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Pearly penile papules: Still no reason for uneasiness,☆☆,,★★

https://doi.org/10.1067/mjd.2003.420Get rights and content

Abstract

Background: Penile lesions and pearly penile papules (PPP) are frequently found in male sexual partners of women with cervical intraepithelial neoplasia (CIN). The former have been associated with human papillomavirus (HPV). Objectives: We estimated the prevalence of PPP in male sexual partners of women with CIN, and investigated the association between PPP and flat and papular penile lesions found in these men. We further evaluated a possible association between PPP and HPV, age, and CIN grade of the female partner. Methods: We evaluated by penoscopy the presence of HPV-associated penile lesions and PPP in 226 male sexual partners of women with CIN. HPV was tested by polymerase chain reaction-enzyme immunoassay and in situ hybridization. Results: The prevalence of PPP was 34% and was not associated with the presence of penile lesions or a positive HPV test. Age and CIN grade of the female partner were not related to the presence of PPP. Conclusion: The prevalence of PPP in male sexual partners of women with CIN is comparable with the prevalence described in men of more diverse populations. Our data do not support a causative role for HPV in the genesis of PPP. (J Am Acad Dermatol 2003;49:50-4.)

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Study population

From 1993 to 2001, 245 consecutive women who were referred to the colposcopic clinic of the Albert Schweitzer Hospital in Dordrecht, the Netherlands, because of an abnormal cervical smear proved to have CIN.

They were asked to bring in their regular male sexual partner to study the presence of penile lesions, PPP, and HPV. The males underwent a HPV test by making a scrape of the top of the penis (glans, corona, sulcus, frenulum, and inner part of the foreskin) and a penoscopy as previously

Results

PPP were found in 71 of the 211 men (34%). Penile lesions were detected in 151 men, 60 men had no lesions. PPP were found in 49 of the 151 men with penile lesions (32%) and in 22 of the 60 men without penile lesions (37%), indicating no difference between the presence of PPP in men with or without penile lesions (Table I).

Histologic findings of the biopsy specimens of PPP showed elevated papular formations, fibrosis, mild inflammatory infiltrate, and vascular proliferation in the papillary

Discussion

We showed that the rate of PPP in male sexual partners of women with CIN in the Netherlands was similar to the prevalence in populations described earlier by Neinstein and Goldenring4 in adolescents and by Rehbein5 in a social hygiene clinic in the United States, ie, approximately 35%. Although the geographic areas were not identical, finding the same rate in these diverse populations favors the notion that PPP represent a physiologic variant of the normal penis. An association between the

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Supported by grants of the Dutch Prevention Fund/Zorg Onderzoek Nederland.

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Conflict of interest: None identified.

Reprint requests: Chris J. L. M. Meijer, MD, PhD, Department of Pathology, Vrije Universiteit Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. E-mail: [email protected].

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0190-9622/2003/$30.00 + 0

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