HPV, a sexually transmitted infection, is strongly associated with invasive cervical, vulvar, and anal cancers in women, penile and anal cancers in men, and anogenital warts in both men and women. Internationally, cervical cancer is the second most common cancer among women. Recent research suggests that the sexual behavior of the male partner may be as or more important than a woman's personal sexual behavior in predicting her risk of HPV infection and cervical disease. Despite a high HPV prevalence (lifetime approximately 50%) the majority of men and women lack knowledge about HPV and its causal relationship with genital warts, cervical dysplasia, and cancer. The IOM recently highlighted lack of communication and secrecy as major contributors to the 'hidden epidemic1 of STIs. Unfortunately little is known about men's knowledge of HPV and their response to an HPV test result due to a general lack of HPV research among men. This has severely limited our ability to design effective strategies to control HPV in men as well as in women. To achieve the goal of reducing HPV infection and associated disease it is imperative that we educate both sexes about HPV and its sequelae. The purpose of this study is to further our understanding of men's cognitive, emotional, and behavioral responses to an HPV test result so that effective programs can be developed to reduce cervical cancer and HPV related disease in both sexes. We are uniquely positioned to fill this information gap by collaborating with a currently funded HPV natural history study in men, (The HIM Study CA098803;PI Dr. Giuliano) where 1000 predominantly heterosexual US men are tested repeatedly for genital HPV over a 5 year period. Our proposed study, the Cognitive and Emotional Response Study (CER Study) will assess the cognitive, emotional, and behavioral responses to an HPV test result in men. We propose a prospective study implementing 4 surveys, completed by 500 HIM Study participants every 6 months over a 2 year period. Our study is unique in that it will be the first to prospectively assess reactions to HPV results among US men;cost-effective as it utilizes the enrollment, HPV testing and follow-up infrastructure of a cohort study currently underway;timely in that it will identify behaviors and responses to HPV test results at a time when HPV prevention vaccines are being introduced. These data will assist in the planning, implementation, and evaluation of interventions to reduce HPV infection in both sexes.
