Gender Differences in Sociodemographic Characteristics and Risk

Factors among Condyloma Acuminata Patients in Dr. Moewardi

General Hospital Surakarta

Adniana Nareswari, Primadhanty Bhadra, Mardiana, Halim Perdana Kusuma, Endra Yustin

Ellistasari

Dermatovenereology Department Medical Faculty of Sebelas Maret University/

Dr. Moewardi General Hospital, Surakarta, Indonesia

Keywords: acuminata, gender difference, sexual behavior, risk factor.

Abstract: Condyloma acuminata (CA) known as anogenital wart is the most frequent sexually transmitted infection

(STI) worldwide. This highly infectious disease is caused by the human papilloma virus (HPV), whose its

high recurrence rates contribute to direct medical costs, productivity loss and increased psychosocial impact.

Thus, the prevention of this viral disease is more important than focusing on its treatment. This cross sectional

retrospective study assessed the gender differences in sociodemographic characteristics and sexual risk factors

of CA patients. There were 94 newly diagnosed CA patients, 47 males (50%) and 47 (50%) females during

the period of January 2013- December 2017. The demographic data were taken from medical record and the

additional data about the risk factors were from the questionnaires. Chi-square test was performed to compare

between genders and p < 0.05 was considered statistically significant. There was significant difference

between genders on all sociodemographic characteristics (age, occupation, education, marrital status) and risk

factors (HIV/AIDS infection, condom using, age at the first sexual intercourse, number of lifetime sexual

partner, type of intercourse) among CA patients. Our study revealed that male CA patients were mostly single,

employed and multipartner, while CA female patients were mostly married, housewives and singlepartners.

1 INTRODUCTION

Condyloma acuminata (CA) which is also known as

anogenital wart is common among sexually active

people. It is caused by the Human Papilloma Virus

(HPV), a sexually transmitted virus. Two low-risk

HPV genotypes, HPV 6 and 11 are believed to be the

cause of 90% of all CA cases.

(

Stanley, 2012). The

prevalence of CA is increasing by time in adult

population. Data from Center for Disease Control and

Prevention showed that in United States there are

more than 19.7 million new cases of STI annually and

14.1 million of them are CA.

(

Center for Disease

Control and Preventon, 2013)

Gender differences in norms for sexual behavior

exist and factors associated with sexual relations may

differ by sex. In studies by Faílde JM et al

(Failde,2008) and Teva I et al

(teva,2009) it was

found that generally, males tend to have more sexual

partners than females and to use condoms less

frequently than women during vaginal intercourse. In

other words, risky sexual behavior is more likely

among males than among females at any given

adolescent age. However, little research has been

conducted on sociodemographic factors or the effect

of addictive substances on sexual behavior, especially

in relation to gender; therefore, it is important to take

into account sexual risk factors, sociodemographic

characteristics and gender when making and

implementing intervention.

Condyloma acuminta is highly infectious and

although it is a benign neoplasma and not life

threatening but its high recurrence rates contribute to

direct medical costs, productivity loss and increased

psychosocial impact (Patel, 2013). Therefore, the

prevention of this disease is important and should be

concerned by investigating its epidemiological

characteristics and sexual risk factors. Some studies

have been performed about CA infection in

Indonesian population, but the data about the pattern

of sexual behaviors and risk factors among CA

patients is still limited, especially studies that

evaluated and compared between male and female

214

Nareswari, A., Bhadra, P., Mardiana, ., Kusuma, H. and Ellistasari, E.

Gender Differences in Sociodemographic Characteristics and Risk Factors among Condyloma Acuminata Patients in Dr. Moewardi General Hospital Surakarta.

DOI: 10.5220/0008154202140218

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 214-218

ISBN: 978-989-758-494-7

CA patients. Our study analyzed the gender

differences in sociodemographic characteristics and

sexual risk factors of CA patients in order to plan

future health interventions.

2 METHODS

This cross sectional retrospective study used

purposive random sampling technique, 94 patients

who were newly diagnosed with condyloma

acuminata were evaluated. They visited

dermatovenereology outpatient clinic, dr. Moewardi

General Hospital from January 2013 to December

2017. Sociodemographic data of the patients with CA

included gender, age, educational status, occupation

and marrital status were taken from medical record

while the sexual risk factors include HIV/AIDS

infection, age at the first sexual intercourse, condom

using, type of intercourse and number of lifetime

sexual partner) were from questionnaires. This

information was routinely asked to the patients on

their first visit and recorded in medical files. The data

were analyzed using Predictive Analysis Software,

version 22.0 (SPSS Inc, US). Chi-square test was

performed to determine the association between

gender and behavior as well as risk factors of CA

patients. P value < 0.05 was cosidered to be

statistically significant.

3 RESULTS

Fourty seven males (50%) and 47 females (50%)

with condyloma acuminata were statistically

analyzed. There were significant difference between

genders in age (p = 0.014), occupation (p = 0.001),

education (p = 0.019) and marrital status (p = 0.036)

of CA patients. In our study, the most common age of

CA patients was 21-30 years old. The male patients

were mostly single and workers. Female patients who

were affected by CA were mostly married and

housewives. Both female and male patients with CA

were mostly twenties years old and high school

graduates. (Table 1)

Table 1. Gender differences in demographic and general information among patients with condyloma acuminata.

umber of sub

ects (%)

PARAMETERS Male (n = 47)

n (%)

Female (n = 47)

n (%)

p Value

Age

<20

21-30

31-40

41-50

>50

1 (2.1)

21 (44.8)

16 (34.0)

3 (6.4)

6 (12.8)

8 (17.0)

22 (46.8)

12 (25.5)

5 (10.6)

0 (0)

.014

Occupation

Self employed

University student

Housewife/

Unemployed

Emplo

11 (23.4)

4 (8.5)

3 (6.4)

29 (61.7)

7 (14.9)

4 (8.5)

19 (40.4)

17 (36.2)

.001

Education

Elementary school

Junior school

High school

Universit

0 (0)

8 (17.0)

34 (72.3)

5 (10.6)

3 (6.4)

15 (31.9)

20 (42.6)

9 (19.1)

.019

Marriage status

Single

Married

Divorced

Widow

24 (51.1)

22 (46.8)

1 (2.1)

0 (0)

12 (25.5)

34 (72.3)

0 (0)

1 (2.1)

.036

Gender Differences in Sociodemographic Characteristics and Risk Factors among Condyloma Acuminata Patients in Dr. Moewardi General

Hospital Surakarta

215

There were significant difference between

genders in HIV infection status (p=0.035). Most

patients did not have HIV infection. The age of their

first sexual intercourse (p=0.039) were mostly in the

age of 15-20 years old. There was also significant

difference between genders in the number of lifetime

sexual partner (p=0.000), most of male CA patients

were multipartners with 2-4 sexual partners, while

female CA patients were singlepartner. The type of

intercourse among male and female patients was

significantly different (p=0.000), the male CA

patients mostly liked oral intercouse, differ from

female patients who preferred genital intercourse.

(Table 2).

Table 2. Gender differences in sexual risk factors among patients with condyloma acuminate.

4 CONCLUSIONS

The diagnosis of CA in our study was based on

history taking, physical and supportive examinations.

Application of 3-5% asetic acid which lead to

whitened of the lesion (acetowhite) is used to detect

HPV infection in genital mucous. Acetowhite test

sensitivity is reliable detecting in HPV infection.

There are many previous studies in condyloma

acuminata however only a few of them which studied

about gender differences among CA patients.

In this present study, there are significant

difference between gender in group age of CA

patients (p= 0.014) . The highest incidence is in the

age of 21-30 years old in both genders. This is similar

with the previous study by Patel et al who showed that

incidence of CA peaked before 24 years old in

females and between 25 and 29 years old among

males (Patel, 2013). These corelate with the sexual

reproductive age of the patients since CA is highly

infectious sexually transmitted disease.

Many of male CA patients in our study are

workers (n=29, 61.7%). This perhaps they earn a lot

of money, have their own flexible time and they are

also good at socializing. This is supported by a study

by Aprilianingrum which reported that most female

sex workers’s client are self employed. This may

demonstrate that there is a correlation between the

high occurence of CA in this community.

(Aprilianingrum, 2007)

In contrast, most of female

CA patients in this study are housewives (n=19,

umber of sub

ects (%)

PARAMETERS Male (n = 47)

n (%)

Female (n = 47)

n (%)

p Value

Condom Using

Sometimes

Always

eve

15 (31.9)

8 (17.0)

24 (51.1)

5 (10.6)

8 (17.0)

34 (72.3)

.035

HIV

Yes

19 (40.4)

28 (59.6)

7 (14.9)

40 (85.1)

.006

Age at the first sexual intercourse

<15

15-20

21-25

26-30

>30

3 (6.4)

32 (68.1)

9 ( 19.1)

1 (2.1)

2 (4.3)

0 (0.0)

27 (57.4)

14 (29.8)

6 (12.8)

0 (0.0)

.039

umber of lifetime sexual partne

2-4

≥5

9 (19.1)

28 (59.6)

10 (21.3)

33 (70.2)

14 (29.8)

0 (0.0)

.000

Type of intercourse

Genital

Anal

Oral

Anal oral genital

13 (27.7)

7 (14.9)

20 (42.6)

7 (14.9)

34 (72.3)

1 (2.1)

11 (23.4)

1 (2.1)

.000

RCD 2018 - The 23rd Regional Conference of Dermatology 2018

216

40.4%). This result similar with study among women

in Kermansyah Province, Iran which showed that

about 51,5% female CA patients are housewives.

(Najafi, 2016)

Sexual behaviour was found to be strongest risk

predictor for CA in both males and females. The age

of the first sexual intercourse differs in various

population according to the cultural and religious

beliefs. For example, in Indian study the mean age of

firts sexual experience was 13 years old but in

American study it was reported as 17 years old.

(Insinga, 2003) (Shewl,2006) .In our study, mostly of

patients started their first intercourse at the age of 15-

20 (males 68.1% vs females 57.4%). Given that most

of our male patients were single, it indicates that

many male CA patients started their sexual activity

before marriage and even in early adolescence. Thus,

this should be emphasized that sexual health

education in our country should be started for junior

and high school students and premarital couples.

Moreover, similiar with study by

Panchanadeswaran et al which reported that males

were much likely than females to have more than 1

lifetime sexual partners and to have concurrent

regular as well as casual partner

(Panchanadeswaran,2006), 38 of 47 male patients in

our present study are multipartners with more than 2

sexual partners in lifetime (80.9%) and only 9 of them

(19.1%) are singlepartners. It was sigfinicantly

different from females CA patients who mostly only

has 1 sexual partner in lifetime (n=33, 70.2%) and

none of them had sexual partner more than four.

Study by Wen et al stated that greater numbers of

lifetime sexual partners were independently

associated with increased risk of genital CA in men

only. Men with 10 or more lifetime partners were

approximately twice as likely to acquire CA than man

with no or one lifetime sexual partner. But there is no

such association was found for women. (Gage,1998).

Many studies have reported the role of condom

use in the prevention of HPV infection.

In our study,

most of CA patients confessed that they never use

condom in their sexual activity (51.1% male vs 72.3%

female). Some adolescents believe that condoms are

unnatural, that they reduce pleasure or sensation and

that their use indicates a general lack of respect for

the female partner. The nonmonetary costs of condom

use appear to be even higher among famales than

males. Some females feel that a partner’s wish to use

a condom suggest that they, the females, are not

clean, that they are commercial sex workers or that

they are in extra-relationship sexual activity. It seems

that safe sex and the use of condom in preventing CA

should be considered and educated to all groups.

(Gage, 1998).

In this present study there were 19 (40.4%) male

CA patients and 7 (14.9%) of female CA patients who

had HIV infection. Human Immunodeficiency Virus

(HIV) is a predisposed factor for HPV infection,

including CA. Many studies reported that the

incidence of CA increasing in HIV/ AIDS patients.

Systemic review by Baruna et al in Sub Saharan

population showed a significantly high prevalence of

CA in HIV/ AIDS patients. (Banura,2013).

International Institute for Allergy and Infectious

Diseases in a study titled HPV FACT SHEET

reported that CA can be transmitted by oral, vaginal

and anal sex. However, oral and anal sex behaviors

are the most common routes.

Twenty of all male CA

patients in this study were engaged to oral intercourse

(42.6%) and 14 of them (29.8%) were male sex male

patients who had anal intercourse.

5 CONCLUSIONS

Our study showed that CA are more involves younger

patients in sexual active age, males who were singles,

workers and multipartnersand females who were

married, housewives and singlepartners. Further

studies with larger sample size are needed to achieve

more information about various aspects of CA as well

as sexual behaviors and risk factors, to help policy

makers make informative decisions about adopting

effective tratment and preventative practices. Early

sex education starting from junior high school

especially about STI and HIV is necessary.

Condyloma acuminta sexual partners is suggested to

get routine STI examination and also Voluntary

Counselling and Testing (VCT) must be performed in

CA patients

ACKNOWLEDGEMENTS

We acknowledge that this study was not funded by

any organization. There was no conflict of interest in

this study.

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