Mediators of the Association Between Age of First Sexual Intercourse and Subsequent Human Papillomavirus Infection

Abstract

ABSTRACT.Objective. Previous studies have demonstrated that early age of first sexual intercourse is associated with human papillomavirus (HPV) infection. The objective of this study was to identify a set of risk behaviors and partner characteristics that mediate the association between age of first sexual intercourse and subsequent HPV infection in adolescent and young adult women.Methods. Female university students completed surveys and underwent HPV testing every 6 months for up to 3 years. HPV-positive participants were matched to HPV-negative participants (252 pairs, total N ‫؍‬ 504). Associations were examined between risk behaviors/partner characteristics and both age of first sexual intercourse and HPV infection. Those variables associated with either age of first sexual intercourse or HPV infection were entered into a generalized estimating equation (to account for the matched study design) modeling the association between age of first sexual intercourse and HPV infection.Results. Mean age of first sexual intercourse was 16.7 (؎1.8) years, and early age of first sexual intercourse was associated significantly with HPV infection (␤ ‫؍‬ ؊0.20; odds ratio: 0.82; 95% confidence interval: 0.74 -0.90). The association was mediated by number of sexual partners in the past 6 months, history of sexually transmitted infection, alcohol and drug use related to sexual behaviors, and partner's number of sexual partners.Conclusion. A set of behavioral risk factors and partner characteristics partially mediate the association between age of first sexual intercourse and subsequent HPV infection. Pediatrics 2002;109(1). URL: http://www. pediatrics.org/cgi/content/full/109/1/e5; human papillomavirus, sexual intercourse, adolescent, risk behaviors, mediator.ABBREVIATIONS. HPV, human papillomavirus; STI, sexually transmitted infection; GEE, generalized estimating equation. G enital human papillomavirus (HPV) infection is one of the most common sexually transmitted infections in the United States, with a prevalence of approximately 50% in sexually active adolescent and young adult women. 1,2 Infection with certain HPV types, particularly types 6 and 11, is associated with the development of anogenital warts, which has a prevalence of approximately 2% in sexually active men and women. 3 HPV infection with high-risk oncogenic types, such as 16, 18, 31, and 45, may progress from infection to cervical dysplasia, carcinoma in situ, and invasive cervical cancer. 4 -8 Although HPV infection is frequently transient in adolescent and young adult women and the natural history of HPV infection and cytologic abnormalities is still being defined, 9 this population has a relatively high incidence of abnormal Papanicolaou (Pap) smears. Mount and Papillo 10 reported that the incidence of Pap smears with squamous intraepithelial lesion was higher in adolescents 10 to 19 years of age than in adult women, and other investigators 11,12 have proposed that the prevalence of abnormal Pap smears and cervical dysplasia is increasing worldwide in y...

Proximity of first intercourse to menarche and the risk of human papillomavirus infection: A longitudinal study

“…This additional restriction allowed a more precise examination of the role of the male factor in the acquisition of infection. 9,10 We found that older partners were more likely to be reported as sexually experienced and that among women with sexually experienced partners, the risk of infection increased with increasing age of partner.…”

Prevalence of Genital Human Papilloma Virus Infection and Genotypes among Young Women in Sicily, South Italy

“…The age at first sexual intercourse, time since first sexual intercourse, use of oral contraceptives, and a smoking habit revealed an association with HPV infection in a crude analysis but not in a multivariate analysis. Across various studies, the results of the association between these variables and HPV infection have been inconsistent (15,21,23,24). A possible explanation may be that they could be a marker for other risky sexual behavior (e.g., greater numbers of partners; ref.…”

“…A possible explanation may be that they could be a marker for other risky sexual behavior (e.g., greater numbers of partners; ref. 24).…”

Acadêmicos, a percepção sobre o papilomavírus humano e sua relação com o câncer cervical

“…Contudo, é necessário ajustar este dado para a idade do início da atividade sexual, sendo estes dois fatores muito importantes em relação ao risco de infecção por HPV (KAHN et al, 2002a). Assim, quanto mais precoce o início das atividades sexuais, maior o risco de infecção (KAHN et al, 2002b). Na idade de 50 anos, 80% das mulheres terão sido contaminadas por esse vírus (BROOMALL; REYNOLDS; JOCOBSON, 2010).…”