Reproductive and genital health and risk of cervical human papillomavirus infection: results from the Ludwig-McGill cohort study.

Eileen Shaw,Eduardo L Franco,Agnihotram V Ramanakumar,Mariam El-Zein,Lenice Galan,Maria L Baggio,Luisa L Villa,Flavia R Silva

doi:10.1186/s12879-016-1446-x

Eileen Shaw, Eduardo L Franco + Show 6 more

Open Access

https://doi.org/10.1186/s12879-016-1446-x

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Abstract

BackgroundThere 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.MethodsWe 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.ResultsLifetime (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.ConclusionsCervical HPV infection was associated with reproductive and genital health factors. Further studies are necessary to confirm the low to moderate associations observed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1446-x) contains supplementary material, which is available to authorized users.

Highlights

There are inconsistencies in the literature on reproductive and genital health determinants of human papillomavirus (HPV) infection, the primary cause of cervical cancer
Of the 3589 eligible women, 2528 participants were enrolled in the Ludwig-McGill cohort study (Fig. 1), with an average follow-up time of 7 years
1267 women were HPVnegative and 600 women tested positive for any HPV infection on at least one of the four visits

Summary

Introduction

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 LudwigMcGill Cohort Study, a longitudinal, repeated-measurements investigation on the natural history of HPV infection. Despite recent advances in human papillomavirus (HPV) vaccines and screening programs, cervical cancer remains a large global health burden. HPV is a necessary cause of cervical cancer, but it is not sufficient. Condom use has been inconsistently associated with a decreased risk of HPV infection [5, 6]. Evidence of a relationship between these factors and risk of HPV infection remains equivocal as there have been

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