Human papillomavirus (HPV)-associated male and female genital carcinomas in a Hindu population. The male as vector and victim.

Epidemiologic, histologic and immunohistochemical data concerning male (penile) and female (cervical and vulvar/vaginal) genital carcinomas in a Hindu population are reported. The data are from Bali, an Indonesian Hindu island in a country with a predominantly Muslim population. In contrast to the surrounding Muslim population, circumcision is rare in the people of Bali, and the rate of phimosis in grown men is very high. The Balinese epidemiologic data of 1985 to 1986 were compared with 1986 data from The Netherlands. In Bali, cervical carcinoma was the most frequent carcinoma in women, and vulvar/vaginal carcinoma ranked seven. These carcinomas were much less frequent in The Netherlands. In Balinese men, penile carcinoma is the second most frequent carcinoma, whereas it is rarely diagnosed in The Netherlands. Penile carcinomas are found in Bali in younger age groups than in The Netherlands. Based on the immunohistochemical staining results, it is estimated that over 75% of the studied Balinese genital carcinomas contain human papillomavirus (HPV). The data presented in this paper may indicate that the cofactor of impeded postcoital hygiene can be of great importance for male and female HPV-associated genital carcinogenesis. It is clear that Balinese men, in particular men with extreme phimosis, are both vectors and victims of HPV. In The Netherlands the man is exclusively the vector of HPV.