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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Significant Reduction in the Incidence of Genital Warts in Young Men 5 Years Into the Danish Human Papillomavirus Vaccination Program for Girls and Women

BACKGROUND:

Denmark introduced the quadrivalent human papillomavirus vaccine into the vaccination program for 12- to 15-year-old girls in 2008 to 2009. In 2012, the program was supplemented with a catch-up program for women aged up to 27 years. We evaluated the effectiveness of the Danish vaccination program on the nationwide incidence of genital warts (GWs), after the second catch-up by including information on both hospital treatments and on self-administered treatment with podophyllotoxin. Genital wart incidence was investigated in both sexes; however, the main focus was on potential herd protection of men.

METHODS:

Incident cases of GWs were identified from the Danish National Patient Register and through redemptions of prescription for podophyllotoxin in the Danish National Prescription Registry in 2006 to 2013. Age-specific incidence rates (IRs) were assessed, and estimated annual percentage change (EAPC) was calculated by Poisson regression.

RESULTS:

Genital wart incidence was either stable or increased in both sexes in 2006 to 2008. After introduction of the vaccination program, GW incidence decreased significantly in women aged 12 to 35 years and men aged 12 to 29 years, with rapid decrease among 16- to 17-year-olds (IRwomen, from 1071 to 58 per 100,000 person-years [EAPC, -55.1%; 95% confidence interval, -58.7 to-51.2]; IRmen, from 365 to 77 per 100,000 person-years [EAPC, -36.6%; 95% confidence interval, -40.5 to -32.5] in 2008-2013).

CONCLUSIONS:

We found a significantly decreasing incidence of GWs in women up to 35 years of age after the start of the human papillomavirus vaccination program. A similar pattern was observed for men aged 12 to 29 years, indicating substantial herd protection.

Purchase full article at:  http://goo.gl/7LNc8l

By:  Bollerup S1, Baldur-Felskov B, Blomberg M, Baandrup L, Dehlendorff C, Kjaer SK.

• 1From the *Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark; †Statistics, Bioinformatics and Registry, Danish Cancer Society Research Center, Copenhagen, Denmark; and ‡Department of Gynecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
• Sex Transm Dis. 2016 Apr;43(4):238-42. doi: 10.1097/OLQ.0000000000000418. 

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Trends in Genital Warts by Socioeconomic Status After the Introduction of the National HPV Vaccination Program in Australia: Analysis of National Hospital Data

BACKGROUND:

Human papillomavirus (HPV) vaccination targeting females 12-13 years commenced in Australia in 2007, with catch-up of females 13-26 years until the end of 2009. No analyses of HPV vaccination program impact by either socioeconomic or geographic factors have been reported for Australia.

METHODS:

Hospital admissions between July 2004-June 2011 involving a diagnosis of genital warts were obtained from a comprehensive national database. We compared sex- and age-specific admission rates in July 2006-June 2007 (pre-vaccination period) and July 2010-June 2011 (post-vaccination period) according to Index of Relative Socio-economic Disadvantage, nationally and stratified by remoteness area relating to the individual's area of residence, using Poisson/ negative binomial models.

RESULTS:

Admission rates per 100,000 population in females aged 10-19 years (predominantly vaccinated at school), reduced from 42.2 to 6.0 (rate reduction 86.7 %; 95 % CI:82.2-90.0 %) in more disadvantaged areas and from 26.8 to 4.0 (85.0 %; 95 % CI:79.7-88.9 %) in less disadvantaged areas. In females aged 20-29 years (predominantly vaccinated in the community), the decreases were from 73.9 to 26.4 (66.0 %; 95 % CI:57.7-72.6 %) and from 61.9 to 23.8 (61.6 %; 95 % CI:52.9-68.7 %) in more and less disadvantaged areas, respectively. The reductions were similar in more vs less disadvantaged areas both inside major cities (88.6 %; 95 % CI: 82.2-92.7 % vs 87.9 %; 95 % CI:82.6-91.6 % in females aged 10-19 years; 64.0 %; 95 % CI:57.0-69.9 % vs 63.8 %; 95 % CI:52.9-72.1 % for females aged 20-29 years) and outside major cities (88.8 %; 95 % CI: 83.7-92.3 % vs 85.8 %; 95 % CI:73.5-92.4 % in females aged 10-19 years; 71.1 %; 95 % CI:58.8-79.7 % vs 67.6 %; 95 % CI:48.2-79.8 % for females aged 20-29 years). Admission rates in males aged 20-29 years also reduced, by 23.0 % (95 % CI:4.8-37.8 %) and 39.4 % (95 % CI:28.9-48.3 %) in more versus less disadvantaged areas respectively.

CONCLUSIONS:

The relative reduction in genital warts appears similar in young females across different levels of disadvantage, including within and outside major cities, both for females predominantly vaccinated at school and in the community.

Below:  Admissions involving a diagnosis of genital warts (per 100,000 population), by age and socioeconomic status, in a) females and b) males. Males aged 10–19 years were excluded due to the small number of admissions

Below:  Admissions involving a diagnosis of genital warts (per 100,000 population), by age, socioeconomic status and remoteness area of residence. a Females 10–19 years; b Females 20–29 years; c Females 30–39 years; d Males 20–29 years; e Males 30–39 years

Below:  Admission rate ratio (relative to pre-vaccination mean) by age, SES and remoteness area of residence (females). a and b 10–19 years; c and d 20–29 years; e and f 30–39 years

Below:  Admission rate ratio (relative to pre-vaccination mean) by age, SES and remoteness area of residence (males). a and b 20–29 years; c and d 30–39 years

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By:  Smith MA1,2,3, Liu B4,5, McIntyre P6, Menzies R7,8,9, Dey A10, Canfell K11,12,13.

• 1School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia. megan.smith@nswcc.org.au.
• 2Prince of Wales Clinical School, UNSW Australia, Sydney, NSW, 2052, Australia. megan.smith@nswcc.org.au.
• 3Present address: Cancer Research Division, Cancer Council NSW, Kings Cross NSW 1340, PO Box 572, Sydney, NSW, 2011, Australia. megan.smith@nswcc.org.au.
• 4School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia. bette.liu@unsw.edu.au.
• 5The Sax Institute, Sydney, PO Box K617, Haymarket, NSW, 1240, Australia. bette.liu@unsw.edu.au.
• 6National Centre for Immunisation Research and Surveillance Children's Hospital, Westmead, Locked Mail Bag 4001, Sydney, 2145, NSW, Australia. peter.mcintyre@health.nsw.gov.au.
• 7National Centre for Immunisation Research and Surveillance Children's Hospital, Westmead, Locked Mail Bag 4001, Sydney, 2145, NSW, Australia. r.menzies@unsw.edu.au.
• 8Sydney Medical School, University of Sydney, Sydney, NSW, 2006, Australia. r.menzies@unsw.edu.au.
• 9Present address: School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia. r.menzies@unsw.edu.au.
• 10National Centre for Immunisation Research and Surveillance Children's Hospital, Westmead, Locked Mail Bag 4001, Sydney, 2145, NSW, Australia. aditi.dey@health.nsw.gov.au.
• 11School of Public Health, University of Sydney, Sydney, NSW, 2006, Australia. karen.canfell@nswcc.org.au.
• 12Prince of Wales Clinical School, UNSW Australia, Sydney, NSW, 2052, Australia. karen.canfell@nswcc.org.au.
• 13Present address: Cancer Research Division, Cancer Council NSW, Kings Cross NSW 1340, PO Box 572, Sydney, NSW, 2011, Australia. karen.canfell@nswcc.org.au. 
• BMC Infect Dis. 2016 Feb 1;16(1):52. doi: 10.1186/s12879-016-1347-z.

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Sexual Activity, Psychosexual Distress, and Fear of Progression in Women with Human Papillomavirus-Related Premalignant Genital Lesions

INTRODUCTION:

Genital human papillomavirus (HPV) infections are very common in women 18 to 30 years old and substantially affect women's sexual health.

AIM:

To examine sexual activity, psychosexual distress, and fear of progression in women diagnosed with HPV-related precancerous genital lesions.

METHODS:

In this observational study, women diagnosed with premalignant lesions of the cervix, vagina, or vulva were recruited from a university hospital-based colposcopy clinic.

MAIN OUTCOME MEASURES:

Quantitative data from three validated patient-administered questionnaires (Sexual Activity Questionnaire, German version of the Cervical Dysplasia Distress Questionnaire, and Fear of Progression Questionnaire) were compared within the study population, according to the location of the genital lesion, and with relevant reference populations. Qualitative data from two written open-ended questions about women's thoughts regarding diagnosis and information were analyzed.

RESULTS:

Two-hundred nine women completed the questionnaires. Seventy-eight percent of women (n = 162) were referred for evaluation of suspect lesions of the cervix, 8% (n = 17) of the vagina, and 14% (n = 30) of the vulva. There were no significant differences in questionnaire results among the three patient groups, except for sexual consequences (Cervical Dysplasia Distress Questionnaire) and recent sexual activity (Sexual Activity Questionnaire). Women with vulvar lesions were most likely to worry about sexual consequences (ie, being unable to have children, being sexually less attractive, or infecting a sexual partner; P = .04). The Sexual Activity Questionnaire subscales sexual pleasure (P = .15) and sexual habits (P = 1.00) were similar to those in a healthy control population, whereas sexual discomfort (P = .51) was comparable to that in a reference population of women who survived cervical cancer. The subscale partner-specific concerns (Fear of Progression Questionnaire) was similar to that in a reference population of patients with cancer (P = .28).

CONCLUSION:

HPV-related precancerous genital lesions, especially of the vulva, are likely to cause concerns about sexual health. Effective information and communication are important to lessen negative sexual consequences and anxiety.

Full article at:   http://goo.gl/1Efvxh

By:  Nagele E1, Reich O2, Greimel E1, Dorfer M1, Haas J3, Trutnovsky G4.

• 1Psychology, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
• 2Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria.
• 3Statistics, Department of Obstetrics and Gynecology, Medical University of Graz, Austria.
• 4Gynecology, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria. Electronic address: gerda.trutnovsky@medunigraz.at.
• J Sex Med. 2016 Jan 9. pii: S1743-6095(15)00028-4. doi: 10.1016/j.jsxm.2015.12.012.  

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