Cervical human papillomavirus detection is not affected by menstrual phase

Abstract

Objectives In many settings, human papillomavirus (HPV) DNA testing already plays an important role in cervical cancer screening. It is unclear whether hormonal fluctuations associated with menstrual phase or oral contraceptive (OC) use have any effect on HPV detection. We evaluated the effects of OC use and timing of cervical sampling in relation to women’s last menstrual period (LMP) on HPV detection, and viral load in the Brazilian Ludwig-McGill cohort study. Methods Women in the cohort were followed every 4–6 months, and at each clinic visit they were asked to complete a questionnaire and to provide a cervical sample for HPV testing. Specimens from 6093 patient visits (n = 2209 women) were categorised according to date of LMP into four distinct phases: follicular (days 5–9), midcycle (days 10–15), luteal (days 16–22), or late luteal (days 23–31). Results Compared with follicular phase (referent group), HPV detection did not differ according to reported LMP for midcycle (OR = 1.14, 95% CI 0.95 to 1.37), luteal (OR = 1.03, 95% CI 0.85 to 1.25), or late luteal menstrual phase (OR=1.01, 95% CI 0.83 to 1.24), and was also not influenced by OC use. Analyses restricted to high-risk HPV types (grouped) and HPVs 16 and 18 (separately), produced similar non-significant associations. For HPV-positive samples, we found that the menstrual phase did not influence the total viral load. Conclusions These results indicate HPV detection is not associated with menstrual phase. Our findings suggest that standardising the timing of specimen collection for HPV testing is not necessary.

Tracking vaginal, anal and oral infection in a mouse papillomavirus infection model

“…Another study found all HPV DNA likely peaks at the periovulatory phase (Liu et al, 2013). However, no correlation was found in Tota's study (Tota et al, 2013). In our current study, even with a small number of animals, we found that animals at the oestrous stage, the only stage at which the animals mate, had the highest viral DNA load in the vaginal lavage samples.…”

“…HSV shedding did not vary with the menstrual cycle, but CMV shedding was significantly more frequent in the luteal phase (Mostad et al , 2000). The correlation between HPV detection and menstrual cycle has been inconsistent in the literature (Liu et al , 2013; Schmeink et al , 2010; Tota et al , 2013). In one study, HR HPV detection was significantly influenced by sample timing in the menstrual cycle (Schmeink et al , 2010).…”

Depo Medroxyprogesterone (DMPA) Promotes Papillomavirus Infections but Does Not Accelerate Disease Progression in the Anogenital Tract of a Mouse Model

“…Our findings agreed with reports in the literature that progesterone hormones increase viral mRNA and significantly stimulate viral replication [ 39 , 64 , 65 ]. Studies on the relationship between contraceptive use and HPV infections have produced discordant findings in humans [ 27 , 55 , 66 , 67 ]. A recent study showed that contraceptives did not increase the risk of acquiring new HPV infections [ 27 , 28 ].…”

“…A recent study showed that contraceptives did not increase the risk of acquiring new HPV infections [ 27 , 28 ]. Some published studies postulate that sex hormone use could have a protective effect, depending on age: frequent acquisition of infections by different papillomavirus types may stimulate immunologic control in a young age group [ 67 ]. However, the continuous stimulatory effect of the hormones on expression of the papillomavirus genes could also lead to an increase in expression of the viral oncogenes, i.e., E6 and E7, thereby enhancing their transforming potential.…”

Highlights from this issue

“…Of course, the relationship between viral shedding and infectivity remains murky. A related issue is explored by Franco et al 11 in a study which explores HPV shedding through the menstrual cycle. Like gonorrhoea, the biology and epidemiology of HPV will continue to evolve.…”