Can You Get Hpv From Touching Someone Hand

Lancet Infect Dis. Author manuscript; bachelor in PMC 2022 Mar ane.

Published in final edited form every bit:

PMCID: PMC6404546

NIHMSID: NIHMS1521552

Is there a role for hand-to-genital sexual manual of man papillomaviruses? Results from the HITCH cohort report

Talía Malagón, PhD,^# ¹ Karolina Louvanto, PhD,^# ^two Michel Wissing, PhD,¹ Ann North Burchell, PhD,^three, ^four Pierre-Paul Tellier, Md,^v Mariam El-Zein, PhD,¹ François Coutlée, Medico,^{half dozen,} ⁷ and Eduardo L Franco, DrPH^1, ⁸

Talía Malagón

ⁱDivision of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada

Karolina Louvanto

ⁱⁱDepartment of Obstetrics and Gynaecology, Turku University Hospital, Academy of Turku, Kiinanmyllynkatu 4-8, 205201 Turku, Republic of finland

Michel Wissing

^oneDivision of Cancer Epidemiology, Department of Oncology, McGill Academy, Montreal, Canada

Ann Due north Burchell

³Section of Family and Community Medicine and Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada

⁴Department of Family and Customs Medicine and Dalla Lana Schoolhouse of Public Health, University of Toronto, Toronto, Canada

Pierre-Paul Tellier

⁵Department of Family Medicine, McGill University, Montreal, Canada

Mariam El-Zein

¹Partition of Cancer Epidemiology, Department of Oncology, McGill Academy, Montreal, Canada

François Coutlée

^{half dozen}Département de microbiologie et infectiologie, Centre Hospitalier de l'Université de Montréal, Montreal, Canada

^sevenDépartement de microbiologie et immunologie, Université de Montréal, Montreal, Canada

Eduardo L Franco

^aneDivision of Cancer Epidemiology, Section of Oncology, McGill University, Montreal, Canada

⁸Section of Epidemiology, Biostatistics and Occupational Health, McGill Academy, Montreal, Canada

Abstract

Background:

Hand-to-genital contact is hypothesized to be a manual manner of HPV of genus Alphapapillomavirus. We compared the relative importance of mitt-to-genital and genital-to-genital HPV transmission betwixt sexual partners.

Methods:

We recruited and followed-up female university students xviii-24 years quondam and their male person sexual partners in Montréal, Canada (2005-2011). Partners provided hand and genital samples, which we tested for DNA of 36 HPV types using PCR. We assessed predictors of incident type-specific HPV detections using Cox proportional hazards models.

Findings:

264 women and 291 men had valid paw samples. The hazard ratio (Hr) of incident female person genital HPV detection was five·0 (95% confidence interval [CI] 1·v-16·four) when her partner was same type mitt-positive vs -negative, but adjustment for his genital HPV status reduced the HR to 0·5 (95%CI 0·1-1·8). Similarly, the HR of incident male person genital HPV detection was 17·nine (95%CI vii·9-38·five) when his partner was same blazon manus-positive vs negative, but adjustment for her genital HPV status reduced the HR to 2·three (95%CI 0·ix-vi·2). Conversely, the HR of blazon-specific incident genital HPV detections associated with partner genital HPV positivity was 19·3 (95%CI 11·8-31·8) for females and 28·4 (95%CI fifteen·4-52·1) for males after adjustment for their hand HPV condition.

Interpretation:

Clinicians tin can reassure their patients that HPV transmission is unlikely to occur through hand-to-genital contact. The bulk of genital HPV infections are likely caused by genital-to-genital sexual transmission.

Funding:

Canadian Institutes for Health Research, National Institutes of Health, Fonds de la Recherche en Santé du Québec, Merck & Co. Ltd.

Introduction

Homo papillomavirus (HPV) types of the genus Alphapapillomavirus (alpha) are sexually transmitted infections, many of which crusade anogenital and oropharyngeal cancers in men and women.¹ Blastoff HPV types mainly infect mucosal tissues.ⁱⁱ Because HPV prevalence is highly correlated with the number of contempo and lifetime genital sexual practice partners, a big torso of evidence suggests alpha HPV types are mainly transmitted through genital-to-genital contact.³ Over the years, some accept likewise speculated as to the possibility of hand-to-genital transmission of alpha HPV types.^4–eight This hypothesis is supported past the frequent detection of alpha HPV Deoxyribonucleic acid on hands and under fingernails,^8–ten as well as the high concordance between hand and genital HPV types in the same person^{half dozen,ix} and between partners.⁸ Nevertheless, at that place has always been skepticism as to the importance of hand-to-genital transmission of alpha HPV types.¹¹ The high correlation between hand and genital HPV detections makes it difficult in well-nigh studies to separate crusade from outcome and the directionality of transmission. Information technology remains unclear to what extent HPV transmission events occur from hand-to-genital or genital-to-hand contact.

The general public is condign more aware of HPV due to the availability of vaccines and cervical cancer screening with HPV tests, and many may have questions and anxieties regarding the transmission and adventure of HPV infections.^12,thirteen Clinicians and public wellness workers must be able to inform the public on the modes and risks of manual of HPV. Information technology is therefore important to elucidate the importance of paw-to-genital transmission, and provide public health messages based on stiff scientific evidence. This could assuage fears of inadvertently transmitting HPV to partners or of becoming infected from mitt-to-genital contacts.

Our objective was to determine whether hand-to-genital transmission of HPV is supported past examining cantankerous-sectional and prospective dynamics of manus and genital HPV detection in couples, or whether the detection of HPV Deoxyribonucleic acid in the hand is just carriage that is incidental to genital infections.

Methods

Report design and data drove

We used data from the HPV Infection and Transmission Among Couples through Heterosexual Action (HITCH) report, which examined the transmission of HPV in young, heterosexual, newly-formed couples. Written report procedures have been previously described.^14–17 Briefly, HITCH was a prospective cohort study which enrolled young female university and college students anile xviii-24 years erstwhile and their male partners ≥18 years erstwhile in Montréal, Canada, during 2005-2011. Participants were recruited through promotional materials distributed on campus and pupil venues. Eligible couples needed to accept initiated sexual practice inside the past vi months. The ethical review committees of McGill Academy, Concordia University, and the Centre Hospitalier de l'Université de Montreal canonical the written report. All participants provided written informed consent.

Women were examined at dispensary visits at baseline and every four- to 6-months for up to 24 months. Men had a baseline visit and a single follow-up visit approximately iv months later. Participants answered self-administered behavioral questionnaires and provided biologic samples for HPV testing at each study visit. Initially, only genital samples were nerveless, but beginning in 2008 we started collecting hand samples during the first two visits (at enrolment and 4 months) when both men and women were scheduled to attend. If a couple terminated their human relationship during the report, the participants were encouraged to enrol any new eligible partner, though this was not required for connected participation.

These participants provided additional hand samples corresponding with the first two visits of their newly recruited partner, which were included in analyses. Most hand samples came from couples recruited later 2008; at that place were however some exceptions where hand samples were taken from individuals recruited previously who recruited new partners into the study after 2008, or whose 2nd visit occurred following the start of manus sample drove.

Participants were instructed to wash their hands with soap and water prior to paw sampling. An ultra-fine emery paper was used to exfoliate the palmar surface of the index and eye fingers before sampling with a Dacron swab. Wearing latex gloves, the study nurse used a cytobrush to swab the fingertips and nether the nails of the dominant hand. Women self-collected vaginal specimens using a Dacron swab, after being instructed past the study nurse. For men, the nurse collected epithelial cells from the penis and scrotum in divide sample containers using gentle exfoliation with ultra-fine emery paper followed by swabbing with a Dacron swab. The Dacron swabs were placed into vials with Preservcyt^™ (Hologic, Marlborough, MA, USA), agitated to release cells, and then discarded; the emery papers were as well placed in the respective vials. Samples were processed and Dna extracted as previously described.¹⁷

HPV Deoxyribonucleic acid testing

Genital and hand specimens were tested by a polymerase chain reaction using the Linear Assortment HPV genotyping assay (LA-HPV) (Roche Molecular Systems, Alameda, CA, USA).¹⁸ This technique detects DNA from 36 mucosal HPV genotypes of the Alphapapillomavirus genus (6, xi, 16, 18, 26, 31, 33, 34, 35, 39, xl, 42, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 67, 68, 69, 70, 71, 72, 73, 81, 82 [including its subtype IS39], 83, 84, and 89). β-globin DNA was co-amplified to assess Deoxyribonucleic acid integrity of samples and to command for the presence of cells. A sample was considered valid if β-globin DNA was detected. An individual was considered hand type-specific HPV positive if either the fingernail or finger samples were positive for a given HPV type. A man was considered genital blazon-specific HPV positive if either the penile or scrotal samples were positive for a given HPV type.

Statistical analysis

We restricted analyses to dispensary visits where participants had valid hand samples. The unit of measurement of assay was blazon-specific HPV positivity in the hand or genital samples at each clinic visit. Each participant therefore contributed multiple observations to each analysis with 36 different HPV types and with multiple dispensary visits.

Prevalent HPV analyses.

Nosotros calculated the observed/expected (O/Due east) ratio of the probability of detecting the aforementioned HPV type in participants' hand and genital samples during a given visit, summed over all 36 HPV types:

$\frac{O}{E} = \frac{\sum_{i = 1}^{36} o_{i} ∕ \sum_{i = ane}^{36} due north}{(\sum_{i = 1}^{36} a_{i} ∕ \sum_{i = 1}^{36} n) \times (\sum_{i = ane}^{36} b_{i} ∕ \sum_{i = 1}^{36} n)}$

Where o_i , is the observed number of visits where both hand and genital samples are positive for HPV type i, a_i is the observed number of hand samples positive for HPV type i, b_i is the observed number of genital samples positive for HPV type _i, and north is the number of visits with valid hand and genital samples. O/East ratios to a higher place ane indicates a type-specific co-detection design occurs more oft than would exist expected if the probability of HPV infection were completely independent between mitt and genitals, whereas ratios below 1 signal a blazon-specific co-detection pattern occurs less often than would be expected if HPV were distributed completely independently beyond hands and genitals. The 95% confidence intervals (95%CI) were generated using block bootstrapping with 1000 resamples of participants^xix. We used multilevel logistic regression models to assess whether type-specific hand and genital HPV positivity was associated with aforementioned-type positivity at other sites during the same visit. Multilevel models included a random intercept for each participant. This accounts for potentially correlated data due to repeated measurements on the same person (multiple HPV types and multiple clinic visits). For partner-level analyses, we further restricted the analyses to written report visits in which couples both had valid samples taken on the aforementioned day. In a separate analysis, we analyzed whether the questionnaire-reported frequency of performing hand-genital and vaginal sex were associated with the hand-genital cyclopedia between partners. Nosotros averaged both partners' reports for this analysis.

Incident HPV analyses.

We plotted the cumulative risks of incident HPV acquisition using Kaplan-Meier curves. We assessed whether incident hand and genital HPV detection were associated with HPV positivity at other self- and partner-sites at the preceding visit using Cox proportional hazards models with a random outcome for each participant (log-normal frailty model) and Efron'southward gauge likelihood.^20,21 We restricted prospective analyses to individuals with at least two visits with valid hand samples, who were blazon-specific HPV negative at the baseline visit at the analyzed site, and who had valid HPV data at the baseline visit for the other self and partner sample sites. Considering HPV infections are asymptomatic, we imputed incident HPV acquisitions as occurring mid-way through the interval when the individual became HPV positive. Participants who had no incident type-specific HPV detection were censored at their concluding written report visit with a valid hand sample. In sensitivity analyses, nosotros fitted a fixed effects Cox model using interval-censoring methods to assess whether midpoint imputation affected results.

Due to the infectious nature of HPV, positivity at different sites is expected to be highly correlated. To control for confounding, we included type-specific HPV positivity at all other exposure sites as predictors in multivariable logistic and Cox regression models. The objective was to determine which sites were the strongest predictors of blazon-specific HPV detection at the upshot site, unconfounded by aforementioned-type HPV positivity at other sites. Statistical analyses were done using SAS 9.4 and R.

Role of the funding source

The study sponsors had no role in the study design, data collection, data analysis, information interpretation, or writing of the report. The corresponding writer had total admission to all the information in the study and had final responsibility for the decision to submit for publication.

Results

Hand samples available for analysis

There were 264 women and 291 men (37 recruited after baseline) who provided at least one valid manus HPV Deoxyribonucleic acid sample during 479 and 489 visits, respectively (Figure 1). The concomitant genital Dna samples were valid in 473 and 483 [99%] of male and female visits. The participants included in the present analyses had a mean age of 20·9 years (standard deviation 2·iv) for women and 22·9 years (standard deviation four·0) for men, and reported a median of 4 vaginal sexual activity acts/week. More characteristics of this subset of HITCH participants are presented in Supplementary Table one.

An external file that holds a picture, illustration, etc. Object name is nihms-1521552-f0001.jpg

Flow chart of HITCH study participants and exclusions.

Mitt sampling began half-manner through study recruitment in 2008. Invalid hand and genital samples had no detected β-globin DNA. *At that place are more couples (270) than women (264) in cross-sectional partnered analyses because some women recruited multiple male person partners in the study and were role of more than one couple.

In that location were 188 women and 194 men who had more than than ane study visit with a valid hand sample and were included in prospective analyses. The median number of visits was 2 (range 1-5) for women and two (range 1-ii) for men. Women were followed for a median (interquartile range [IQR]) of 141 (IQR 113-194) days, and men for a median of 135 (IQR 112-176) days.

HPV positivity in the easily and genitals

Beyond women's visits, in that location were 300 HPV types detected in 479 mitt samples and 748 HPV types detected in 483 vaginal samples. Across men's visits, there were 352 HPV types detected in 489 hand samples and 903 HPV types detected in 483 genital samples. The prevalence of at least one HPV type was 35·v% [170/479] in female hand samples, 36·four% [178/489] in male person mitt samples, 59·8% [283/473] in female genital samples, and 63·4% [306/483] in male person genital samples (Tabular array 1). Across individual HPV types, the type-specific HPV prevalence was most always lower in hand than in genital samples (Supplementary Tabular array 2).

Table 1.

HPV DNA type-specific number of detections and prevalence in valid mitt samples and concomitant genital samples.

HPV group	Sexual activity	Total HPV type detections (n)^{^a}			HPV prevalence^{^b}
		Mitt	Genital	Either Paw or Genital	Hand (women N=479 men N=489)		Genital (women N=473 men N=483)
					due north	(%)	n	(%)
Whatsoever	Women	300	748	805	170	35·5%	283	59·8%

	Men	352	903	959	178	36·4%	306	63·4%

Hour^{^C}	Women	126	326	344	95	19·viii%	203	42·ix%

	Men	143	356	384	105	21·5%	218	45·i%

LR^{^C}	Women	126	291	317	99	20·7%	186	39·3%

	Men	135	386	399	101	20·7%	226	46·viii%

HPV co-detection patterns in the hands and genitals

The probability of detecting the aforementioned HPV type in both an individual's hand and genital samples was 16-18 times higher than expected if HPV types were independently distributed across mitt and genital samples (Figure 2A-B). The probability of detecting the same HPV blazon in both partners' hand and/or genital samples was three.8-32.8 times higher than expected if HPV types were independently distributed across partnerships (Figure 2C). This over-representation of partners concurrently positive for the same-type and nether-representation of co-negative samples when a partner is HPV positive at whatsoever site would be expected if at that place is cross-site HPV transmission, either within individuals or between sex partners. The peculiarly lower than expected observed cases of same-blazon hand positive/genital negative (0/Eastward=0.16-0.19) than observed cases of same-type hand-negative/genital-positive (O/E=0.69) may possibly reverberate asymmetry in transmission or clearance between sites.

An external file that holds a picture, illustration, etc. Object name is nihms-1521552-f0002.jpg

Observed to expected ratios of type-specific detection patterns past site pooled over all HPV types in women A), in men B), and in partnerships C).

Analyses are restricted to visits with concurrently valid hand and genital samples (473 for women, 483 for men, and 403 for couples). Marginal totals (the denominators) are derived from the number of visits with concurrent valid manus & genital samples * 36 HPV types. Marginal totals are lower in C) than in A-B) because partnership analyses are restricted to the visits where both partners had valid hand and genital samples taken on the same twenty-four hour period. The vertical graded color bar indicates the magnitude of the observed-to-expected ratios. Numbers in parentheses represent the 95% percentiles of 1000 block bootstrap resamples.

Table ii shows the probability of blazon-specific HPV positivity at a given site, stratified by sex and aforementioned-type HPV positivity at other sites. For instance, the probability of being hand HPV positive for a type was respectively 45·2% [141/312] for women and 53·8% [141/262] for men if their partner's hand was positive for that type at the aforementioned visit. The probability of being genital HPV positive for a blazon was respectively 81·8% [243/297] for women and 84·6% [296/350] for men if their ain hand sample was positive for that type at the same visit.

Tabular array 2.

Probability and odds ratios of hand and genital HPV DNA positivity stratified past HPV positivity at other sites at the same visit, pooled over all HPV types.

Outcome	Exposure site	HPV type-specific positivity probability (exposure site positives)^{^a} northward/Northward^{^d} (%)	HPV blazon-specific positivity probability (exposure site negatives)^{^b} n/North^{^d} (%	Univariate OR (95% CI)	Adjusted for all sites^{^c} OR (95% CI)
Women

Paw HPV positivity	Genital (own)	243/748 (32·five%)	54/16280 (0·3%)	170·i (121·0-239·0)	49·5 (xxx·six-80·2)
	Genital (partner)	194/792 (24·5%)	68/13860 (0·5%)	74·3 (53·9-102·5)	three·0 (1·8-4·ix)
	Hand (partner)	141/312 (45·2%)	121/14484 (0·8%)	127·0 (88·8-181·vii)	six·7 (4·2-ten·four)

Genital HPV positivity	Hand (own)	243/297 (81·8%)	505/16731 (3·0%)	189·iv (131·7-272·5)	50·7 (xxx·5-84·3)
	Genital (partner)	436/777 (56·i%)	205/13731 (ane·5%)	96·iv (76·4-121·v)	44·5 (34·1-58·0)
	Mitt (partner)	222/306 (72·6%)	423/14346 (three·0%)	105·half-dozen (76·five-145·8)	4·ane (two·7-6·3)

Men
Mitt HPV positivity	Genital (own)	296/903 (32·8%)	54/16485 (0·3%)	189·3 (133·3-268·7)	54·four (34·5-85·nine)
	Genital (partner)	222/645 (34·4%)	84/14007 (0·vi%)	104·7 (76·i-144·2)	v·1 (iii·3-7·8)
	Hand (partner)	141/262 (53·8%)	171/14534 (1·two%)	133·5 (92·0-193·7)	7·three (iv·seven-11·4)

Genital HPV positivity	Mitt (own)	296/350 (84·6%)	607/17038 (three·six%)	205·0 (142·0-296·1)	51·eight (32·1-83·6)
	Genital (partner)	436/641 (68·0%)	341/13867 (2·5%)	102·4 (80·five-130·iii)	46·7 (35·4-61·v)
	Hand (partner)	194/262 (74·1%)	598/14390 (4·2%)	82·0 (57·9-116·1)	2·5 (ane·five-4·ane)

Variables associated with hand HPV positivity

Prevalent hand HPV.

In univariate cross-exclusive analyses (Table two), men and women were substantially more than likely to exist hand type-specific HPV positive if their own genitals or their partner's hands and genitals were also positive for same HPV type. However, once we adapted for positivity at all sites, HPV positivity in the hand remained almost strongly associated with same-type positivity in the individual'south own genitals. Women and men were respectively 49·v (95%CI: 30·half-dozen-eighty·two) and 54·4 (95%CI: 34·5-85·9) times more than probable to be hand HPV positive if they were genital HPV positive for the same HPV type than if they were genital HPV negative, later adjusting for HPV positivity of their partner'due south samples. Hand HPV positivity was essentially less correlated with the partner's hand or genital status one time we deemed for this intra-private hand-genital correlation. The male person partners who reported performing more than paw-genital sexual activity on their female partner had a higher probability of being hand positive for their partner's genital types, but the overall association was not significant (Supplementary Table 3). Individuals who had more frequent vaginal sex were more likely to accept the aforementioned HPV type in the hand as in their partner's genitals (OR 2·1 [95%CI: 1·1-3·9] for women and ii·7 [95%CI: 1·3-5·iv] for men who accept vaginal sex activity >iv times a week vs ≤2 times a week), just the relationship was no longer significant later on we controlled for HPV positivity in their own genitals (Supplementary Table 3)·

Incident paw HPV.

In incident HPV analyses (Table three), in one case we adapted for HPV positivity at all other sites at the previous visit, a woman was most likely to have an incident manus HPV detection if she was beginning genital positive for that HPV blazon (hazard ratio [Hr] 17·9, 95%CI: 8·eight-36·5) at the previous visit. She was likewise significantly more likely to take an incident hand HPV detection if her partner was genital positive for that HPV type (HR 5·9, 95%CI: ii·8-12·4), but non if he was mitt positive for the same type (HR 1·4, 95%CI: 0·7-2·8) at the previous visit. Adjusting for positivity at all other sites, a human was more likely to take an incident manus HPV detection if he was commencement genital positive for that HPV type (HR 7·2, 95%CI: three·4-xv·5) or if his partner was type-specific genital positive for that HPV blazon (HR 9·5, 95%CI: 4·3-21·1) at the previous visit, but not if she was hand positive (Hr one·0, 95%CI: 0·4-ii·7). Sensitivity analyses with interval-censored proportional adventure models provided very similar estimates (Supplementary Table 4). Kaplan-Meier curves of cumulative incident hand HPV detections are presented in Figure 3A-B.

An external file that holds a picture, illustration, etc. Object name is nihms-1521552-f0003.jpg

Cumulative incidence of hand and genital type-specific HPV detections.

A) Incident mitt HPV detections in women; B) incident manus HPV detections in men; C) incident genital HPV detections in women; C) incident genital HPV detections in men. Results are stratified by partner's hand and genital same-type HPV positivity at the previous visit, and by ain same-type genital positivity at the previous visit (for A-B). Results are pooled over all HPV types.

Table three.

Incidence rate and hazard ratios of blazon-specific incident hand and genital HPV DNA positivity stratified past HPV positivity at other sites at the previous visit, pooled over all HPV types.

		Exposure site positive			Exposure site negative
Consequence	Exposure site	Number at risk^{^a}	Events (n)^{^a}	Incidence rate (/100 years)	Number at risk^{^a}	Events (n)^{^a}	Incidence rate (/100 years)	Univariate 60 minutes (95% CI)	Adjusted for all sites^{^b} HR (95% CI)
Women

Incident hand	Genital (ain)	223	45	fifty·half dozen	7218	33	one·0	51·0 (31·4–82·7)	17·ix (eight–8-36–5)
positivity	Genital (partner)	284	39	32·five	6633	30	i·0	33·8 (20·ii–56·5)	5·9 (2–8-12–4)
	Hand (partner)	80	sixteen	48·three	6909	54	ane·7	26·7 (14·3-49·8)	1·4 (0·7-two·8)

Incident genital	Paw (ain)	34	5	29·9	7140	101	3·1	9·8 (3·8-25·4)	two·7 (0·eight-eight·5)
positivity	Genital (partner)	164	28	38·2	6435	62	2·i	nineteen·2 (12·0-30·8)	19·three (11·8-31·8)
	Paw (partner)	41	3	15·five	6630	87	two·nine	five·0 (1·5-16·iv)	0·five (0·1-ane·viii)

Men

Incident paw	Genital (own)	221	34	45·viii	6496	42	ane·vi	27·iv (16·7-45·0)	7·2 (3·4-15·5)
positivity	Genital (partner)	170	28	50·2	6090	37	ane·five	31·seven (18·5-54·two)	ix·5 (4·3-21·ane)
	Hand (partner)	57	viii	39·2	6238	57	ii·3	xiv·3 (6·4-32·3)	ane·0 (0·iv-2·7)

Incident genital	Manus (own)	25	3	29·eight	6496	89	three·iv	8·7 (two·6-29·v)	0·5 (0·one-3·ane)
positivity	Genital (partner)	ninety	22	75·5	5921	58	2·4	33·3 (nineteen·4-57·1)	28·4 (15·4-52·1)
	Manus (partner)	37	8	59·5	6005	72	3·0	17·iv (vii·ix-38·5)	2·3 (0·9-6·2)

Variables associated with genital HPV positivity

Prevalent genital HPV.

In univariate cross-sectional analyses (Table 2), men and women were substantially more likely to exist genital blazon-specific HPV positive if their own manus or their partner's hand or genital samples were positive for the aforementioned HPV type. However, once we adjusted for positivity at all sites, HPV positivity in the genitals was substantially less associated with same blazon HPV positivity in the partner's hands. For instance, while women were 105·6 times more than likely to be genital HPV positive if their partner was aforementioned type hand positive than if he was negative, this clan declined to 4·ane (95%CI: two·vii-6·three) upon conditioning on same-type HPV positivity at other sites.

Incident genital HPV.

In prospective analyses (Table 3), once we adjusted for HPV positivity at all other sites, both women and men were nearly likely to have an incident genital HPV detection if their partner was genital-positive for that HPV blazon at the previous visit (60 minutes xix·three [95%CI: eleven·8-31·viii] and 28·iv [95%CI: 15·4-52·1], respectively). The incidence of genital HPV detections was not significantly associated with their own or their partner's manus HPV positivity once nosotros accounted for their partner's same-blazon genital HPV positivity at the previous visit. Sensitivity analyses with interval-censored proportional risk models provided very similar estimates (Supplementary Table 4). Kaplan-Meier curves of cumulative incident genital HPV detections are presented in Figure 3C-D. In that location were no incident female person genital HPV detections in couples where the male partner'southward hand was the only HPV positive site at the previous visit (Figure 3C). There was merely one incident male genital HPV89 detection in couples where the female partner'due south hand was the only HPV89-positive site at the previous visit (Figure 3D); this human reported having ended the relationship and having new sexual partners during the interval, so he may accept acquired HPV89 from another partner.

HPV Persistence

If an HPV type was detected in a hand sample, the probability of detecting the same type in the side by side hand sample visit was 26·four% (95%CI: xviii·8-36·3) [40/151] for women and 36·0% (95%CI: 27·7-46·eight) [58/161] for men. If an HPV type was detected in a genital sample, the probability of detecting the same blazon in the adjacent genital sample visit was 69·0% (95%CI: 60·6-78·six) [234/339] for women and 75·2% (95%CI: 66·six-84·9) [267/355] for men.

Discussion

The importance of hand-to-genital transmission has to date been uncertain. While some have proposed that hand-to-genital transmission is plausible based on a loftier observed concordance betwixt easily and genitals within individuals and between partners,^{half dozen,8} others accept deemed it unlikely, due to the transience of HPV detected on the hands^ix and doubts as to whether sufficient alive virus is present on the easily or shed via exfoliation for successful transmission.¹¹ In this study, we found that the detection of blastoff type HPV on the easily is common in men and women, merely that it is most likely to concurrently occur with a same-blazon HPV genital infection. Alpha HPV Dna detection in the hands alone without a same-blazon genital infection within the same individual or their sexual partner occurs substantially less often than expected due to chance alone. Both HPV positivity in the private'southward own genitals and their partner's genitals were important predictors of incident hand HPV detection. This suggests that the majority of alpha HPV DNA detection in the hands in couples is due to self-inoculation from the person's ain genitals or from the partner's genitals rather than hand-to-hand transmission. Conversely, hand HPV positivity was non a significant predictor of incident same type genital HPV detections after we accounted for partner genital HPV positivity. This suggests that the majority of incident genital infections are caused by genital-to-genital transmission, and that hand-to-genital manual is unlikely to essentially contribute to the sexual transmission of alpha HPV types.

We constitute similar cross-site concordance rates as previous studies, which constitute that if HPV was detected in the hand, there was >lx% probability that the person's or their partner'southward genitals were positive for the same type.^viii,9 Others have also estimated high rates of genital-to-mitt transmission rates.^7,8,10 A force of this written report relative to previous studies was that nosotros had sufficient information to arrange our analyses for HPV positivity at different sites. This allowed us to study the directionality of transmission while taking into account confounding due to other routes of manual, which to date had been a major claiming for studying hand HPV transmission. Our results suggest that the high observed genital-paw HPV concordance is due to genital-to-paw transmission rather than manus-to-genital transmission. A limitation of our data is that we even so had very few observations from individuals exposed to a partner who is but hand type-specific positive in incident genital detection analyses (17 for women and 17 for men), and that there were very few couples in HITCH who were non having vaginal sexual practice. This express our power to completely rule out hand-to-genital HPV transmission. Nevertheless, if there is manus-to-genital transmission, our report suggests information technology is unlikely to be an important mode of HPV transmission. The low prevalence of hand HPV positivity contained of genital positivity also further supports that the hand is unlikely to be an important reservoir of transmission. While we did not find that the frequency of hand-genital sexual activity was significantly associated with hand-genital HPV partner concordance, we had low statistical ability for this analysis because very few couples reported never performing hand-genital sex.

It is impossible to decide whether the detection of HPV Dna represents an active infection at a site or simply the deposition of virions and/or complimentary viral DNA. Participants had been asked to launder their hands with soap previously to sampling in lodge to reduce the likelihood of detecting contaminations in hand samples. We had concluded in a previous analysis that up to 14·1% of genital HPV detections in HITCH might exist partner deposition from recent sexual action,²² but it is unknown what proportion of HPV DNA detected in the hand represents deposition. The depression persistence of hand HPV between visits in this and a previous study⁹ suggests many hand detections are likely to exist depositions. Alpha HPV types are thought to mostly infect the genitals or the oropharynx.² Notwithstanding, mouse models propose that blastoff HPV infections may get established in cutaneous tissues after peel trauma.²³ Reports of cutaneous squamous cell carcinomas (SCC) (Bowen'southward disease) on the hands linked with alpha HPV types suggest that blastoff HPV can infect the easily in some cases.^5,24,25 The same HPV type is oft found in both cervical and finger samples of patients with a history of both SCC of the fingers and SCC of the neck.²⁵ Because the diagnosis of cervical cancer generally predates that of SCC of the finger, this finding is besides consistent with manual generally occurring from genital-to-hand. Regardless of whether the HPV is present due to degradation or due to an agile hand infection, we did not find that HPV detected on the easily substantially increased genital infection risk.

Compared to our written report population, the general population is older, and has a higher proportion of individuals who study no recent sexual partners or vaginal sexual practice.²⁶ It is therefore likely that nigh hand HPV detections in the general population are due to self-inoculation rather than partner deposition, equally the exposure to an infected partner is lower in the general population. The associations nosotros measured between HPV positivity in the genitals and hands are probable generalizable to almost heterosexual populations. Our results may not be generalizable to non-heterosexual partnerships, equally the relative importance of unlike modes of HPV transmission may be dissimilar.

The transmission modes of HPV are important for shaping the public health narrative surrounding HPV. HPV testing is condign widely implemented in many countries for cervical cancer screening. There are likely to exist increasing numbers of women who will learn for the first time that they are HPV positive and who will have questions and concerns regarding their HPV diagnosis, including how they acquired it.^12,xiii The information that HPV transmission is largely transmitted by sexual genital contact may lead some to feel shame over having a sexually transmitted infection; however, the reassurance that HPV is highly common and that most people volition go infected in their lifetime may reduce this stigma.^13,27 Given that transmission is most likely to occur from genital-to-genital contact, this may also be an opportunity to emphasize the preventive benefits of condoms to reduce HPV manual to partners.²⁸ Clinicians might as well reassure women that hand-to-genital transmission of HPV to cocky or to others is non as efficient a mechanism of transmission as genital intercourse, based on our results.

Our results do not necessarily indicate that hand-to-genital HPV transmission does not occur, because information technology is easier to decline than to prove a null hypothesis of no transmission. However, our report does bolster the assertion that if at that place is paw-to-genital transmission, it is unlikely to be an of import manner of transmission of genital HPV infections in sexual partnerships. Our study suggests that genital blastoff HPV detections are more likely acquired by genital-to-genital manual, and that most alpha HPV Deoxyribonucleic acid detections in the paw are likely acquired by either genital-to-hand deposition and/or manual (either from one's own genitals or from a partner'southward genitals). The loftier cumulative incidence of detection of HPV in the hand suggests genital-to-mitt HPV deposition is mutual. However, detection of HPV in the hand should not be crusade for business organisation every bit information technology is unlikely to substantially increase the take a chance of genital HPV transmission to oneself or to ane's partners.

Research in context

Evidence before this study

While hand-to-genital manual has long been hypothesized as a mode of HPV transmission, there has been very piddling published data on the prevalence and incidence of HPV on easily to test this hypothesis. We performed a literature review by searching Pubmed for ("Papillomavirus Infections/transmission"[MeSH Terms] OR "Papillomavirus Infections"[MeSH Terms] OR "Alphapapillomavirus"[MeSH Terms] OR "HPV"[Title/Abstract]) AND ("Paw/virology"[MeSH Terms] OR "Fingers/virology"[MeSH Terms] OR "Disease Manual, Infectious"[MeSH Terms]) and for ("hand" and "HPV" and "transmission"). We identified 5 studies that examined Alphapapillomavirus type concordance betwixt manus and genital sites or incidence of transmission between sites in the past twenty years. The conclusions from these studies have been conflicting, with some concluding that mitt-to-genital transmission is possible, others concluding it is unlikely, and others final information technology is unclear. The main limitations of previous studies have been a small sample size and/or the lack of data on sexual partners to assess sexual manual.

Added value of this study

This is the largest study to appointment of sexual activity partners with genital and hand HPV information. Nosotros controlled for confounding due to the correlation in HPV positivity at multiple sites to assess the directionality of HPV transmission between sites and between partners. Our results provide the strongest evidence to date that genital HPV conquering is unlikely to exist due to mitt-to-genital manual, occurs more often than not as a effect of genital-to-genital contact, and that near HPV DNA on the easily is likely from cocky-inoculation from the genitals.

Implications of the available testify

Due to the carcinogenicity of many HPV types, cervical cancer screening is increasingly done using HPV testing. Many women will become aware that they are HPV positive and have questions regarding how they contracted HPV, and the risk of transmission to their partners. Our results suggest that clinicians can reassure their patients that transmission is unlikely to occur through hand contact.

Supplementary Material

1

Acknowledgements

This work was supported by CIHR [operating grant 68893 and team grant 83320 to ELF, and Fellowship Awards to TM & MW]; the U.s.a. National Institutes of Health [grant AI073889 to ELF]; the Réseau FRSQ Fonds de la Recherche en Santé du Québec AIDS and Infectious disease Network (SIDA-MI) [back up for optimization of molecular techniques to FC]; and supplementary and unconditional funding by Merck-Frosst Canada Ltd and Merck & Co Ltd. The funders played no role in the writing of the manuscript, the collection/analysis of the information, or the conclusion to submit information technology for publication. The corresponding author had total admission to all the data in the study and had final responsibility for the decision to submit for publication.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accustomed for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its concluding citable class. Please note that during the product process errors may be discovered which could bear upon the content, and all legal disclaimers that employ to the periodical pertain.

Conflicts of interests

TM & MW study postdoctoral grants from the Canadian Institutes of Health Research (CIHR) during the carry of the study. KL reports grants from the Sigrid Juselius Foundation and the Finnish Medical Foundation. ELF reports grants from CIHR, grants from Merck, and grants from the National Institutes of Health during the conduct of the written report; personal fees from Roche, personal fees from BD, personal fees from Merck, and personal fees from GlaxoSmithKline exterior of the submitted work. FC reports grants from Reseau FRQS-SIDA during the carry of the study and grants from Becton Dickinson outside of the submitted piece of work. ANB, PPT, and MEZ have no conflicts of involvement to disclose.

References

ane. Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a constructed assay. Lancet Glob Health 2016; four(nine): e609–16. [PubMed] [Google Scholar]

2. Egawa N, Egawa K, Griffin H, Doorbar J. Human Papillomaviruses; Epithelial Tropisms, and the Evolution of Neoplasia. Viruses 2015; vii(seven): 3863–xc. [PMC gratis commodity] [PubMed] [Google Scholar]

iii. Burchell AN, Winer RL, de Sanjose South, Franco EL. Chapter 6: Epidemiology and manual dynamics of genital HPV infection. Vaccine 2006; 24, Supplement 3: S52–S61. [PubMed] [Google Scholar]

4. Fairley CK, Gay NJ, Forbes A, Abramson M, Garland SM. Hand-genital transmission of genital warts? An analysis of prevalence information. Epidemiol Infect 1995; 115(1): 169–76. [PMC free article] [PubMed] [Google Scholar]

5. Mitsuishi T, Sata T, Matsukura T, Iwasaki T, Kawashima M. The presence of mucosal human papillomavirus in Bowen'due south disease of the hands. Cancer 1997; 79(ten): 1911–7. [PubMed] [Google Scholar]

6. Sonnex C, Strauss S, Gray JJ. Detection of human papillomavirus DNA on the fingers of patients with genital warts. Sexual practice Transm Infect 1999; 75(5): 317–9. [PMC gratis article] [PubMed] [Google Scholar]

vii. Hernandez BY, Wilkens LR, Zhu Ten, et al. Transmission of Human Papillomavirus in Heterosexual Couples. Emerging infectious diseases 2008; xiv(6): 888–94. [PMC complimentary commodity] [PubMed] [Google Scholar]

8. Widdice L, Ma Y, Jonte J, et al. Cyclopedia and transmission of human papillomavirus within heterosexual couples observed over short intervals. J Infect Dis 2013; 207(8): 1286–94. [PMC gratis commodity] [PubMed] [Google Scholar]

9. Winer RL, Hughes JP, Feng Q, et al. Detection of genital HPV types in fingertip samples from newly sexually active female academy students. Cancer Epidemiol Biomarkers Prev 2010; 19(7): 1682–v. [PMC free article] [PubMed] [Google Scholar]

10. Partridge JM, Hughes JP, Feng Q, et al. Genital human papillomavirus infection in men: incidence and run a risk factors in a cohort of university students. J Infect Dis 2007; 196(8): 1128–36. [PubMed] [Google Scholar]

xi. Mindel A, Tideman R. HPV manual--notwithstanding feeling the manner. Lancet 1999; 354(9196): 2097–8. [PubMed] [Google Scholar]

12. Patel H, Moss EL, Sherman SM. HPV PRIMARY CERVICAL SCREENING IN ENGLAND: WOMEN'S AWARENESS AND ATTITUDES. Psychooncology 2018. [PubMed] [Google Scholar]

xiii. McRae J, Martin C, O'Leary J, Sharp L. "If y'all can't treat HPV, why test for it?" Women'due south attitudes to the changing face up of cervical cancer prevention: a focus grouping report. BMC Womens Health 2014; 14: 64. [PMC free article] [PubMed] [Google Scholar]

14. Burchell AN, Tellier PP, Hanley J, Coutlee F, Franco EL. Man papillomavirus infections among couples in new sexual relationships. Epidemiology 2010; 21(1): 31–seven. [PMC free article] [PubMed] [Google Scholar]

15. Burchell AN, Tellier PP, Hanley J, Coutlee F, Franco EL. Influence of partner's infection condition on prevalent man papillomavirus amidst persons with a new sexual practice partner. Sex Transm Dis 2010; 37(one): 34–40. [PMC gratis article] [PubMed] [Google Scholar]

sixteen. Burchell AN, Coutlee F, Tellier P-P, Hanley J, Franco EL. Genital Manual of Human Papillomavirus in Recently Formed Heterosexual Couples. Journal of Infectious Diseases 2011; 204(11): 1723–nine. [PMC free commodity] [PubMed] [Google Scholar]

17. Burchell AN, Rodrigues A, Moravan V, et al. Determinants of prevalent human papillomavirus in recently formed heterosexual partnerships: a dyadic-level analysis. J Infect Dis 2014; 210(6): 846–52. [PMC free article] [PubMed] [Google Scholar]

xviii. Coutlee F, Rouleau D, Petignat P, et al. Enhanced detection and typing of human papillomavirus (HPV) DNA in anogenital samples with PGMY primers and the Linear array HPV genotyping test. J Clin Microbiol 2006; 44(6): 1998–2006. [PMC free article] [PubMed] [Google Scholar]

19. Angelo C, Ripley B. boot: Bootstrap R (S-Plus) Functions R package version 1.iii-20. 2017. [Google Scholar]

xx. Ripatti S, Palmgren J. Interpretation of multivariate frailty models using penalized fractional likelihood. Biometrics 2000; 56(4): 1016–22. [PubMed] [Google Scholar]

21. Efron B The Efficiency of Cox's Likelihood Role for Censored Data. Journal of the American Statistical Association 1977; 72(359): 557–65. [Google Scholar]

22. Malagon T, Burchell AN, El-Zein 1000, et al. Estimating HPV DNA Degradation Between Sexual Partners Using HPV Concordance, Y Chromosome Dna Detection, and Self-reported Sexual Behaviors. J Infect Dis 2017; 216(10): 1210–viii. [PMC free commodity] [PubMed] [Google Scholar]

23. Handisurya A, Day PM, Thompson CD, et al. Murine skin and vaginal mucosa are similarly susceptible to infection by pseudovirions of unlike papillomavirus classifications and species. Virology 2012; 433(2): 385–94. [PMC free article] [PubMed] [Google Scholar]

24. Clavel CE, Huu VP, Durlach AP, Birembaut PL, Bernard PM, Derancourt CG. Mucosal oncogenic human papillomaviruses and extragenital Bowen disease. Cancer 1999; 86(2): 282–7. [PubMed] [Google Scholar]

25. Forslund O, Nordin P, Hansson BG. Mucosal human papillomavirus types in squamous jail cell carcinomas of the uterine cervix and subsequently on fingers. Br J Dermatol 2000; 142(6): 1148–53. [PubMed] [Google Scholar]

26. Mercer CH, Tanton C, Prah P, et al. Changes in sexual attitudes and lifestyles in United kingdom of great britain and northern ireland through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). The Lancet 2013; 382(9907): 1781–94. [PMC gratis article] [PubMed] [Google Scholar]

27. O'Connor M, Costello 50, Potato J, et al. 'I don't care whether information technology's HPV or ABC, I just want to know if I have cancer.' Factors influencing women's emotional responses to undergoing man papillomavirus testing in routine management in cervical screening: a qualitative study. Bjog 2014; 121(11): 1421–nine. [PubMed] [Google Scholar]

28. Winer RL, Hughes JP, Feng Q, et al. Condom Use and the Risk of Genital Man Papillomavirus Infection in Young Women. New England Journal of Medicine 2006; 354(25): 2645–54. [PubMed] [Google Scholar]

hartindetur1945.blogspot.com

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404546/