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Abstract

We appreciate the comments by Vidulich et al concerning the role of heterosexual anal intercourse (HAI) in anal human papillomavirus (HPV) acquisition. We agree that HAI is likely underreported, and that condoms are strongly recommended for prevention of sexually transmitted infection transmission for both women and men engaging in anal receptive intercourse. There were 2 studies in our review that specifically addressed anal HPV in the context of HAI. Goodman et al,1Goodman M.T. Shvetsov Y.B. McDuffie K. et al.Sequential acquisition of human papillomavirus (HPV) infection of the anus and cervix: the Hawaii HPV Cohort Study.J Infect Dis. 2010; 201: 1331-1339Crossref PubMed Scopus (99) Google Scholar evaluating a cohort of healthy adult women in Hawaii, found that: (1) 29% of women reported ever having HAI; and (2) the risk of an incident anal HPV infection among women with a preceding concordant cervical HPV infection was 20.5 (95% confidence interval [CI], 16.3–25.7) whereas the risk of a cervical HPV infection after an anal HPV infection with a concordant genotype was 8.8 (95% CI, 6.4–12.2). Moreover, in the absence of a self-reported history of anal sex, they found that the risk of acquiring concordant anal HPV genotypes was higher after documented infection of those genotypes in the cervix (63% of infections) compared to acquiring the anal HPV genotypes prior to infection in the cervix (48% of infections), demonstrating that anal HPV infection occurs in the absence of HAI, and is highly correlated to cervical HPV infection. In the second study, Castro et al2Castro F.A. Quint W. Gonzalez P. et al.Prevalence of and risk factors for anal human papillomavirus infection among young healthy women in Costa Rica.J Infect Dis. 2012; 206: 1103-1110Crossref PubMed Scopus (39) Google Scholar reported that rate of HAI was 21.4% among young Costa Rican women. Multivariate analysis found that concurrent cervical HPV, history of HAI with at least 2 partners, and lifetime number of sexual partners ≥4 had odds ratios (95% CI) of: 4.8 (3.9–5.9), 2.8 (1.7–4.5), and 2.3 (1.7–3.1), respectively. Thus, the rates of HAI reported in these studies by Goodman et al1Goodman M.T. Shvetsov Y.B. McDuffie K. et al.Sequential acquisition of human papillomavirus (HPV) infection of the anus and cervix: the Hawaii HPV Cohort Study.J Infect Dis. 2010; 201: 1331-1339Crossref PubMed Scopus (99) Google Scholar and Castro et al2Castro F.A. Quint W. Gonzalez P. et al.Prevalence of and risk factors for anal human papillomavirus infection among young healthy women in Costa Rica.J Infect Dis. 2012; 206: 1103-1110Crossref PubMed Scopus (39) Google Scholar are similar to those reported by Benson et al3Benson L.S. Martins S.L. Whitaker A.K. Correlates of heterosexual anal intercourse among women in the 2006–2010 survey of family growth.J Sex Med. 2015; 12: 1746-1752Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar by age and ethnicity, and based on the data from Goodman et al,1Goodman M.T. Shvetsov Y.B. McDuffie K. et al.Sequential acquisition of human papillomavirus (HPV) infection of the anus and cervix: the Hawaii HPV Cohort Study.J Infect Dis. 2010; 201: 1331-1339Crossref PubMed Scopus (99) Google Scholar we maintain that women can have anal HPV in the absence of HAI. Because our publication was a systematic review of other previously published literature in the last 2 decades, the data provided in our article were summaries of previous studies. As a result, there were no studies in our review that reported the rates of squamous cell cancer of the anus among women who had received prophylactic HPV vaccination. However, we do hope that research conducted in the next several decades will be able to demonstrate the impact of prophylactic HPV vaccination on squamous cell cancer of the anus incidence. Prevalence of anal human papillomavirus infection and anal human papillomavirus–related disorders in women: a systematic reviewAmerican Journal of Obstetrics & GynecologyVol. 214Issue 3PreviewStier et al1 bring focus to the growing incidence of squamous cell cancer of the anus (SCCA) in women over the last 4 decades, which has doubled from 1975 through 2008. Moreover, human papillomavirus (HPV) has been detected in 80–90% of SCCA with types 16 and 18 found in 80% of anal cancers.1 The current increase in the incidence of SCCA among women dictates that more attention is needed on women’s risk factors and the mechanism of transmission of SCCA. Full-Text PDF