Incidence data on human papillomavirus (HPV) infection are limited, and risk factors for transmission are largely unknown. The authors followed 603 female university students in Washington State at ...4-month intervals between 1990 and 2000. At each visit, a sexual and health questionnaire was completed and cervical and vulvovaginal samples were collected to detect HPV DNA. At 24 months, the cumulative incidence of first-time infection was 32.3% (95% confidence interval: 28.0, 37.1). Incidences calculated from time of new-partner acquisition were comparable for enrolled virgins and nonvirgins. Smoking, oral contraceptive use, and report of a new male sex partner—in particular, one known for less than 8 months before sex occurred or one reporting other partners—were predictive of incident infection. Always using male condoms with a new partner was not protective. Infection in virgins was rare, but any type of nonpenetrative sexual contact was associated with an increased risk. Detection of oral HPV was rare and was not associated with oral-penile contact. The data show that the incidence of HPV associated with acquisition of a new sex partner is high and that nonpenetrative sexual contact is a plausible route of transmission in virgins.
In June 2000, the United States National Institutes of Health (NIH) organized a review of the scientific evidence on the effectiveness of condoms in preventing sexually transmitted infections (STIs). ...The review concluded that condoms were effective in protecting against transmission of HIV to women and men and in reducing the risk of men becoming infected with gonorrhoea. Evidence for the effectiveness of condoms in preventing other STIs was considered to be insufficient. We review the findings of prospective studies published after June 2000 that evaluated the effectiveness of condoms in preventing STIs. We searched Medline for publications in English and included other articles, reports, and abstracts of which we were aware. These prospective studies, published since June 2000, show that condom use is associated with statistically significant protection of men and women against several other types of STIs, including chlamydial infection, gonorrhoea, herpes simplex virus type 2, and syphilis. Condoms may also be associated with protecting women against trichomoniasis. While no published prospective study has found protection against genital human papillomavirus (HPV) infection, two studies reported that condom use was associated with higher rates of regression of cervical intraepithelial neoplasia and clearance of cervical HPV infection in women and with regression of HPV-associated penile lesions in men. Research findings available since the NIH review add considerably to the evidence of the effectiveness of condoms against STIs. Although condoms are not 100% effective, partial protection can substantially reduce the spread of STIs within populations.
Infection with human papillomavirus (HPV) is the primary cause of cervical cancer, other anogenital cancers, genital warts, and recurrent respiratory papillomatosis. Clinical studies have ...demonstrated that a prophylactic HPV vaccine can prevent infection, genital warts, and the precancerous lesions that lead to cervical cancer. Given the absence of data on the long-term effectiveness of HPV vaccination, a number of mathematical models have been developed to provide insight to policy makers by projecting the long-term epidemiologic and economic consequences of vaccination and evaluate alternative vaccination policies. This paper reviews the state of these models. Three types of HPV mathematical models have been reported in the literature: cohort, population dynamic, and hybrid. All have demonstrated that vaccination can significantly reduce the incidence of cervical cancer in the long term. However, only the cohort and hybrid models have evaluated the cost-effectiveness of vaccination strategies for preventing cervical cancer. These models have generally shown that vaccinating females can be cost-effective. None has accounted for the potential benefits of vaccinating the population to reduce the burden of recurrent respiratory papillomatosis and cancers of the vagina, vulva, anus, penis, and head/neck. Given that only the population dynamic model can account for both the direct and indirect (i.e., herd immunity effects) benefits of vaccination in the population, future research should focus on further development of dynamic models by expanding the range of epidemiologic outcomes tracked and including the ability to assess the cost-effectiveness of alternative vaccination policies.
The aim of this study was to evaluate the use of GP5+/6+, MY09/11 and PGMY09/11 primer sets for the detection of human papillomavirus (HPV) DNA by single step polymerase chain reaction (PCR) and ...nested PCR in formalin-fixed and paraffin-embedded (FFPE) tissues from oral squamous cell carcinomas (OSCCs). DNA extracted from FFPE tissues were tested for amplification of the human beta globin gene with PCO3/4 primers. Positive samples for this gene were tested for HPV DNA using single step PCR with GP5+/6+, MY09/11 and PGMY09/11 primer sets. All negative samples at single step PCR with MY09/11 and PGMY09/11 were subjected to a further PCR with GP5+/6+ primers using the non-amplified product in the previously reactions (nested PCR) as samples. Among 26 samples, 23 were positive for the human beta globin gene and were considered viable for HPV DNA detection by PCR. Single step PCR with GP5+/6+ and MY09/11 primers and MY/GP+ nested PCR did not amplify HPV DNA in any samples. PGMY09/11 primers detected HPV DNA in 13.0% of OSCC cases and this rate was raise to 17.4% with the use of PGMY/GP+ nested PCR. According to our results the PGMY/GP+ nested PCR is the most appropriate primer set for the detection of HPV DNA using FFPE samples from OSCC.
•Association between HPV and oral squamous cell carcinomas•Molecular detection of HPV DNA from formalin-fixed, paraffin-embedded tissues•Utility of different primer sets for detection of HPV DNA by single and nested PCR
Human papillomavirus (HPV) infection is a necessary but not sufficient cause of cervical cancer. While chlamydia infection has been associated with cervical cancer, the meaning of this association ...remains unclear. The authors' objective was to investigate this association by evaluating whether concurrent genital tract infections are associated with HPV persistence, a precursor to cervical cancer. Interview data and biologic samples for HPV, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and bacterial vaginosis testing were collected from female adolescents in an Atlanta, Georgia, longitudinal cohort study at 6-month visits (1999–2003). Associations with persistence (detection of the same HPV type at two sequential visits (visit pair)) were assessed among subjects with 2–5 visits and ≥6 months of follow-up. Associations were evaluated by logistic regression using methods for correlated data. Type-specific persistence of high-risk HPV types was detected in 77 of 181 (43%) analyzed visit pairs. Concurrent infection with C. trachomatis was independently associated with persistence of high-risk HPV types (adjusted odds ratio = 2.1, 95% confidence interval: 1.0, 4.1). Infection with more than one HPV type at the initial visit was also associated with high-risk persistence (adjusted odds ratio = 2.8, 95% confidence interval: 1.6, 4.9). The association between chlamydia infection and cervical cancer may be due to an effect of chlamydia infection on persistence of high-risk HPV.
The authors constructed a Markov model as part of a systematic review of cervical cytology conducted at the Duke University Evidence-based Practice Center (Durham, North Carolina) between October ...1997 and September 1998. The model incorporated states for human papillomavirus infection (HPV), low- and high-grade squamous intraepithelial lesions, and cervical cancer stages I–IV to simulate the natural history of HPV infection in a cohort of women from ages 15 to 85 years. The age-specific incidence rate of HPV, and regression and progression rates of HPV and squamous intraepithelial lesions, were obtained from the literature. The effects of varying natural history parameters on cervical cancer incidence were evaluated by using sensitivity analysis. The base-case model resulted in a lifetime cervical cancer risk of 3.67% and a lifetime cervical cancer mortality risk of 1.26%, with a peak incidence of 81/100, 000 at age 50 years. Age-specific distributions of precursors were similar to reported data. Lifetime risk of cancer was most sensitive to the incidence of HPV and the probability of rapid HPV progression to high-grade lesions (two- to threefold variations in risk). The model approximates the age-specific incidence of cervical cancer and provides a tool for evaluating the natural history of HPV infection and cervicai cancer carcinogenesis as well as the effectiveness and cost-effectiveness of primary and secondary prevention strategies. Am J Epidemiol 2000; 151: 1158-71.
The authors estimated plausible ranges of the probability of human papillomavirus (HPV) transmission per coital act among newly forming couples by using stochastic computer simulation. Comparative ...empirical data were obtained in 1996–2001 from a cohort study of female university students in Montreal, Canada. Female prevalence and frequency of sexual intercourse and condom use were set equal to those in the cohort. Simulations included 240 combinations of male prevalence, the relative risk for protected versus unprotected sex, and per-act transmission probabilities. Those that produced expected HPV incidence within the 95% confidence interval observed in the cohort were selected. The observed 6-month cumulative incidence following acquisition of a new partner was 17.0% (95% confidence interval: 11.4, 23.0). Expected incidences consistent with those from cohort findings occurred in 54/240 simulations. The range of per-act transmission probabilities was 5–100% (median, 40%). Male HPV prevalence was the same as or greater than that for women in all consistent simulations. Varying condom effectiveness did not produce better-fitting data. This simulation suggests that HPV transmissibility is several-fold higher than that for other viral sexually transmitted infections such as human immunodeficiency virus or herpes simplex virus 2. With high transmissibility, any potential protective effect of condoms would disappear over multiple intercourse acts, underlining the need for an effective HPV vaccine.
Objective: To explore the clinical significance of the quantitative detection of human papillomavirus (HPV) E6/E7mRNA in triage of patients with atypical squamous cells of undetermined significance ...(ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Methods: A cross-sectional screening study was conducted among women who underwent outpatient gynecological screening at the Obstetrics and Gynecology Hospital of Fudan University from September 2015 to July 2016. A total of 500 patients from our hospital with ASC-US or LSIL based on cytology testing were subjected to HPV DNA and HPV E6/E7 mRNA quantitative analysis. Results: The specificity of the HPV E6/E7 mRNA test for detecting ≥ high-grade squamous intraepithelial lesion (HSIL+) was statistically higher than that of the HPV DNA test (61.3% vs. 40.0%, P < 0.05), whereas there was no significant difference in the sensitivity of HPV E6/E7 mRNA test and HPV DNA test (90.0% vs. 95.0%, P > 0.05). The positive rates of HPV in the participants tested by HPV E6/E7 mRNA and HPV DNA were, respectively, 42.8% (214/500) and 62.8% (314/500), with statistical significance (P < 0.05). Conclusions: The HPV E6/E7 mRNA test was slightly less sensitivity than that of the HPV DNA test for diagnosing HSIL+ in patients with ASC-US and LSIL, but the difference was not significant, although the specificity of the former was significantly higher. HPV E6/E7 mRNA detection can effectively reduce overdiagnosis and overtreatment of patients with ASC-US and LSIL and has important clinical value in triage of patients with ASC-US and LSIL.
Sera from 1483 female subjects in England aged 10-29 years were tested. The age-standardised seroprevalence was 10.7% (95% confidence intervals 9.0-12.3) for human papillomavirus (HPV) 6, 2.7% ...(1.8-3.6) for HPV 11, 11.9% (10.2-13.6) for HPV 16, 4.7% (3.5-5.8) for HPV 18, and 20.7% (18.6-22.7) for any of the four types.
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