Natural History of Cervicovaginal Papillomavirus Infection in Young Women

Ho, Gloria Y.F.; Bierman, Robert; Beardsley, Leah; Chang, Chee Jen; Burk, Robert D.

doi:10.1056/nejm199802123380703

Cited by 2,178 publications

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“…Prevalence of HPV DNA (a measure of HPV exposure at a given time point) and HPV seroprevalence (a measure of cumulative HPV exposure) are strongly associated with number of lifetime and recent sexual partners [13][14][15][16]. Women tend to become HPV positive soon after initiation of sexual activity [11,17]. Around 20-30 % of HPV-infected women harbour multiple HPV types [18][19][20].…”

Section: What Causes Cervical Cancer ? Human Papillomavirus (Hpv)mentioning

confidence: 99%

Vaccines for cervical cancer

Lowndes¹

2006

Epidemiol. Infect.

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SUMMARYThis review focuses on current and future prevention of invasive cervical cancer (ICC), the second most common cancer among women worldwide. Implementation of population-based cytological screening programmes, using the 'Pap ' smear to detect pre-cancerous lesions in the cervix, has resulted in substantial declines in mortality and morbidity from ICC in North America and some European countries. However, cases of, and deaths from, ICC continue to occur. Primary prevention of infection with high-risk human papillomavirus (HPV) types, the central causal factor of ICC, could further reduce incidence of and mortality from ICC. This is particularly the case in developing countries, which bear 80% of the burden of ICC, and where effective Pap screening programmes are extremely difficult to implement. Very promising results from several trials of synthetic HPV type-specific monovalent (HPV 16) and bivalent (HPV 16 and 18) vaccines have recently been published, showing high efficacy against type-specific persistent HPV infection and development of type-specific pre-cancerous lesions. Large-scale phase III trials of a number of such vaccine candidates are currently underway, and there is real hope that an effective vaccine capable of protecting against infection with HPV types 16 and 18 (which together account for y70% of cervical cancer cases worldwide), and thereby of preventing development of a very significant proportion of cases of ICC, could be available within the next 2 years.

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Section: What Causes Cervical Cancer ? Human Papillomavirus (Hpv)mentioning

confidence: 99%

Vaccines for cervical cancer

Lowndes¹

2006

Epidemiol. Infect.

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“…Genital infections with HPV are very common, and these infections are transmitted by sexual contact. 1 In most cases, HPV infections disappear naturally in a relatively short time period and carry only a small risk of disease development; [2][3][4] however, some investigators believe that pregnancy affects the host immune system; for example, pregnancy is believed to reduce seroreactivity against HPV infection. 5 Estrogen and progesterone have been shown to activate the upstream regulatory region of HPV18 (see ref.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of human papillomavirus genotypes in pregnant Japanese women

et al. 2011

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To investigate the pre-vaccination epidemiology of genital human papillomavirus (HPV) infections and genotypes in pregnant Japanese women, we performed Pap smear tests and HPV genotype testing in patients attending Nagasaki University Hospital and collaborating hospitals from August 2007 to July 2010. Serial uterine cervical specimens were obtained from 151 pregnant women. The HPV test was positive on the first visit in 54 women (35.8%; 54/151, average age 30). A total of 49 women (32.5%; 49/151) were infected by at least one high-risk HPV and 5 women were infected by only low-risk HPV. The three most prevalent high-risk HPV genotypes were HPV 52 (31.5%; 17/54), HPV 16 (29.6%; 16/51) and HPV 31 (13.0%; 7/51). The HPV infection pattern (negative, single infection and multiple infection) differed significantly according to the pregnancy trimester (v 2 -test; Po0.01(Pearson)). Among HPV-infected pregnant Japanese women, HPV52 was the most common genotype. The second most common genotype was HPV16, and these two genotypes accounted for B60% of HPV-positive pregnant women. Infection with multiple HPV genotypes was observed more frequently in the first trimester of pregnancy and the pattern of infection changed significantly depending on pregnancy stage. (2011) 56, 313-315; doi:10.1038/jhg.2011 published online 10 February 2011 Keywords: epidemiology; genotype; HPV; infection; pregnancy; uterine cervical neoplasia INTRODUCTION Persistent infections with human papillomavirus (HPV) are recognized as a major cause of cervical cancer. Genital infections with HPV are very common, and these infections are transmitted by sexual contact. 1 In most cases, HPV infections disappear naturally in a relatively short time period and carry only a small risk of disease development; 2-4 however, some investigators believe that pregnancy affects the host immune system; for example, pregnancy is believed to reduce seroreactivity against HPV infection. 5 Estrogen and progesterone have been shown to activate the upstream regulatory region of HPV18 (see ref. 6). Thereby altering HPV clearance rates compared with non-pregnant women. During persistent infection, important factors of disease susceptibility include HPV genotypes and viral characteristics, such as the distribution of each type in the population and the evasive ability against the host's immune system. It is not clear how persistent infection relates to the host, such as how the host immune system reacts against a specific HPV genotype and how sexual behavior in pregnant women affects infection rates. In particular, there are very few data detailing HPV genotype prevalence in pregnant Japanese women. To determine the distribution of HPV infections in pregnant Japanese women, we performed HPV genotype testing. Journal of Human Genetics MATERIALS AND METHODS Study population and sample collectionCytology and HPV DNA test samples were collected by six hospitals that collaborated with Nagasaki University Hospital from August 2007 to July 2010. All pregnant women whose first visit ...

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“…To our knowledge this is the highest cumulative prevalence that has ever been reported for women with normal cervical cytology after such a short follow-up of only 4 weeks. Several other studies demonstrated cumulative cervical HPV prevalence in cytologically normal women of 34.7 to 66.7% (de Villiers et al, 1992;Schneider et al, 1992;Wheeler et al, 1996;Ho et al, 1998;Woodman et al, 2001). However, in those studies multiple samples were taken during study periods of 10 weeks to 5 years in contrast to 4 weeks in our study (Table 2).…”

Section: Discussionmentioning

confidence: 89%

“…Newly acquired genital HPV is usually transient in women with normal cervical cytology (Evander et al, 1995). The mean duration of cervical HPV infection in a healthy population varies between 8.2 -13.5 months (Ho et al, 1998;Franco et al, 1999). Short-term fluctuations of an individual's HPV status, however, are still a matter of debate.…”

mentioning

confidence: 99%

“…Short-term fluctuations of an individual's HPV status, however, are still a matter of debate. Several studies have reported a fluctuating expression of HPV (Ho et al, 1998;Schneider et al, 1992;Wheeler et al, 1996), probably due to differences in viral load, inadequate sampling or reactivation of endogenous infection (Woodman et al, 2001). Single point measurements of HPV 16 in cervical smears are of limited value for assessment of an individual's HPV status .…”

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Fluctuations in prevalence of cervical human papillomavirus in women frequently sampled during a single menstrual cycle

et al. 2002

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In the last few years much attention has been focused on the implementation of human papillomavirus detection in population based screening programmes to identify women at risk for cervical cancer. Short-term fluctuations in prevalence of human papillomavirus were investigated within a single menstrual cycle. The highest prevalence was found at the follicular phase (55%), whereas the cumulative prevalence was 75%. (Schiffman et al, 1993;Chichareon et al, 1998;Ngelangel et al, 1998; Liaw et al, 1999;Walboomers et al, 1999;Andersson et al, 2001;Lehtinen et al, 2001). A systematic review on the role of HPV testing within a cervical cancer screening program showed that the high risk HPV prevalence in CIN 1 ranged from 30 to 65%, in CIN 2 from 40 to 70% and in CIN 3 from 60 to 90% (Cuzick et al, 1999). Furthermore, HPV can be detected in almost all cervical carcinomas (Walboomers et al, 1999).The estimated point prevalences of genital HPV infections detected by PCR based methods among populations of women with cytological normal cervical smears range from 1.5 to 44.3%, with a weighted average of 16.2% (Xi and Koutsky, 1997) and show an age-related pattern (Melkert et al, 1993). The highest prevalences are found in women in their early twenties (de Villiers et al, 1992;Melkert et al, 1993). Newly acquired genital HPV is usually transient in women with normal cervical cytology (Evander et al, 1995). The mean duration of cervical HPV infection in a healthy population varies between 8.2 -13.5 months (Ho et al, 1998;Franco et al, 1999). Short-term fluctuations of an individual's HPV status, however, are still a matter of debate. Several studies have reported a fluctuating expression of HPV (Ho et al, 1998;Schneider et al, 1992;Wheeler et al, 1996), probably due to differences in viral load, inadequate sampling or reactivation of endogenous infection (Woodman et al, 2001). Single point measurements of HPV 16 in cervical smears are of limited value for assessment of an individual's HPV status .Before incorporation of HPV testing in screening programs for prevention of cervical cancer it is important to gain more insight in the actual prevalence of HPV, influenced by short-term fluctuations. The aim of this study was to investigate the presence of cervical HPV in the different phases of a single menstrual cycle in women with regular cycles. MATERIALS AND METHODSCervical samples for HPV detection and cytological examination were obtained from 20 women visiting the outpatient clinic for fertility problems at the University Medical Centre Nijmegen, the Netherlands. Only women with regular menstrual cycles were included. Patients with cervical treatment for abnormal cervical cytology in the past 10 years were not included in the study. After giving informed consent, patients were interviewed regarding their medical history, smoking habits, use of contraceptives and sexual behaviour.Cervical smears for HPV detection and cytological classification were obtained using the Cervex brush (Rovers, Oss, the Netherlands).On a weekly bas...

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Natural History of Cervicovaginal Papillomavirus Infection in Young Women

Abstract: The incidence of HPV infection in sexually active young college women is high. The short duration of most HPV infections in these women suggests that the associated cervical dysplasia should be managed conservatively.

Cited by 2,178 publications

References 29 publications

Vaccines for cervical cancer

Vaccines for cervical cancer

Epidemiology of human papillomavirus genotypes in pregnant Japanese women

Fluctuations in prevalence of cervical human papillomavirus in women frequently sampled during a single menstrual cycle

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