Reproductive & Genital Health & Risk of Cervical Human Papillomavirus Infection: Results from the Ludwig-Mcgill Cohort Study

Background

There are inconsistencies in the literature on reproductive and genital health determinants of human papillomavirus (HPV) infection, the primary cause of cervical cancer. We examined these factors in the Ludwig-McGill Cohort Study, a longitudinal, repeated-measurements investigation on the natural history of HPV infection.

Methods

We analyzed a cohort subset of 1867 women with one complete year of follow-up. We calculated odds ratios (OR) and 95 % confidence intervals (CI) for reproductive and genital health characteristics from questionnaire and laboratory data in relation to 1-year period prevalence of HPV infection. Two outcomes were measured; the first based on phylogenetic grouping of HPV types based on tissue tropism and oncogenicity (Alphapapillomavirus Subgenus 1: species 1, 8, 10 and 13; Subgenus 2: species 5, 6, 7, 9, 11; Subgenus 3: species 3, 4 and 14) and the second based on transient or persistent HPV infections.

Results

Lifetime (Subgenus 3 OR = 2.00, CI: 1.23–3.24) and current (Subgenus 3 OR = 2.00, CI: 1.15–3.47) condom use and use of contraceptive injections (Subgenus 1 OR = 1.96, CI: 1.22–3.16, Subgenus 2 OR = 1.34, CI: 1.00–1.79) were associated with increased risk of HPV infection. Intrauterine device use was protective (Subgenus 1 OR = 0.48, CI: 0.30–0.75, Subgenus 2 OR = 0.78, CI: 0.62–0.98). These factors were not associated with persistence of HPV infection. Tampon use, previous gynecologic infections and cervical inflammation were associated with an overall increased risk of HPV infection.

Conclusions

Cervical HPV infection was associated with reproductive and genital health factors. Further studies are necessary to confirm the low to moderate associations observed.

Associations between reproductive health and vaginal hygiene factors and the 1-year period prevalence of HPV infection by phylogenetic group in the Ludwig-McGill cohort study

Variable	Subgenus 1a (n = 108)		Subgenus 2a (n = 495)		Subgenus 3a (n = 131)
	ORb	95 % CI	ORb	95 % CI	ORb	95 % CI
Reproductive Health Factors
Condom Use
Former vs. Never	1.28	0.79, 2.07	0.90	0.71, 1.15	2.00	1.23, 3.24
Current vs. Never	1.43	0.83, 2.48	1.09	0.82, 1.45	2.00	1.15, 3.47
Oral Contraceptives
< 6 years vs. Never	1.25	0.66, 1.38	0.98	0.71, 1.35	1.40	0.83, 2.37
6+ years vs. Never	1.23	0.60, 2.53	1.00	0.70, 1.43	0.62	0.32, 1.19
Intrauterine Device
Yes vs. No	0.48	0.30, 0.75	0.78	0.62, 0.98	0.73	0.49, 1.08
Tubal Sterilization
Yes vs. No	1.24	0.65, 1.36	0.84	0.59, 1.21	0.65	0.33, 1.30
Contraceptive Injection
Yes vs. No	1.96	1.22, 3.16	1.34	1.00, 1.79	1.34	0.83, 2.17
Natural Products
Yes vs. No	-	-	0.37	0.13, 1.05	0.74	0.17, 3.20
Vaginal Products
Yes vs. No	-	-	0.82	0.37, 1.81	0.32	0.04, 2.40
Genital Health and Hygiene Factors
Menstrual Cloth
Yes vs. No	0.54	0.32, 0.91	0.93	0.74, 1.18	1.02	0.68, 1.53
Hygienic Tampon
Yes vs. No	1.49	0.87, 2.54	1.33	0.98, 1.81	1.30	0.79, 2.14
Douching
Frequent vs. Infrequent	1.20	0.53, 2.69	1.29	0.83, 2.00	0.11	0.02, 0.81
Douching Products
Natural vs. None	0.96	0.60, 1.54	0.92	0.72, 1.17	0.90	0.57, 1.41
Medical vs. None	1.09	0.23, 5.15	0.97	0.46, 2.06	2.75	0.98, 7.73
Unknown vs. None	1.18	0.27, 5.22	0.51	0.21, 1.21	2.92	1.20, 7.12
Genital Discomfort
Yes vs. No	0.96	0.64, 1.45	0.96	0.78, 1.20	0.89	0.60, 1.31
Recent Discomfort
Yes vs. No	0.99	0.65, 1.50	1.11	0.89, 1.38	1.22	0.84, 1.75
Pain or Bleeding
Yes vs. No	2.83	0.59, 13.51	1.14	0.34, 3.75	0.91	0.12, 7.00
Gynecologic Products
Antibiotic
Former vs. Never	3.86	0.86, 17.34	0.83	0.51, 1.33	1.43	0.52, 3.97
Current vs. Never	5.95	1.14, 30.97	0.97	0.53, 1.79	1.84	0.56, 6.02
Antifungal
Former vs. Never	5.14	1.17, 22.52	1.10	0.70, 1.75	1.85	0.68, 5.02
Current vs. Never	1.64	0.22, 12.24	1.06	0.56, 2.02	1.74	0.49, 6.11
Abrasion
Former vs. Never	-	-	1.68	0.40, 7.72	-	-
Current vs. Never	-	-	1.10	0.08, 16.23	-	-
External Products
Former vs. Never	0.75	0.20, 2.84	-	-	-	-
Current vs. Never	1.36	0.48, 3.89	-	-	-	-
Unknown Products
Former vs. Never	2.82	0.64, 12.42	0.96	0.62, 1.49	2.21	0.81, 6.01
Current vs. Never	3.44	0.63, 18.68	1.10	0.60, 2.03	2.82	0.83, 9.53
Home-made Products
Natural vs. None	1.22	0.78, 1.92	0.91	0.72, 1.15	0.98	0.66, 1.47
Medical vs. None	0.80	0.27, 2.40	1.26	0.77, 2.04	0.76	0.29, 2.02
Unknown vs. None	2.75	0.53, 14.15	1.33	0.45, 3.91	5.33	1.80, 15.82
Vaginal Health Characteristics
Cervical Ectropion
Yes vs. No	0.37	0.05, 2.77	0.89	0.42, 1.91	0.74	0.17, 3.10
Gynecologic Surgery
Yes vs. No	2.05	1.11, 3.79	0.90	0.60, 1.37	0.89	0.42, 1.89
Gynecologic Treatment/Infection
Yes vs. No	1.73	1.13, 2.65	1.17	0.92, 1.50	1.26	0.83, 1.89
Previous Gynecologic Infection
HPV vs. None	3.87	2.09, 7.14	2.02	1.27, 3.19	1.21	0.54, 2.71
Non-HPV vs. None	1.33	0.81, 2.19	1.03	0.78, 1.34	1.27	0.82, 1.97
Cytology Observations
Bacterial Infection
Yes vs. No	1.28	0.63, 2.63	1.30	0.88, 1.91	1.31	0.68, 2.52
Fungal Infection
Yes vs. No	1.25	0.61, 2.54	1.29	0.88, 1.87	1.48	0.83, 2.66
General Inflammation
Yes vs. No	2.10	1.37, 3.22	1.53	1.21, 1.94	1.12	0.74, 1.69

a Subgenus 1 (HPVs-6, 11, 32, 40, 42, 44, 54 and 55), Subgenus 2 (HPVs-16, 18, 26 31, 33–35, 39, 45, 51–53, 56, 58, 59, 66–70, 73 and 82) and Subgenus 3 (HPVs-57, 61, 62, 71, 72, 81, 83, 84 and 89) infections were determined based on the phylogenetic classification of HPV types

b Odds ratios were adjusted for age, lifetime number of sexual partners and empirical confounders (identified using a 5 % change in estimate strategy) such as race, marital status, education, age at first intercourse, age at menarche, number of pregnancies, smoking, alcohol drinking and years since last Pap smear

Full article at:   http://goo.gl/bWRJrg

By:  Eileen Shaw, Agnihotram V. Ramanakumar, Mariam El-Zein, Flavia R. Silva, Lenice Galan, Maria L. Baggio, Luisa L. Villa, Eduardo L. Franco, and for the Ludwig-McGill Cohort Study

Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 546 Pine Avenue West, Montreal, QC H2W 1S6 Canada

Ludwig Institute for Cancer Research, São Paulo, Brazil

Molecular Biology Laboratory, Centre of Translational Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil

BMC Infect Dis. 2016; 16: 116. Published online 2016 Mar 8. doi:  10.1186/s12879-016-1446-x

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