Contributions of Recent and Past Sexual Partnerships on Incident Human Papillomavirus Detection: Acquisition and Reactivation in Older Women

Abstract

Understanding the fraction of newly detected human papillomavirus (HPV) infections due to acquisition and reactivation has important implications on screening strategies and prevention of HPV-associated neoplasia. Information on sexual activity and cervical samples for HPV DNA detection using Roche Linear Array were collected semi-annually for two years from 700 women age 35–60 years. Incidence and potential fraction of HPV infections associated with new and lifetime sexual partnerships were estimated using Poisson models. Cox frailty models were used to estimate hazard ratios (HR) for potential risk factors of incident HPV detection. Recent and lifetime numbers of sexual partners were both strongly associated with incident HPV detection. However, only 13% of incident detections were attributed to new sexual partners whereas 72% were attributed to ≥5 lifetime sexual partners. Furthermore, 155 out of 183 (85%) incident HPV detections occurred during periods of sexual abstinence or monogamy, and were strongly associated with cumulative lifetime sexual exposure (HR: 4.1, 95% CI: 2.0, 8.4). This association increased with increasing age. These data challenge the 20 paradigm that incident HPV detection is driven by current sexual behavior and new viral acquisition in older women. Our observation that most incident HPV infection was attributable to past, not current, sexual behavior at older ages supports a natural history model of viral latency and reactivation. As the highly exposed baby-boomer generation of women with sexual debut after the sexual revolution transition to menopause, the implications of HPV reactivation at older ages on cervical cancer risk and screening recommendations should be carefully evaluated.

Knowledge of HPV and HPV Vaccine among Women Ages 19 to 26

“…Many women did not understand the transient nature of most HPV infections (75% did not know that HPV usually goes away on its own). Although recent data suggest that HPV infection may become dormant and reappear (Rositch et al, 2012;Gravitt et al, 2013), at the time of data collection in 2011, these publications were not yet part of the scientific literature and the item ("HPV usually goes away on its own") was coded as Figure 1. Sources of human papillomavirus (HPV) vaccine information among those who had heard of vaccine (n ¼ 279).…”

“…Percentages add to more than 100% because participants could select more than one source. (Rositch et al, 2012;Gravitt et al, 2013), at the time of data collection in 2011, these publications were not yet part of the scientific literature and the item ("HPV usually goes away on its own") was coded as "true." Ambiguity on this subject remains as the CDC website currently states, "In most cases, HPV goes away on its own and does not cause any health problems" (last updated February 23, 2015).…”

Immunodeficiency-associated viral oncogenesis

“…Given the ability of HPV DNA to persist long-term in the absence of disease, mucosal immune dysfunction may cause latent HPV reactivation at local sites, despite patient general immune reconstitution [64,65]. Reports in HIV+ patients [66], in older women [67] and in transplant [68] are in keeping with this hypothesis. In this latter population having less at-risk sexual behaviours, increased HPV infections and high-grade lesions rates were recently reported [68], differently from previous studies.…”

Reconsidering Primary HPV Testing in Cervical Cancer Screening

“…Most incident HPV infections are attributable to past, not current, sexual behavior, supporting a natural history model of viral latency and reactivation [24].…”