Penile HPV prevalence among high-risk men in SriLanka: Baseline insight for HPV preventionstrategies in a lower-middle-income country

Background: Human Papilloma Virus (HPV) infection is the most common sexually transmitted viral infection in the world. Persistent infection lasting more than two years with high-risk genotypes has the potential for malignant transformation. High-risk (HR) HPV is responsible for nearly all cases of anal squamous cell carcinoma (SCC), approximately 53% of penile SCC, and 13-70% of oropharyngeal SCC in men. Male HPV prevalence among high-risk men in Sri Lanka is crucial for establishing a baseline to guide prophylactic vaccination and high risk precancer screening strategies for men in Sri Lanka. Method: A hospital-based descriptive cross-sectional study was conducted to estimate the prevalence of HPV infection among 20-70-year-old men (n=187) attending sexually transmitted disease (STD) clinics in Gampaha district, Sri Lanka. Patients were consecutively recruited based on a probability proportionate to the reported STD clinic attendance in 2021. Data was collected using interviewer administered questionnaire and HPV detection was performed via PCR using GP5+/GP6+ primers to amplify HPV DNA in penile samples and genotyping of positive samples were performed using Sanger sequencing. Penile prevalence of any and HR HPV genotype was estimated and distribution of HPV infection acquisition and persistent related factors were assessed and described. Results: Among STD clinic attendees 5.3% reported having over 51 male sex partners, with 42.8% having 2-5 male partners in their lifetime. Despite being a high-risk group 26.2%(n=56) of attendees, reported never using condoms. Penile HPV prevalence among STD clinic attendees was 24.6% (n=46) (95% CI: 18.6,31.4) for any and 5% (95% CI:1.5,12.3) for HR HPV genotype. Identified HR HPV genotypes were, 16(n=3) \& HPV 31(n=1) however, HPV 18 was not detected (Gene-sequencing done only for first 80 samples). Conclusion: The percentage of having more than 51 male sex partners among men is alarming and low condom usage among STD clinic attendees underscores the urgent need to promote and increase safe sexual practices. The penile HPV prevalence is high while vaccine-preventable HPV HR genotype 16 is the most prevalent HR genotype among STD clinic attendees, detection and monitoring of HPV prevalence over time is important for policy making for introduce HPV prophylactic vaccination.