised skin in order to elucidate the spectra of pathological diagnoses that needed further clinical management.
Materials and methods
Consecutively excised symptomatic foreskins (N=351) were sent for histopathological evaluation. During the surgical procedure a fresh biopsy was taken for HPV analysis by MGP-PCR. A medical questionnaire regarding medication, smoking habits, number of lifetime sexual partners, former diseases and surgery performed on penis was completed by all participants.
Histopathologically inflammatory dermatological conditions were present in 87% of the cases. The most common histopathological diagnosis was lichen sclerosus (LS) observed among 58.7%. Notably penile intraepithelial neoplasia (PeIN) was present in 2% without former clinical suspicion. Overall, HPV was detected in 17.1% of cases and 28 different HPV types were found. High risk (HR) HPV types was identified in 9.1 %. Current smoking increased the risk for HPV (odds ratio (OR) 2.8, confidence interval (CI) 1.4-5.6, p-value 0.005). Having > 15 sexual partners over life increased the risk for HPV (OR 2.6, 95% CI 1.4-5.1, p-value 0.003) and when adjusting for current smoking the OR was substantially increased (OR 6.0, CI 2.2-16.8, p-value <0001).
Histopathological evaluation of circumcised symptomatic foreskin revealed PeIN in 2% of the cases without any clinical suspicion of malignancy and that treatable dermatological conditions were present in 87%, LS being the most common. HR HPV types were present in 9%. Due to risk of malignant development both in PeIN and in inflammatory skin diseases we recommend that all symptomatic foreskins should be histopathologically evaluated as guidance for further clinical management.
34 IUSTI Congress - European Congres on Sexually transmitted Infections and HIV/AIDS
TAMING THE TIDE of STIs & HIV
Bucharest, September 3-5,