A longitudinal study of genital human papillomavirus infection in a cohort of closely followed adolescent women

Abstract

Background: We performed a study to better characterize the natural history of genital human papillomavirus (HPV) infection in a cohort of closely followed adolescent women.

Methods: A cohort of 60 adolescent women was followed over a 2.2-year period, on average. A median of 41.5 self-collected vaginal and clinician-obtained cervical swabs were obtained from each subject.

Results: HPV was detected in 45.3% of all adequate specimens, by use of a polymerase chain reaction/reverse blot strip assay. Oncogenic--or high-risk (HR)--HPV types were detected in 38.6% of specimens, and nononcogenic--or low-risk (LR)--types were detected in 19.6% of specimens. During the entire study period, 49 of 60 subjects tested positive for HPV (cumulative prevalence, 81.7%). The most frequently detected HR types were HPV types 52, 16, and 59. Infections with multiple HPV types were common. The median duration of persistence of a specific HPV type was 168 days, and HR types were more persistent than LR types. Abnormal cervical cytological results occurred in 37% of the adolescent women and were significantly associated with HR HPV infection.

Conclusions: The cumulative prevalence of HPV infection in sexually active adolescent women is extremely high, involves numerous HPV types, and frequently results in cervical dysplasia.

Figure 1

Distribution of specific human papillomavirus (HPV) types in cervical swabs, vaginal swabs, and all swabs. The upper rows show the no. of swabs that were positive for each HPV type, and the lower rows show the percentage of swabs that were positive for each type.

Figure 2

Human papillomavirus (HPV) type distribution among 60 adolescent women. The upper row shows the no. of swabs that were positive for each HPV type, and the lower row shows the percentage of subjects in whom each type was detected.

Figure 3

Kaplan-Meier estimates of human papillomavirus (HPV) clearance time in high-risk (HR; oncogenic) and low-risk (LR; nononcogenic) runs. The estimated median clearance time for HR HPV was 226 days, and the estimated median clearance time for LR HPV was 170 days.

Figure 4

Kaplan-Meier estimates of human papillomavirus (HPV) persistence in individual subjects with or without abnormal Pap smear results. The Kaplan-Meier estimates of the median clearance time were 255 and 170 days, in HPV runs with and without abnormal pap smear results, respectively.

Figure 5

The complete analysis of 4 individual adolescent woman (subjects A, B, C, and D), shown to illustrate the acquisition and persistence of specific human papillomavirus (HPV) types during the study period. The week in which the specimen was acquired is shown in the left-most column. HPV types are indicated at the top of the figure. c, clinician-obtained cervical swab; v, self-collected vaginal swab. Plus (+) signs indicate positive results for the specimen.

Figure 5

The complete analysis of 4 individual adolescent woman (subjects A, B, C, and D), shown to illustrate the acquisition and persistence of specific human papillomavirus (HPV) types during the study period. The week in which the specimen was acquired is shown in the left-most column. HPV types are indicated at the top of the figure. c, clinician-obtained cervical swab; v, self-collected vaginal swab. Plus (+) signs indicate positive results for the specimen.

Figure 5

The complete analysis of 4 individual adolescent woman (subjects A, B, C, and D), shown to illustrate the acquisition and persistence of specific human papillomavirus (HPV) types during the study period. The week in which the specimen was acquired is shown in the left-most column. HPV types are indicated at the top of the figure. c, clinician-obtained cervical swab; v, self-collected vaginal swab. Plus (+) signs indicate positive results for the specimen.

Figure 5

The complete analysis of 4 individual adolescent woman (subjects A, B, C, and D), shown to illustrate the acquisition and persistence of specific human papillomavirus (HPV) types during the study period. The week in which the specimen was acquired is shown in the left-most column. HPV types are indicated at the top of the figure. c, clinician-obtained cervical swab; v, self-collected vaginal swab. Plus (+) signs indicate positive results for the specimen.