Abstract
Risk factors for the different human papillomavirus (HPV) genotypes are not well understood, although the risk of cancer is known to vary among them. Our aim was to evaluate the association of diverse behavioral and reproductive factors with genotype-specific HPV prevalence among 879 unvaccinated women aged 18–75 years referred to the colposcopy clinic at Helsinki University Hospital in Finland. Cervical swabs for HPV genotyping were collected in the first visit and assessed for 34 high-risk (hr) and low-risk (lr) HPV genotypes. Participants completed a questionnaire on behavioral, reproductive, and lifestyle factors. Differences in genotype-specific HPV prevalence were analyzed overall and in age groups using binary logistic regression. Smoking was associated with higher prevalence in HPV16 compared with other hrHPV genotypes together with decreasing age, being highest among younger women <30 years old, odds ratio (OR) 3.74 (95% CI 1.42–9.88). The later the sexual debut, the more it seemed to protect from HPV16 infection. The best protection was achieved when the sexual debut took place at >20 years of age, with an OR of 0.43 (95% CI 0.23–0.83). This association was not seen with other hrHPV genotypes. Methods of contraception seemed not to have an effect on hrHPV positivity, regardless of the HPV genotype. The genotype specific hrHPV prevalence differs, depending on behavioral factors, especially among younger women referred to colposcopy.
Highlights
IntroductionPersistent infection with high-risk human papillomavirus (hrHPV) is necessary for the development of cervical precancerous lesions and cancer [1]
Of the 1383 recruited women, the final study population consisted of 879 women who filled in the background questionnaire and for whom human papillomavirus (HPV) genotyping was successfully performed
Most of the women were referred due to abnormal cytology (94.0%); other reasons included a history of postcoital bleeding (1.0%), persistent HPV infection (1.4%), and a loop electrosurgical excision procedure (LEEP) or follow-up (3.6%)
Summary
Persistent infection with high-risk human papillomavirus (hrHPV) is necessary for the development of cervical precancerous lesions and cancer [1]. Among women with normal cytology, the most common HPV genotype is HPV16, but the prevalence of other genotypes varies in different geographic regions. HPV53 is the second-most common genotype in North America while it is HPV52 in Asia, whereas the second-most common genotypes in Europe and Africa are HPV31 and HPV58, respectively [2]. The prevalence of HPV18 (1.1) lists fifth globally, being the sixth-most prevalent in Europe and ninth in Microorganisms 2021, 9, 750.
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