Understanding the fraction of newly detected human papillomavirus (HPV) infections due to acquisition and reactivation has important implications on screening strategies and prevention of HPV-associated neoplasia. Information on sexual activity and cervical samples for HPV DNA detection using Roche Linear Array were collected semi-annually for two years from 700 women age 35–60 years. Incidence and potential fraction of HPV infections associated with new and lifetime sexual partnerships were estimated using Poisson models. Cox frailty models were used to estimate hazard ratios (HR) for potential risk factors of incident HPV detection. Recent and lifetime numbers of sexual partners were both strongly associated with incident HPV detection. However, only 13% of incident detections were attributed to new sexual partners whereas 72% were attributed to ≥5 lifetime sexual partners. Furthermore, 155 out of 183 (85%) incident HPV detections occurred during periods of sexual abstinence or monogamy, and were strongly associated with cumulative lifetime sexual exposure (HR: 4.1, 95% CI: 2.0, 8.4). This association increased with increasing age. These data challenge the 20 paradigm that incident HPV detection is driven by current sexual behavior and new viral acquisition in older women. Our observation that most incident HPV infection was attributable to past, not current, sexual behavior at older ages supports a natural history model of viral latency and reactivation. As the highly exposed baby-boomer generation of women with sexual debut after the sexual revolution transition to menopause, the implications of HPV reactivation at older ages on cervical cancer risk and screening recommendations should be carefully evaluated.
human papillomavirus; HPV; sexual behavior; older women; reactivation; incidence; acquisition; perimenopause; aging
Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. About 75 to 80% of sexually active Americans will be infected with HPV at some point in their lifetime. The risk of HPV infection seems to be related with age at first intercourse, younger age and number of sexual partners. HPV infection is limited to the basal cells of stratified epithelium of the skin or mucous membranas. There is a wide latency period, from months to years, before squamous intraepithelial lesions develop. Most HPV infections are cleared within 2 years by the immune system. Only in 5% to 10% of infected women with “high risk” types the infection persists determining a high risk of developing intraepithelial neoplasias, as cervical cancer, vulvar cancer, penile cancer, and/or anal cancer. The gynecological evaluation and Papanicolau smear are the primary screening tools for detecting HPV infection. There is currently no specific treatment for HPV infection. The Transfer Factor (TF) or Dialyzable Leukocyte Extract is an immunomodulator that has been successfully used as an adjuvant in the treatment of intracelular infections such as recurrent herpes virus diseases. TF induces the expression of RNAm and IFN-γ and increases CD4+ cells. The IFN-γ activates macrophages, neutrophils, B lymphocytes, NK cells, and favours the differentiation of T cells into Th1 lymphocytes that are requiried for the control of intracellular patho gens.
We used TF in a group of patients with persistent genital human papillomavirus infection.
We included 12 patients, aged 19 to 45 years old (mean 30), with 14 to 23 years at first intercourse and a mean of 3 sexual partners in their lifetime. All of them had persistent HPV that had been treated before with local and ablative therapeutic options (including cervical freezing, cauterizing loop, imiquimod, podophyllin and/or cervical conization). Transfer factor was administered daily for 5 days, and subsequently at 7-day intervals for 5 weeks. We found an important improvement in the gynecological evaluation of cervix and perineal lesions and a significant reduction in the frequency of relapses.
Transfer factor could be used as an adjuvant in patients with persistent genital human papillomavirus infection.
Clinical, subclinical, and latent human papillomavirus (HPV) infections are distinguished from HPV-associated neoplasia. Besides HPV additional cofactors are necessary to transform HPV infected tissue to intraepithelial or invasive neoplasia. Risk factors for the presence of HPV are high number of sexual partners, early cohabitarche, young age at first delivery, suppression and alteration of immune status, young age and hormonal influences. While the fact of a high number of sexual partners exclusively increases the risk of HPV infection, it is not known whether the other factors lead to either an increased risk for HPV infection and/or to HPV-associated neoplasia. Subclinical and latent genital HPV infections are highly prevalent. The prevalence rate depends on the sensitivity of the HPV detection system used, on age and sexual activity of the population screened, and on the number of subsequent examinations performed for each subject. Sexual transmission is the main pathway for genital HPV's, however, vertical, peripartal, and oral transmission are also possible. Seroreactivity against genital HPV may be due to an active infection or the result of contact with HPV earlier in life. Antibodies against the HPV 16 E7 protein indicate an increased risk for cervical cancer. Compared with humoral response cellular immune response is probably more important for regression of genital HPV infection: impaired cellular response is characterized by depletion of T helper/inducer cells and/or Langerhans cells and impaired function of natural killer cells and/or the infected keratinocyte. In condylomata replication and transcription of viral nucleic acids and antigen production coincide with cellular differentiation. However, the interaction between HPV and the keratinocyte on a molecular level in subclinical and latent disease is not well understood. Regression or persistence of subclinical and latent genital HPV infections as observed in longitudinal investigations show a constant come-and-go of HPV presence. Subclinical or latent cervical infections with high-risk HPV types (such as HPV 16 and 18) have an increased risk for the development of HPV-associated neoplasia.
Human Papillomavirus (HPV) is the main risk factor for cervical cancers and is associated with close to 36% of oropharyngeal cancers. There is increasing evidence that oral HPV transmission is related to sexual behavior but to our knowledge studies that involve women who have sex with women have not been performed. We examined the prevalence of oral HPV according to sexual behavior among a population-based sample of 118 women and have made some inferences of possible predictors of oral HPV infection. Women were categorized as heterosexual (history of vaginal sex and/or oral sex with males only, n = 75), bisexual (history of vaginal sex and oral sex with females, n = 32) and other (no history of vaginal sex but oral sex with females [homosexuals], virgins and women with incomplete sexual exposure data, n = 11) The prevalence of oral HPV infection was 12/118 (10.2%) for the overall study population and was not significantly different between heterosexual and bisexual women (10.7% (8/75) vs. 12.5% (4/32), p = 0.784). There was no oral HPV detected among homosexual women, virgins or among women where sexual exposure was unknown. Never smokers were more likely to be oral HPV+ compared to former smokers (Adjusted Odds Ratio (Adj OR) = 0.1, 95% CI, 0.0–1.1) and there was no difference in risk between never smokers and current smokers (Adj OR = 0.7, 95% CI, 0.1–4.6). Twenty-five percent (3/12) of oral HPV+ women had a history of HPV and/or genital warts compared to 9% (10/106) of oral HPV-women (p = 0.104). For the women with a history of vaginal sex (n = 110), oral HPV status was statistically significantly different according to oral sex exposure (p = 0.039). A higher proportion of oral HPV-positive women reported that they had no history of oral sex exposure compared to oral HPV-negative women (4/12, 33% vs. 7/98, 8%). The prevalence of cervical HPV infection did not vary between heterosexuals and bisexuals (35.7% (25/70) vs. 35.5% (11/31), p-value 0.411) and for all other women the cervical HPV prevalence was significantly lower (11.1%, 1/9). Our study suggests that smoking and sexual behavior involving males rather than female partners may be possible predictors of oral HPV infection in women. Further studies with larger sample size are needed to confirm these findings.
sexual behavior; HPV; oral; cervical
Background. Few studies have assessed genital human papillomavirus (HPV) concordance and factors associated with concordance among asymptomatic heterosexual couples.
Methods. Genotyping for HPV was conducted with male and female sex partners aged 18–70 years from Tampa, Florida. Eligibility included no history of HPV-associated disease. Type-specific positive concordance (partners with ≥1 genotype in common) and negative concordance (neither partner had HPV) were assessed for 88 couples. Factors associated with concordance were assessed with Fisher exact tests and tests for trend.
Results. Couples reported engaging in sexual intercourse for a median of 1.7 years (range, 0.1–49 years), and 75% reported being in the same monogamous relationship for the past 6 months. Almost 1 in 4 couples had type-specific positive concordance, and 35% had negative concordance for all types tested, for a total concordance of 59%. Concordance was not associated with monogamy. Type-specific positive concordance was associated with an increasing difference in partners’ lifetime number of sex partners and inversely associated with an increasing difference in age. Negative concordance was inversely associated with both the couple's sum of lifetime number of sex partners and the difference in the partners’ lifetime number of sex partners.
Conclusions. Genital HPV concordance was common. Viral infectiousness and number of sex partners may help explain concordance among heterosexual partners.
Human papillomavirus (HPV) is a sexually transmitted infection that may lead to development of precancerous and cancerous lesions of the cervix. The aim of the current study was to investigate socio-demographic, lifestyle, and medical factors for potential associations with cervical HPV infection in women undergoing cervical cancer screening in Spain.
The CLEOPATRE Spain study enrolled 3 261 women aged 18–65 years attending cervical cancer screening across the 17 Autonomous Communities. Liquid-based cervical samples underwent cytological examination and HPV testing. HPV positivity was determined using the Hybrid Capture II assay, and HPV genotyping was conducted using the INNO-LiPA HPV Genotyping Extra assay. Multivariate logistic regression was used to identify putative risk factors for HPV infection.
A lifetime number of two or more sexual partners, young age (18–25 years), a history of genital warts, and unmarried status were the strongest independent risk factors for HPV infection of any type. Living in an urban community, country of birth other than Spain, low level of education, and current smoking status were also independent risk factors for HPV infection. A weak inverse association between condom use and HPV infection was observed. Unlike monogamous women, women with two or more lifetime sexual partners showed a lower risk of infection if their current partner was circumcised (P for interaction, 0.005) and a higher risk of infection if they were current smokers (P for interaction, 0.01).
This is the first large-scale, country-wide study exploring risk factors for cervical HPV infection in Spain. The data strongly indicate that variables related to sexual behavior are the main risk factors for HPV infection. In addition, in non-monogamous women, circumcision of the partner is associated with a reduced risk and smoking with an increased risk of HPV infection.
HPV infection; Prevalence; Risk factors; Sexual behavior; Questionnaire; Spain
Given the established links between young age at first intercourse (AFI), number of sex partners, high-risk human papillomavirus infection, and squamous cell cervical cancer (SCC), we hypothesized that women diagnosed with SCC at younger ages would be more likely to report young AFI than women diagnosed later in life.
We performed a population-based investigation among invasive SCC cases who were diagnosed between 1986 and 2004, were 22 to 53 years old, and lived in the metropolitan Seattle-Puget Sound region (n=333). Using multivariate linear regression, we estimated coefficients and 95% confidence intervals (CI) to assess the association between age at SCC diagnosis and AFI (<15, 15–18, ≥19) and number of sex partners before age 20 (0, 1, 2–4, 5–14, 15+), accounting for birth year and other factors. Interactions were assessed using the likelihood ratio test.
The interval between AFI and SCC diagnosis ranged from 4 to 35 years. In a multivariate model, compared to SCC cases reporting AFI≥19, the mean age of diagnosis was 3.1 years younger for SCC cases reporting AFI<15 (CI: −5.8, −0.5) and 2.6 years younger for SCC cases reporting AFI 15–18 years (CI: −4.6, −0.6). Although number of sex partners before age 20 was associated with age at SCC diagnosis in a crude analysis, the association was not independent of AFI. However, in the AFI≥19 and AFI<15 groups, differences in effect were seen by number of sex partners before age 20 (p for interaction=0.08), with the association remaining strong and significant only in the AFI<15 group that had 2 or more partners before age 20 (coefficient: −4.2, CI: −6.3, −2.1).
Among younger and middle-aged women with SCC, early age of diagnosis was associated with early AFI, though the effect appeared to be modified by number of sex partners before age 20.
Cervical Carcinoma; Sexual Initiation; Age
Experiences at sexual debut may be linked to reproductive health later in life. Additionally, young women with older sexual partners may be at greater risk for HIV and sexually transmitted infections. This study examines sexual debut with an older partner and subsequent reproductive health outcomes among 599 sexually experienced women aged 15–24 who utilized voluntary counseling and testing or reproductive health services in Port-au-Prince, Haiti.
Logistic regression models, controlling for socioeconomic and demographic factors, examined whether age differences at first sex were significantly associated with STI diagnosis in the previous 12 months and family planning method use at last intercourse.
Sixty-five percent of women reported sexual initiation with a partner younger or less than 5 years older, 28% with a partner 5 to 10 years older, and 7% with a partner 10 or more years older. There was a trend towards decreased likelihood of recent use of family planning methods in women who had first sexual intercourse with a partner 5 to 9 years older compared to women with partners who were younger or less than 5 years older. Age differences were not linked to recent STI diagnosis.
Programs focusing on delaying sexual debut should consider age and gender-based power differentials between younger women and older men. Future research should examine whether wide age differences at sexual debut are predictive of continued involvement in cross-generational relationships and risky sexual behaviors and explore the mechanisms by which cross-generational first sex and subsequent reproductive health may be connected.
Objectives: Genital infection with certain types of human papillomavirus (HPV) is the most important risk factor for cervical cancer. The male sexual partner is supposed to be the vector of the infection. However, the knowledge of risk factors for genital HPV DNA in men is limited. The objective of this paper is to study the risk factors for HPV infection in men and to compare them with those found in women, including the study of whether there are different risk profiles for oncogenic and non-oncogenic HPV types.
Methods: From a sexually transmitted diseases (STD) clinic in Denmark, 216 men were consecutively included. A personal interview was done and material for genital HPV DNA detection was obtained with swabs. HPV DNA was detected by polymerase chain reaction (PCR). Odds ratios (OR) for HPV as well as for oncogenic and non-oncogenic types separately were computed with a 95% confidence interval (CI) by means of unconditional multiple logistic regresssion.
Results: The most important predictors of any HPV were lifetime number of sex partners (OR = 4.3; 95% CI 1.4 to 13.1 for 25–39 v 1–9 partners), young age, and being uncircumcised. The most important risk factor for oncogenic HPV types was lifetime number of partners, whereas number of partners in the past year and ever having genital warts were risk factors for the non-oncogenic HPV types. Young age predicted risk of both oncogenic and non-oncogenic HPV types.
Conclusions: Most risk factors for HPV DNA detection in men resemble those found in women. As in women, the risk factor profile for the oncogenic HPV types was different from that of the non-oncogenic HPV types.
Background. An increasing incidence of anal cancer among men suggests a need to better understand anal canal human papillomavirus (HPV) infection among human immunodeficiency virus–negative men.
Methods. Genotyping for HPV was conducted on cells from the anal canal among men who have sex with women (MSW) and men who have sex with men (MSM), aged 18–70 years, from Brazil, Mexico, and the United States. Factors associated with anal HPV infection were assessed using multivariable logistic regression.
Results. The prevalence of any HPV type and oncogenic HPV types did not differ by city. Anal canal HPV prevalence was 12.2% among 1305 MSW and 47.2% among 176 MSM. Among MSW, reporting a lifetime number of ≥10 female sex partners, a primary sexual relationship <1 year in duration, and a prior hepatitis B diagnosis were independently associated with detection of any anal HPV in multivariable analysis. Among MSM, a younger age, reporting ≥2 male anal sex partners in the past 3 months, and never using a condom for anal sex in the past 6 months were independently associated with detection of any anal HPV in multivariable analysis.
Conclusions. Number of sex partners was associated with anal HPV infection in both MSW and MSM. Anal HPV infection in men may be mediated by age, duration of sexual relationship, and condom use.
Male circumcision (MC) reduces high-risk human papillomavirus (HR-HPV) in HIV-uninfected men and their female partners. We assessed whether MC of HIV-infected men reduces HR-HPV infection in their female partners.
Female partners of married HIV-infected men with CD4 counts >350 cells/mL randomized to immediate MC (intervention, n=211) and delayed MC (control, n=171) were evaluated for HR-HPV in vaginal swabs by Roche HPV Linear Array. Prevalence risk and incident rate ratios (PRR and IRR) and 95% confidence intervals (95%CI) of HR-HPV were estimated by Poisson multiple regression using an intention-to-treat analysis. In women with pre-existing HR-HPV, we estimated the risk ratio (RR) of clearance of infection (i.e., loss of detection). The trial was registered with ClinicalTrials.gov, NCT00124878.
Female characteristics and HPV prevalence were generally similar between arms at enrollment, except the intervention arm women were younger (p=0.04). Female HR-HPV prevalence at enrollment was 67.0% in intervention arm and 61.9% in control arm p=0.33. Two year female retention rates were 75.8% (160/211) in the intervention arm and 77.2% (132/171) in the control arm. Female HR-HPV prevalence at year two was 55.4% in intervention arm and 51.9% in control arm (PRR = 1.07, 95%CI0.86–1.32, p=0.64). HR-HPV incidence over 2 years was 32.0/100py in intervention arm and 30.6/100py in control arm female partners (IRR=1.05, 95%CI 0.77–1.43, p=0.78). There was no difference in female genotype-specific HR-HPV clearance by study arm (RR=0.96, 95%CI 0.83–1.11, p=0.61).
Contrary to findings in HIV-negative men, male circumcision of HIV-infected men did not affect HR-HPV transmission to female partners.
Bill & Melinda Gates Foundation and National Institutes of Health.
Male circumcision; transmission; female partners; human papillomavirus (HPV); cervical cancer; HIV; Uganda; sexually transmitted infections
Prevalence of human papillomavirus (HPV) is high in both men and women, yet men have seldom been involved in HPV education/prevention programmes, and their disclosure of known HPV infection has rarely been studied. This analysis sought to determine factors associated with men's HPV test result disclosure and HPV-related information sharing with partners.
From 2007 to 2010, men enrolled in a psychosocial study of responses to HP testing who reported having a female main sexual partner (N=251) completed surveys including questions about HPV test results, disclosure of HPV test results to partner(s), relationship characteristics and stigma (for those who reported HPV-positive results) approximately 3 weeks after receiving an HPV test result. Logistic regression was conducted to determine factors associated with disclosure of HPV test results in cross-sectional analysis.
Most men disclosed their test results to a main partner (82%). Self-reported HPV-negative test result, a high school education and a higher commitment to a sexual partner were significantly associated with increased disclosure in multivariable analysis. Men who disclosed (vs those who did not) were significantly more likely to provide their partners with HPV-related information. Among men who disclosed to their main partner, nearly half reported that partner asked them questions about HPV.
Results from this study highlight the critical role that men who are symptomatic for, who are tested for or who are vaccinated against HPV can play in educating their sexual partners, independent of whether they actually disclose their test results.
Cervical human papilloma virus (HPV) detection increases after menopause, but its determinants need clarification.
In a case–control study nested within a 10,049 women cohort, we evaluated women 45 to 75 years old who acquired HPV infection and were HPV positive 5 to 6 years after enrollment (N = 252), and HPV-negative women as matched controls (N = 265). Detailed sexual behavior and cellular immune response were investigated. Odds ratios (OR) and attributable fractions were estimated.
Women with 2+ lifetime partners had 1.7-fold (95% CI = 1.1–2.7) higher risk than monogamous women, with similar findings if their partners had other partners. Women with 2+ partners after last HPV-negative result had the highest risk (OR = 3.9; 95% CI = 1.2–12.4 compared with 0–1 partners). Weaker immune response to HPV-16 virus-like particles increased risk (OR = 1.7; 95% CI = 1.1–2.7 comparing lowest to highest tertile). Among women with no sexual activity in the period before HPV appearance, reduced immune response to phytohemagglutinin was the only determinant (OR = 2.9; 95% CI = 0.94–8.8). Twenty-one percent of infections were explained by recent sexual behavior, 21% by past sexual behavior, and 12% by reduced immune response.
New infections among older women may result from sexual activity of women and/or their partners or reappearance of past (latent) infections possibly related to weakened immune response.
HPV infections among older women are associated with current and past sexual exposures and possibly with immune senescence. The risk of cancer from these infections is likely to be low but could not be fully evaluated in the context of this study.
In the USA, sexual intercourse is the leading route of human immunodeficiency virus transmission among women, primarily through their main partner. Because male condom use is not directly under a woman's control, gender inequalities may help shape this sexual risk behavior. To examine this association, data came from follow-up interviews of young, primarily minority, pregnant women enrolled in a prospective, randomized controlled trial. Specifically, we aimed to determine the relationship between economic dependence on a male partner and condom use, and to establish whether this relationship was mediated by sexual assertiveness. Overall, 28% of women reported being economically dependent on a male partner. Young women dependent on a male partner were 1.6 times more likely to report not using a condom at last sex than women not dependent on their partner (95% confidence interval = 1.11–2.32; p = 0.01). Sexual assertiveness mediated the relationship between economic dependence and condom use (Sobel = 2.05, p = 0.04). Coupled with past research, this study supports the premise that sexual behaviors may be rooted in a complex web of social determinants. Addressing gender inequalities in contextual factors may promote healthier decisions within sexual relationships.
Sexual risk; Gender; Economic dependence; Social determinants
Background. Cohort effects, new sex partnerships, and
human papillomavirus (HPV) reactivation have been posited as explanations for the bimodal
age-specific HPV prevalence observed in some populations; no studies have systematically
evaluated the reasons for the lack of a second peak in the United States.
Methods. A cohort of 843 women aged 35–60 years
were enrolled into a 2-year, semiannual follow-up study. Age-specific HPV prevalence was
estimated in strata defined by a lower risk of prior infection (<5 self-reported
lifetime sex partners) and a higher risk of prior infection (≥5 lifetime sex partners).
The interaction between age and lifetime sex partners was tested using likelihood ratio
statistics. Population attributable risk (PAR) was estimated using Levin's
Results. The age-specific prevalence of 14 high-risk
HPV genotypes (HR-HPV) declined with age among women with <5 lifetime sex partners but
not among women with ≥5 lifetime sex partners (P = .01 for
interaction). The PAR for HR-HPV due to ≥5 lifetime sex partners was higher among older
women (87.2%), compared with younger women (28.0%). In contrast, the PAR
associated with a new sex partner was 28% among women aged 35–49 years and
7.7% among women aged 50–60 years.
Conclusions. A lower cumulative probability of HPV
infection among women with a sexual debut before the sexual revolution may be masking an
age-related increase in HPV reactivation in the United States.
Human Papillomavirus; menopause; perimenopause; sexual revolution; cervical cancer; reactivation; cohort effect; age
The number of women who are active duty service members or veterans of the U.S. military is increasing. Studies among young, unmarried, active duty servicewomen who are sexually active indicate a high prevalence of risky sexual behaviors, including inconsistent condom use, multiple sexual partners, and binge drinking, that lead to unintended and unsafe sex. These high-risk sexual practices likely contribute to chlamydia infection rates that are higher than the rates in the U.S. general population. Human papillomavirus (HPV) infection and cervical dysplasia may also be higher among young, active duty servicewomen. Little is known about the sexual practices and rates of sexually transmitted infections among older servicewomen and women veterans; however, women veterans with a history of sexual assault may be at high risk for HPV infection and cervical dysplasia. To address the reproductive health needs of military women, investigations into the prevalence of unsafe sexual behaviors and consequent infection among older servicewomen and women veterans are needed. Direct comparison of military and civilian women is needed to determine if servicewomen are a truly high-risk group. Additionally, subgroups of military women at greatest risk for these adverse reproductive health outcomes need to be identified.
Human papillomavirus (HPV) is the most common newly diagnosed
sexually transmitted infection in the United States. Although the
majority of sexually active adults will be infected with HPV at
least once in their lives, it is sexually active women less than
25 years of age who consistently have the highest rates of
infection. Besides youth and gender, common risk factors for HPV
infection and clinical sequelae of infection include high number
of sexual partners and coinfection with Chlamydia
trachomatis or herpes simplex virus. Most HPV infections are
cleared by the immune system and do not result in clinical
complications. Clinical sequelae in cases of low-risk HPV
infection consist of genital warts, and clinical manifestations of
high-risk HPV infection include abnormal Pap test results,
low-grade squamous intraepithelial lesions (LSIL), high-grade
squamous intraepithelial lesions (HSIL), and cervical cancer.
LSIL, HSIL, and cervical cancer carry significant morbidity and/or
mortality; genital warts and abnormal Pap test results are often
significant sources of psychosocial distress. Currently, there are
neither effective means of preventing HPV transmission nor cures
for clinical manifestations: infection can only be prevented via
complete sexual abstinence, while treatment for clinical sequelae
such as genital warts and cytologic abnormalities consists of
removing the problematic cells and watching for recurrence; this
method consumes significant health care resources and is costly.
New prophylactic HPV vaccines promise to dramatically reduce the
incidence of HPV infection, genital warts, and cytologic
Adolescent females who have early sexual experiences with older male partners report high rates of sexual risk behavior during adolescence, but little is known about whether these early sexual experiences are associated with adult sexual risk behavior. The purpose of this study was to investigate whether having first consensual sex with an older partner was associated with sexual risk behavior in adulthood.
Participants were 292 women (66% African American, mean age = 26 years) attending a public sexually transmitted disease (STD) clinic who reported having voluntary vaginal sex before age 18. Participants completed a computerized survey assessing child/adolescent sexual experiences and current adult sexual risk behavior.
Participants were, on average, 14.6 years at first vaginal intercourse; their partners were, on average, 17.5 years. After controlling for covariates, a greater partner age difference at first intercourse was associated with more episodes of unprotected sex with a steady partner and a greater proportion of episodes of unprotected sex with a steady partner in the past 3 months.
Having an older first sex partner during adolescence was associated with sexual risk behavior in adulthood. Early sexual experiences may be important life events that influence subsequent sexual behavior. Sexual health interventions need to target female adolescents before they initiate sexual intercourse to reduce risk for STDs and human immunodeficiency virus (HIV) infection.
Approximately 291 million women worldwide are HPV DNA carriers. Studies have indicated
that having multiple sexual partners may lead to higher HPV transmission. Thus female sex workers (FSWs) may be at
greater risk of infection compared to the general population. Herein we review publications with data on FSW cervical
HPV test results. We also examine variations of HPV prevalence and risk behaviors by region. Knowledge of prevalent
HPV types in FSWs may lead to improved prevention measures and assist in understanding vaccination in high-risk
We conducted a review of the literature by searching PUBMED using the terms “prostitution” or “female sex
workers”, “human papillomavirus” or “HPV”, and “prevalence” or “PCR” to find articles. We excluded studies without
HPV testing or HPV type specific results, or unconventional HPV testing.
A total of 35 peer-reviewed publications were included in our review. High risk HPV types 16 and 18 ranged
from 1.1-38.9‰ in prevalence. In addition to high-risk HPV types, newer studies reported non-carcinogenic HPV types
also of high prevalence. The most prevalent HPV types reported among FSWs included HPV 6 (11.5%), 16 (38.9%), 18
(23.1%), 31 (28.4%), 52 (32.7%), and 58 (26.0%).
Female sex workers have an overall high prevalence of HPV infection of high-risk types as evident through
various testing methods. FSWs are thought to be at increased risk of cervical cancer because of high HPV exposure. This
highlights the need for HPV and cervical prevention campaigns tailored to FSWs.
Female sex workers; genotype; HPV; PCR; prevalence; prostitution.
Genital infection by human papillomavirus (HPV), a sexually transmitted disease (STD), has increased considerably due to the changes in sexual behaviour and an increase in the practice of oral sex. HPV, in a parallel manner, has been closely studied due to its oncogenic potential. We present the case of a 27-year-old patient, with a multi-partner sexual history and frequent practice of oral sex, who suffered from warts lesions on the genitalia and tongue. Squamous papilloma was diagnosed from a tongue biopsy. The treatment of the oral lesion was by way of surgery, without relapse in the first two years. Our discussion in this report is regarding the HPV infection in the oral cavity.
Human papillomavirus; oral cavity; papilloma; sexually transmitted disease; sexual behaviour
A hospital-based case-control study was undertaken to examine the role of human papillomavirus (HPV) in the development of invasive cervical cancer in Brazil. The study included 199 histologically confirmed incident cases and 225 age-frequency-matched controls selected from a wide range of diagnostic categories. A polymerase chain reaction technique was used to detect HPV DNA in cervical specimens collected with spatula and brush. HPV DNA was detected in 84% of the cases compared with 17% of controls. Grouping HPV types 16, 18, 31 and 33, 66% of the cases were positive compared with only 6% of the controls. In addition to HPV, number of sexual partners, early age at first intercourse, parity and duration of oral contraceptive use were significantly associated with an increased risk of cervical cancer. A history of previous Papanicolaou smears was significantly associated with a decreased risk. After adjustment, only presence of HPV DNA, parity and history of previous smears remained as independent risk factors. The adjusted odds ratios of cervical cancer associated with HPV 16, 18, 31, and 33 was 69.7 (95% confidence interval 28.7-169.6) and with unidentified types was 12.0 (5.1-28.5). The very high risks found in this study further implicate this virus in the aetiology of cervical cancer.
No data exist on the population prevalence of, or risk factors for, human papillomavirus (HPV) infection in predominantly Muslim countries in Asia.
Cervical specimens were obtained from 899 married women aged 15–59 years from the general population of Karachi, Pakistan and from 91 locally diagnosed invasive cervical cancers (ICCs). HPV was detected using a GP5+/6+ PCR-based assay.
The prevalence of HPV in the general population was 2.8%, with no evidence of higher HPV prevalence in young women. The positivity of HPV was associated with women's lifetime number of sexual partners, but particularly with the age difference between spouses and other husbands' characteristics, such as extramarital sexual relationships and regular absence from home. The HPV16/18 accounted for 24 and 88% of HPV-positive women in the general population and ICC, respectively.
Cervical cancer prevention policies should take into account the low HPV prevalence and low acceptability of gynaecological examination in this population.
HPV; prevalence; cervical cancer; Pakistan
Human Papillomavirus (HPV) is the most common sexually transmitted infection. The main risk factors correlated with HPV infection are: early sexual debut, the number of partners, frequency and type of sexual contact and partner’s sexual histories.
We surveyed sexual habits among young people in order to provide information that might orient decision-makers in adopting HPV multi-cohort vaccination policies.
We administered a questionnaire to students (14–24 years old) in five Italian cities.
7298 questionnaires were analyzed (4962 females and 2336 males); 55.3% of females (95% CI 53.9–56.7) and 52.5% of males (95% CI 50.5–54.5) reported regular sexual activity. The mean age at sexual debut was 15.7 ± 1.6 and 15.6 ± 1.6 for females and males, respectively, and the median age was 16 for both sexes.
With regard to contraceptive use during the last year, 63.6% of males and 62.8% of females responded affirmatively; 42.6% of males and 42.8% of females used condoms.
The results reveal precocious sexual activity among respondents, with the mean age at first intercourse declining as age decreases. Condom use proved to be scant. Considering lifestyle-related risk factors, males appear to have a higher probability of acquiring HPV infection than females.
These data support the importance of promoting multi-cohort HPV vaccination strategies for females up to 25 years of age. It is essential to improve vaccination coverage through different broad-spectrum strategies, including campaigns to increase awareness of sexually transmitted diseases and their prevention.
Sexual behaviour; Human papillomavirus; Adolescents; Young people; HPV vaccination; Sexually transmitted diseases (STDs)
The most common cause of mortality related to human papillomavirus (HPV) infection is cervical cancer. However, male HPV infection is also an important concern, both for the disease burden in men and for the risk of transmission to women. HPV is associated with a variety of cancers in men, including anal cancer and a subset of penile and oral cancers. The incidence of anal and oral cancers related to HPV is increasing in the general population and is growing even faster among individuals who are immunocompromised due to HIV infection. Penile HPV infection is very common among heterosexual men and remains high throughout a wide range of ages. Likewise, anal HPV infection and anal intraepithelial neoplasia are very common throughout a wide range of ages in both HIV-negative and HIV-positive men who have sex with men. Other HPV-related diseases of clinical importance in men include condylomata acuminata (genital warts) and recurrent respiratory papillomatosis. The quadrivalent HPV vaccine has been shown to be highly efficacious in the prevention of genital warts in women and precancerous lesions of the cervix, vulva, and vagina. In addition, recent interim data have shown that the quadrivalent HPV vaccine is highly effective in reducing external genital lesions in young men. Although the protective efficacy of HPV vaccination in males has not yet been fully established—pending the outcome of public policy discussions and cost-efficacy studies—there may be a strong rationale for vaccinating boys, similar to girls, at an early age when they have had limited or no prior sexual activity.
human papillomavirus; anal cancer; penile cancer; vaccination
OBJECTIVES: To assess if seropositivity to human papillomavirus type 16 capsids is a better marker of sexual history than the presence of HPV DNA. STUDY DESIGN: A population based age stratified random sample of 234 Norwegian women (mean age 32.8 years, range 20-44) was examined for HPV serum antibodies, cervical HPV DNA, cytology and age in relation to sexual behaviour. RESULTS: Neither age nor age at first sexual intercourse was associated with HPV 16 antibodies. Adjusted ORs for 4-5; 6-10 and > 10 versus 0-1 lifetime sexual partners, were 13.1 (95% CI 1.5-110.8), 8.2 (1.0-69.6) and 10.5 (1.2-94.0) for HPV 16 seropositivity, respectively; and 2.6 (0.2-27.8), 3.4 (0.4-31.7) and 4.1 (0.4-42.8) for HPV 16 DNA positivity, respectively. CONCLUSION: Seropositivity to HPV 16 capsids is positively associated with the number of sexual partners, suggesting that HPV 16 is predominantly sexually transmitted. The fact that serology had a stronger association with number of sexual partners than viral DNA suggests that seroreactivity is a better measure of lifetime history of HPV infection.