Sexual Behavior, Condom Use, and Human Papillomavirus: Pooled Analysis of the IARC Human Papillomavirus Prevalence Surveys

Abstract

Human papillomavirus (HPV) is a sexually transmitted infection but it is unclear whether differences in transmission efficacy exist between individual HPV types. Information on sexual behavior was collected from 11 areas in four continents among population-based, age-stratified random samples of women of ages z15 years. HPV testing was done using PCRbased enzyme immunoassay. Unconditional logistic regression was used to estimate odds ratios (OR) of being HPV positive and corresponding 95% confidence intervals (95% CI). Variables were analyzed categorically. When more than two groups were compared, floating confidence intervals were estimated by treating ORs as floating absolute risks. A total of 11,337 women (mean age, 41.9 years) were available. We confirmed that lifetime number of sexual partners is associated with HPV positivity (OR for z2 versus 1, 1.86; 95% CI, 1.63-2.11) but the association was not a linear one for HPV18, 31, and 33 (i.e., no clear increase for z3 versus 2 sexual partners). Women who had multiple-type infection and highrisk HPV type infection reported a statistically nonsignificant higher number of sexual partners than women who had single-type and low-risk type infections, respectively. Early age at sexual debut was not significantly related to HPV positivity. Husband's extramarital sexual relationships were associated with an OR of 1.45 (95% CI, 1.24-1.70) for HPV positivity in their wives after adjustment for age and lifetime number of women's sexual partners. We did not observe a significant association with condom use. Our study showed an effect of both women's and their husbands' sexual behavior on HPV positivity. Furthermore, it suggests some differences in the pattern of the association between sexual behavior and different HPV types. (Cancer Epidemiol Biomarkers Prev 2006;15(2):326 -33)

Sociodemographic characteristics, sexual behaviour and knowledge about cervical cancer prevention as risk factors for high-risk human papillomavirus infection in Arkhangelsk, North-West Russia

“…Our observation that age at sexual debut and number of lifetime sexual partners are associated with positive HPV status is consistent with previous studies [19–22]. Age at sexual debut appears to have declined over time [45].…”

“…Of these, a positive association with the number of sexual partners has most consistently been reported [20–22]. Multiple lifetime sexual partners has been shown to increase the risk of being HPV-DNA positive [19,40]. However, women tend to underreport the number of lifetime sexual partners [22,35,36].…”

“…Predictors of HPV may differ from those of CC because the development of the latter is influenced by many variables, including co-factors involved in carcinogenesis and adherence to screening guidelines [16,19,20]. Several studies reported an association between HPV positivity and lifetime number of sexual partners [16,19,21].…”

“…Several studies reported an association between HPV positivity and lifetime number of sexual partners [16,19,21]. On the other hand, the influence of age at sexual debut and condom use on the risk of being HPV positive is questionable [20,22,23].…”

“…Other potential risk factors for cervical HPV infection include tobacco smoking [24], nulliparity [25,26], and use of oral contraceptives [25]. Geographic and cultural variations in the sexual behaviour of women and their partners have also been reported to be strongly associated with HPV acquisition [19,27]. …”