The effect of intrauterine devices on acquisition and clearance of human papillomavirus

Abstract

Background Previous studies have shown a decrease in cervical cancer associated with intrauterine device use. It has been hypothesized that intrauterine device use may alter the natural history of human papillomavirus infections, preempting development of precancerous lesions of the cervix and cervical cancer, but the effect of intrauterine devices on the natural history of human papillomavirus infection and subsequent development of cervical cancer is poorly understood. Objective The purpose of this study was to evaluate the association between intrauterine device use and cervical high-risk human papillomavirus acquisition and clearance. Study Design This is a prospective cohort study conducted between October 2000 and June 2014 among 676 sexually active young women enrolled from family planning clinics in San Francisco, California. Data was analyzed using a Cox proportional hazards model, including time varying indicators of intrauterine device use, and adjusting for fixed and time-dependent predictor variables. Results A total of 85 women used an intrauterine device at some time during follow up. Among 14,513 study visits, women reported intrauterine device use at 505 visits. After adjusting for potential behavioral confounders, there was no association between intrauterine device use and or human papillomavirus acquisition, HR= 0.50 (95% CI 0.20–1.23) p=0.13 or clearance of human papillomavirus infection, HR=1.44 (95% CI 0.76–2.72) p=0.26. Conclusions Current intrauterine device use is not associated with acquisition or persistence of human papillomavirus infection. Intrauterine device use is safe among women with human papillomavirus infections and at risk for human papillomavirus acquisition. Intrauterine device use may play a role further downstream in the natural history of cervical cancer by inhibiting the development of precancerous lesions of the cervix in intrauterine device -infected women, or enhancing clearance of established precancerous lesions.

Distribution of HPV Genotypes Differs Depending on Behavioural Factors among Young Women

“…Previous meta-analyses have demonstrated that the use of an IUD was protective for cervical cancer compared with never using an IUD [ 27 , 28 ]. Furthermore, current IUD use has not been associated with the acquisition or persistence of an HPV infection [ 29 ]. However, a study from the US found significant association of CIN2+ with hormonal IUD use in the past 18 months, while the risk of CIN3+ was not increased [ 30 ].…”

Factors Associated with Presence of Human Papillomavirus Infection among Women: Findings from New Cervical Cancer Screening in Kelantan, Malaysia

“…On the other hand, there is no association between non-hormonal contraception used and HPV infection from current study. Besides, previous study had reported that used of non-hormonal method such as IUD has protective association with HPV infection by producing immune mediators that would clear the infection (47).…”