Randomised recruitment in estimating genital human papillomavirus prevalence
Authors: Dan Shan, Yuxuan He, Yi Chen
Journal: The Lancet Global Health (2023)

We commend Laia Bruni and colleagues1Bruni L Albero G Rowley J et al.Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis.Lancet Glob Health. 2023; 11: e1345-e1362Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar for their systematic review of genital human papillomavirus (HPV) prevalence among men worldwide. However, their prevalence estimates are open to debate. The academic definition of a disease's prevalence is the number of cases (both new and existing) of a specific health condition in a population at a given point in time, divided by the number of individuals in that population.2GBD 2017 Disease and Injury Incidence and Prevalence CollaboratorsGlobal, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017.Lancet. 2018; 392: 1789-1858Summary Full Text Full Text PDF PubMed Scopus (7716) Google Scholar In the context of HPV prevalence, this would ideally refer to the number of diagnosed HPV cases divided by the entire population in a specified area during a particular timeframe. However, in Bruni and colleagues’ publication,1Bruni L Albero G Rowley J et al.Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis.Lancet Glob Health. 2023; 11: e1345-e1362Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar it is debatable whether the systematic review and meta-analysis included only original research studies with randomised participant sampling. Although the authors rightfully excluded studies conducted in populations at heightened risk for HPV infection, there appears to be a substantial oversight in sampling methodology in some included studies. For instance, two studies within Bruni and colleagues’ systematic review exclusively recruited participants on a voluntary basis for HPV testing.3Wang H Zhao J Liu X Yan W Li G Yuan Y The prevalence and genotype distribution of human papillomaviruses among men in Henan Province of China.Front Med (Lausanne). 2021; 8676401 Google Scholar, 4Wei F Yin K Wu X et al.Human papillomavirus prevalence and associated factors in women and men in south China: a population-based study.Emerg Microbes Infect. 2016; 5: e119Crossref PubMed Scopus (27) Google Scholar This non-random method can introduce bias. Individuals less cognisant of their potential risk or those not self-identifying as being at risk might not volunteer for such a study. This volunteer-based sampling might skew prevalence estimates upwards, as individuals who engage in risky sexual behaviours and are thus more aware or concerned about their HPV risk are most willing to opt for testing and be more likely to be infected. For future epidemiological research, it is imperative to stress the importance of randomised sampling to attain a genuine representation of prevalence. Admittedly, executing a large-scale, national screening programme might encounter resistance due to public reluctance. Still, if a rigorously designed study is not feasible, researchers should frame their findings more cautiously. For instance, stating that the results reflect the HPV prevalence among testing volunteers, rather than implying a general prevalence, would be more scientifically rigorous and avoid potential misunderstandings. Concluding that one in three individuals globally is infected with an HPV type might incite undue concern.5WHOOne in three men worldwide are infected with genital human papillomavirus.https://www.who.int/news/item/01-09-2023-one-in-three-men-worldwide-are-infected-with-genital-human-papillomavirusDate: Sept 1, 2023Date accessed: September 10, 2023Google Scholar Although the data provide valuable insights, it is crucial that findings are presented in a manner that does not inadvertently alarm the public. We declare no competing interests. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysisAlmost one in three men worldwide are infected with at least one genital HPV type and around one in five men are infected with one or more HR-HPV types. Our findings show that HPV prevalence is high in men over the age of 15 years and support that sexually active men, regardless of age, are an important reservoir of HPV genital infection. These estimates emphasise the importance of incorporating men in comprehensive HPV prevention strategies to reduce HPV-related morbidity and mortality in men and ultimately achieve elimination of cervical cancer and other HPV-related diseases. Full-Text PDF Open Access