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

Abstract

Cross-sectional studies have suggested that compared with women who delay the start of their sexual career, those who first have intercourse soon after menarche are more susceptible to cervical human papillomavirus (HPV) infection and thus have a greater risk of cervical neoplasia. We describe, using longitudinal observations, how the risk of infection with HPV varies with the interval between menarche and first intercourse in 474 women aged 15-19 recruited within 12 months of first intercourse and before the acquisition of a second sexual partner. One hundred forty-five women became HPV-positive; the cumulative risk of HPV infection 3 years after first intercourse was 45.0% (95% CI ‫؍‬ 37.9 -51.2). In univariate analyses, the hazards ratio (HR) of HPV infection increased significantly with age at first intercourse (HR ‫؍‬ Key words: sexual behavior; longitudinal study; human papillomavirus; partner age; interval between menarche and first intercourse Cross-sectional studies have suggested that compared with women who delay the start of their sexual career, those who first have intercourse soon after menarche are more susceptible to cervical human papillomavirus (HPV) infection and thus have a greater risk of cervical neoplasia. 1,2 However, these studies are limited in so far as outcomes are first defined some years after the first sexual experience and therefore the first exposure, when it is not possible to distinguish the effects of early, late and cumulative exposures to HPV. The longer the interval between first intercourse and first sampling, the more likely it is that a woman will have acquired and then cleared at least one HPV infection before first sampling, or possibly have established a latent infection, following which HPV may be only transiently detectable in cervical samples. 3 Clearly, the occurrence of outcomes of interest in the interval immediately following the onset of sexual activity, and those factors that bear on it, can only be described when observations are made during this interval. In order to measure the susceptibility of the adolescent cervix to HPV infection, we describe, using longitudinal data, the risks associated with the proximity of first intercourse to menarche during the first sexual relationship in women who were first sampled within 12 months of the start of their sexual career. Material and methodsBetween 1988 and 1992, 2,011 women aged 15 to 19 were recruited from a family planning clinic for a longitudinal study of the natural history of early cervical neoplasia. 4 At recruitment, a detailed social and sexual history and 2 cervical samples were taken, 1 for immediate cytologic assessment and the other for virologic examination after all clinical follow-up had ended. Women were asked to reattend at intervals of 6 months, when sexual histories were updated and further samples taken. Follow-up ended on 31 August 1997. The study protocol had ethical committee approval and informed oral consent was obtained from all women.The study population for this analysis is a subset ...

Reproductive Factors, Oral Contraceptive Use, and Human Papillomavirus Infection: Pooled Analysis of the IARC HPV Prevalence Surveys

“…Although a previous report (23) suggested an inverse association between age at menarche and HPV infection, our findings are in agreement with the majority of the studies that did not report significant associations (10,17,24).…”

“…Studies on the influence of OC use on HPV infection showed inconsistent results, with modest associations in both directions (10,12,13,(18)(19)(20)(21)(22). Very little is known on the relationship of age at menarche (10,17,23,24) or menopause (25) with HPV infection or cervical cancer.…”

Cervical Carcinoma and Sexual Behavior: Collaborative Reanalysis of Individual Data on 15,461 Women with Cervical Carcinoma and 29,164 Women without Cervical Carcinoma from 21 Epidemiological Studies

“…Although this possibility cannot be ruled out, it is unlikely to involve a specific vulnerability of the cervix to HPV infections in the interval shortly after menarche because we observed a steady increase in ICC risk with decreasing age at first intercourse across the age range considered and not exclusively in the ages surrounding menarche. This conclusion is also supported by a prospective study of HPV infection risk in the first years after menarche (70).…”

Risk Factors for Cervical Cancer in Northeastern Thailand: Detailed Analyses of Sexual and Smoking Behavior

“…Biologically, we found that early sexual activity after menarche (< 6 years) led to greater susceptibility to SCCA. During puberty, the immaturity of cervical cells undergo many changes that might be more vulnerable to damage and HPV infection and/or other sexually-transmitted diseases (Coker et al, 1994;Kahn et al, 2002;Collins et al, 2005;Matos et al, 2005;Louie et al, 2009). This data indicates that a delay of 6 or more years after menarche before sexual intercourse would be safer and afford some protection from sexually-transmitted diseases (including HPV infection) and susceptibility to cervical cancer.…”