Sequential Acquisition of Human Papillomavirus Infection at Genital and Anal Sites, Liuzhou, China

Feixue Wei,Yafei Li,Ningshao Xia,Jun Zhang,Xiaojuan Yu,Qiaoqiao Song,Ting Wu,Kai Yin,Xuelian Cui,Shoujie Huang,Mingqiang Li,Yingying Su

doi:10.3201/eid2610.191646

Abstract

Little is known about the risk for acquiring a concordant human papillomavirus (HPV) infection in a genital (or anal) site after an anal (or genital) HPV infection. We collected 3 sets of anogenital specimens at 6-month intervals from 2,309 men and 2,378 women in Liuzhou, China, and tested these specimens for HPV. The risk for sequential anal HPV infection in participants with a previous genital HPV infection was higher than for participants without an infection (hazard ratio [HR] 4.4, 95% CI 3.4–5.8 for women and HR 2.6, 95% CI 1.4–4.6 for men). For sequential genital HPV infection, women with a previous anal infection had a higher risk (HR 1.9, 95% CI 1.2–3.1), but no major difference was found for men (HR 0.7, 95% CI 0.2–1.9). Our study indicates that autoinoculation might play a major role in anogenital HPV transmission, in addition to direct sexual intercourse, especially for anal infection in women.

Highlights

Little is known about the risk for acquiring a concordant human papillomavirus (HPV) infection in a genital site after an anal HPV infection
Incidence Rates of Sequential Anal HPV Infections among Participants with or without Previous Genital Infection by Sex Incidence rates of anal infection were 8.8/1,000 person-months for any HPV in men with previous genital infection and 3.8/1,000 person-months for men without previous genital infection; the HR was 2.6 for previously genital-positive men versus genital-negative men (Table 1, https://wwwnc.cdc.gov/EID/article/26/10/191646-T1.htm)
An increased risk for sequential acquisition of a genital HPV infection was observed in both sexes with a previous concordant anal HPV infection compared with those without previous anal infection, no significant difference was found for any HPV and high-risk HPV (HR-HPV) types in men on the basis of individual calculation

Summary

Introduction

Little is known about the risk for acquiring a concordant human papillomavirus (HPV) infection in a genital (or anal) site after an anal (or genital) HPV infection. HPV spreads mainly through sexual contact, a study conducted among men who have sex with women (MSW) estimated an anal HPV infection prevalence of 12.2% [6] Another cohort study in Hawaii, USA, observed that women with no receptive anal sex still had anal HPV infections [7]. The other study focused on MSW in the United States, Brazil, and Mexico (HIM study) and reported that the HR of infection with any of the 9-valent vaccine– related types from the genital-to-anal site was 2.80 (95% CI 1.32–5.99) [10] Both studies were conducted in relatively sexually active persons (e.g., 45.2% of women in Hawaii had >7 lifetime sexual partners [7] and 42.4% of MSW in the HIM study had >9 lifetime sexual partners [10)]). The purpose of this study was to assess the risk for sequential type-specific and grouped HPV infection of genital and anal sites

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Conclusion