Penile HPV prevalence among high-risk men in Sri Lanka: baseline insight for HPV prevention strategies in a lower-middle-income country

BACKGROUND: Human Papillomavirus (HPV) infection is the most common sexually transmitted viral infection in the world. Persistent infection lasting more than two years, particularly with High-Risk (HR) HPV genotypes, can lead to malignant transformation. Estimating HPV prevalence among high-risk men in Sri Lanka is essential to establish baseline evidence for guiding prophylactic vaccination and targeted precancer screening strategies. METHOD: A hospital-based descriptive cross-sectional study was conducted among 187 men aged 20–70 years attending STD clinics in the Gampaha district of Sri Lanka. Participants were consecutively recruited using probability proportional to clinic attendance. Data were collected using an interviewer-administered questionnaire, and HPV DNA was detected in penile samples using PCR with GP5+/GP6 + primers. The Chi-square test was used for bivariate analysis (p < 0.05), followed by multivariable binary logistic regression to identify factors associated with HPV infection. Crude and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were calculated. RESULTS: Among STD clinic attendees 5.3% (n = 10) reported having over 50 male sex 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 HPV positive samples in first 80 samples). The associated factors for HPV infection among STD attendees were having an extra partner to the regular partner (p = 0.004) (adjusted OR 5.2,95% CI:0.7–15.9) and having a history of anogenital warts (p = 0.016) (adjusted OR 2.8,95% CI:1.2–6.6). CONCLUSION: The prevalence of HPV infection among men aged 20–70 years attending STD clinics in the Gampaha district was high, with 26.4% overall HPV and 5% high-risk HPV prevalence, and HPV genotype 16 was the most common vaccine-preventable genotype. Having extra partner to the regular partner and a history of anogenital warts were associated with HPV infection, highlighting the need for ongoing surveillance, targeted prevention strategies, and promotion of safer sexual practices.