Abstract
BackgroundHigh-risk human papilloma virus (HR-HPV) infection is associated with the development of cervical cancer. HPV vaccination reduces the risk of developing malignant lesions and is expected to change the dynamics of HPV transmission. Data from non-vaccinated women may provide an important benchmark to allow the impact of HPV vaccination programs to be assessed.This study was designed to prospectively determine the changing dynamics of HR-HPV infection and associated genital diseases in young women, most of whom were non-vaccinated.MethodsData from a population-based cohort study, comprising women of two predefined birth cohorts (women born in 1983/84 or 1988/89), were analyzed between 19 October 2009 and 31 December 2010 to determine risk factors for high-risk HPV infection and the association between specific HR-HPV types and atypical Pap smear test results. HPV status was determined by Hybrid Capture 2 (HC2) assay and genotyping.ResultsThe prevalence of HR-HPV was 22.8% in the 1983/84 cohort (150/659) and 23.7% in the 1988/99 cohort (142/599). Only the number of sexual partners was a significant risk factor for HPV infection (odds ratios 22.687 and 6.124 for more than five versus one partner 84 cohort,/84 and 1988/89 cohorts, respectively) in multivariate analysis. HPV16 positive-women were significantly more likely to have abnormal Pap smears of any degree than HPV16-negative women (22.0% versus 3.61%, p < 0.0001 for the 1983/84 cohort and 9.09% versus 2.52%, p = 0.0482 for the 1988/89 cohort). CIN3 was diagnosed in six women 84 cohort,/84 cohort and two in the 1988/89 cohort. All women with CIN3 tested positive for HC2-HR and all six CIN3 cases 84 cohort,/84 cohort tested positive for HPV16. In the 1988/89 cohort, the rate of HPV16 infection was significantly lower in vaccinated than non-vaccinated women (1.59% versus 8.88%; p = 0.003).ConclusionsHR-HPV infection was highly prevalent in both cohorts and associated with an increased risk of abnormal Pap smears and biopsy proven CIN2+. HPV16 infection was associated with a high risk of clinically relevant lesions. HPV vaccination significantly decreased the risk of HPV16 infection.
Highlights
High-risk human papilloma virus (HR-HPV) infection is associated with the development of cervical cancer
Vaccination programs are expected to change the dynamics of HPV transmission [6] and, it is imperative to monitor the burden of HPV infections and associated diseases in young women who had reached the age of 18 years or more prior to the implementation of routine vaccination
This paper reports the results on the prevalence of HR-HPV types and associated diseases
Summary
High-risk human papilloma virus (HR-HPV) infection is associated with the development of cervical cancer. This study was designed to prospectively determine the changing dynamics of HR-HPV infection and associated genital diseases in young women, most of whom were non-vaccinated. Vaccination programs are expected to change the dynamics of HPV transmission [6] and, it is imperative to monitor the burden of HPV infections and associated diseases in young women who had reached the age of 18 years or more prior to the implementation of routine vaccination. Since 2006, gynecologists in private practice in Wolfsburg have formed an experienced screening and referral network with the Klinikum Wolfsburg to improve cervical cancer prevention This collaboration has provided a final opportunity to prospectively study the dynamics of HPV infection and associated genital diseases in a population comprising mostly non-vaccinated young women in Wolfsburg, Germany. Data for low-risk (LR)-HPV are published separately [12]
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