Thursday, April 7, 2016

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
VariableSubgenus 1a (n = 108)Subgenus 2a (n = 495)Subgenus 3a (n = 131)
ORb95 % CIORb95 % CIORb95 % CI
Reproductive Health Factors
 Condom Use
  Former vs. Never1.280.79, 2.070.900.71, 1.152.001.23, 3.24
  Current vs. Never1.430.83, 2.481.090.82, 1.452.001.15, 3.47
 Oral Contraceptives
   < 6 years vs. Never1.250.66, 1.380.980.71, 1.351.400.83, 2.37
  6+ years vs. Never1.230.60, 2.531.000.70, 1.430.620.32, 1.19
 Intrauterine Device
  Yes vs. No0.480.30, 0.750.780.62, 0.980.730.49, 1.08
 Tubal Sterilization
  Yes vs. No1.240.65, 1.360.840.59, 1.210.650.33, 1.30
 Contraceptive Injection
  Yes vs. No1.961.22, 3.161.341.00, 1.791.340.83, 2.17
 Natural Products
  Yes vs. No--0.370.13, 1.050.740.17, 3.20
 Vaginal Products
  Yes vs. No--0.820.37, 1.810.320.04, 2.40
Genital Health and Hygiene Factors
 Menstrual Cloth
  Yes vs. No0.540.32, 0.910.930.74, 1.181.020.68, 1.53
 Hygienic Tampon
  Yes vs. No1.490.87, 2.541.330.98, 1.811.300.79, 2.14
 Douching
  Frequent vs. Infrequent1.200.53, 2.691.290.83, 2.000.110.02, 0.81
 Douching Products
  Natural vs. None0.960.60, 1.540.920.72, 1.170.900.57, 1.41
  Medical vs. None1.090.23, 5.150.970.46, 2.062.750.98, 7.73
  Unknown vs. None1.180.27, 5.220.510.21, 1.212.921.20, 7.12
 Genital Discomfort
  Yes vs. No0.960.64, 1.450.960.78, 1.200.890.60, 1.31
 Recent Discomfort
  Yes vs. No0.990.65, 1.501.110.89, 1.381.220.84, 1.75
 Pain or Bleeding
  Yes vs. No2.830.59, 13.511.140.34, 3.750.910.12, 7.00
Gynecologic Products
 Antibiotic
  Former vs. Never3.860.86, 17.340.830.51, 1.331.430.52, 3.97
  Current vs. Never5.951.14, 30.970.970.53, 1.791.840.56, 6.02
 Antifungal
  Former vs. Never5.141.17, 22.521.100.70, 1.751.850.68, 5.02
  Current vs. Never1.640.22, 12.241.060.56, 2.021.740.49, 6.11
 Abrasion
  Former vs. Never--1.680.40, 7.72--
  Current vs. Never--1.100.08, 16.23--
 External Products
  Former vs. Never0.750.20, 2.84----
  Current vs. Never1.360.48, 3.89----
 Unknown Products
  Former vs. Never2.820.64, 12.420.960.62, 1.492.210.81, 6.01
  Current vs. Never3.440.63, 18.681.100.60, 2.032.820.83, 9.53
 Home-made Products
  Natural vs. None1.220.78, 1.920.910.72, 1.150.980.66, 1.47
  Medical vs. None0.800.27, 2.401.260.77, 2.040.760.29, 2.02
  Unknown vs. None2.750.53, 14.151.330.45, 3.915.331.80, 15.82
Vaginal Health Characteristics
 Cervical Ectropion
  Yes vs. No0.370.05, 2.770.890.42, 1.910.740.17, 3.10
 Gynecologic Surgery
  Yes vs. No2.051.11, 3.790.900.60, 1.370.890.42, 1.89
 Gynecologic Treatment/Infection
  Yes vs. No1.731.13, 2.651.170.92, 1.501.260.83, 1.89
 Previous Gynecologic Infection
  HPV vs. None3.872.09, 7.142.021.27, 3.191.210.54, 2.71
  Non-HPV vs. None1.330.81, 2.191.030.78, 1.341.270.82, 1.97
Cytology Observations
 Bacterial Infection
  Yes vs. No1.280.63, 2.631.300.88, 1.911.310.68, 2.52
 Fungal Infection
  Yes vs. No1.250.61, 2.541.290.88, 1.871.480.83, 2.66
 General Inflammation
  Yes vs. No2.101.37, 3.221.531.21, 1.941.120.74, 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

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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