Sexual Behaviour and HPV Infections in 18 to 29 Year Old Women in the Pre-Vaccine Era in the Netherlands

Contains fulltext : 71058.pdf ( ) (Open Access)BACKGROUND: Infection with Human Papillomavirus (HPV) is a necessary event in the multi-step process of cervical carcinogenesis. Little is known about the natural history of HPV infection among unscreened young adults. As prophylactic vaccines are being developed to prevent specifically HPV 16 and 18 infections, shifts in prevalence in the post vaccine era may be expected. This study provides a unique opportunity to gather baseline data before changes by nationwide vaccination occur. METHODS AND PRINCIPAL FINDINGS: This cross-sectional study is part of a large prospective epidemiologic study performed among 2065 unscreened women aged 18 to 29 years. Women returned a self-collected cervico-vaginal specimen and filled out a questionnaire. All HPV DNA-positive samples (by SPF(10) DEIA) were genotyped using the INNO-LiPA HPV genotyping assay. HPV point prevalence in this sample was 19%. Low and high risk HPV prevalence was 9.1% and 11.8%, respectively. A single HPV-type was detected in 14.9% of all women, while multiple types were found in 4.1%. HPV-types 16 (2.8%) and 18 (1.4%) were found concomitantly in only 3 women (0.1%). There was an increase in HPV prevalence till 22 years. Multivariate analysis showed that number of lifetime sexual partners was the most powerful predictor of HPV positivity, followed by type of relationship, frequency of sexual contact, age, and number of sexual partners over the past 6 months. CONCLUSIONS AND SIGNIFICANCE: This study shows that factors independently associated with HPV prevalence are mainly related to sexual behaviour. Combination of these results with the relative low prevalence of HPV 16 and/or 18 may be promising for expanding the future target group for catch up vaccination. Furthermore, these results provide a basis for research on possible future shifts in HPV genotype prevalence, and enable a better estimate of the effect of HPV 16-18 vaccination on cervical cancer incidence

Screening for persistent high-risk HPV infections may be a valuable screening method for young women; A retrospective cohort study

Contains fulltext : 197712.pdf (publisher's version ) (Open Access

Screening for persistent high-risk HPV infections may be a valuable screening method for young women; A retrospective cohort study.

INTRODUCTION:Screening of young women is often discouraged because of the high risk of unnecessary diagnostics or overtreatment. Multiple countries therefore use cytology instead of high risk human papillomavirus (hrHPV)-testing as screening method for young women because of the limited specificity of hrHPV-testing. The objective of this study was to investigate how hrHPV screening before the age of 30, can be used to reduce the future prevalence of high-grade cervical lesions in young women. METHODS:We retrospectively analyzed follow-up data from a cohort study on HPV prevalence in unscreened Dutch women aged 18-29 years. Women performed multiple self-collected cervico-vaginal samples for HPV detection and genotyping. At least one valid cervical pathology result was obtained from 1,018 women. Women were categorized as hrHPV negative, cleared- or persistent hrHPV infection. Anonymized follow-up data for each group was obtained. Composite outcome measures were defined as; normal, low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL). The association between prior hrHPV status and cytology and histology outcome was analyzed. RESULTS:After exclusion, a pathology result was registered for 962 women. The prevalence of HSIL was 19.3% in women with a persistent HPV infection at a younger age. This is significantly higher (p<0,001) compared with the HSIL prevalence of 1.5% in HPV-negative women, and 3.1% (n = 8) in women who cleared the hrHPV infection in the past. CONCLUSION:Women with a persistent hrHPV infection in their 20s, show an increased prevalence of HSIL lesions in their early 30s. Screening for persistent hrHPV infections, instead of cytology screening before the age of 30, can be used to reduce the future prevalence of cervical cancer in young women

Effect of the menstrual cycle and hormonal contraceptives on human papillomavirus detection in young, unscreened women.

Contains fulltext : 88745.pdf (publisher's version ) (Closed access)OBJECTIVE: To estimate the effect of the menstrual cycle and oral contraceptive pill (OCP) use on the prevalence, incidence, and persistence of human papillomavirus (HPV). METHODS: A longitudinal study was conducted among 2,065 women aged 18-29 years. The women returned a self-collected cervicovaginal sample and filled out a questionnaire. A total of 1,812 women participated at all three time points, month 0, month 6, and month 12. RESULTS: Low- and high-risk HPV prevalence at study entry was 8.9% and 11.8%, respectively. The annual incidence of low-risk HPV infections was 12.5% and the persistence was 2.0%. For high-risk HPV, the incidence and persistence was 12.1% and 4.5%, respectively. These results did not differ between OCP users and nonusers. A significant relationship between high-risk HPV detection and the timing of sampling was found when OCP users and nonusers were analyzed separately. In the second half of the menstrual cycle, high-risk HPV detection decreased in nonusers (P=.007) and increased in OCP users (P=.021). When women used OCPs continuously, high-risk HPV detection returned to the level of the first half of the menstrual cycle. CONCLUSION: High-risk HPV detection was significantly influenced by sample timing in the menstrual cycle when analyzed separately for OCP users and women with a natural menstrual cycle. This may have implications in the future, when high-risk HPV detection may become a primary screening tool in cervical cancer prevention. LEVEL OF EVIDENCE: II.1 juli 201

A. Prevalence of Low-Risk and High-Risk Types by Age (n = 2065).

<p>Prevalence of overall and both hr- and lr-HPV types showed an almost similar age-distribution. In some women both low-risk and high-risk types were detected. B. Prevalence of Low-Risk and High-Risk Types by Sexual Age (n = 1943). Only sexually active women were selected (n = 1943). Overall HPV prevalence, as well as hr- and lr-HPV prevalence, showed an increase with rising sexual age. However, hr-HPV prevalence decreased from a sexual age of 10 years. In some women both low-risk and high-risk types were detected.</p

HPV prevalence and Odds Ratio's for HPV prevalence among sexually active women using univariate analysis and logistic regression.

<p>HPV+ if one or more genotypes are detected simultaneously.</p><p>Sample sizes change because of missing values of the questionnaire.</p><p>n = number.</p><p>95% C.I. Confidence Interval.</p><p>p: p-value.</p>∧<p>Mann Whitney.</p>*<p>by Chi-square test.</p><p>Ref: reference.</p><p>OCC oral contraceptives.</p>¤<p>Living apart together.</p>**<p>below the age of 10 years several cases of sexual abuse were reported.</p>°<p>STI, Sexually Transmitted Infection.</p>□<p>Sexual age in years with 0 and 1 combined as well as sexual age higher than 13.</p

HPV prevalence by demographic variables among all women.

<p>HPV+ if one or more genotypes(high risk as well as low risk) are detected simultaneously.</p><p>Sample sizes change because of missing values of the questionnaire.</p><p>n = number.</p><p>- not applicable.</p>*<p>by Chi-square test.</p>○<p>ethnicity was self-reported.</p>∧<p>type of education: group of lower secondary education includes 2 women who reported only primary/no education.</p>¤<p>Living apart together.</p><p>OCC oral contraceptives.</p

Adjusted Odds Ratio's for HPV prevalence among sexually active women using multivariate logistic regression (n = 1820).

<p>n = number.</p><p>95% C.I. Confidence Interval.</p><p>p: p-value.</p>¤<p>Living apart together.</p><p>Ref: reference.</p>°<p>STI, Sexually Transmitted Infection.</p>□<p>Sexual age in years with 0 and 1 combined as well as sexual age higher than 13.</p