Meta-analysis of human papillomavirus infection concordance

Abstract

Background: Estimates of human papillomavirus (HPV) concordance among sexual partners are important for various public health activities, from counseling individual patients to predicting the effect of HPV vaccination.

Methods: We systematically searched the PubMed and EMBASE databases for studies of HPV concordance among heterosexual couples published through 2008 in English. Two coders independently abstracted data using standardized forms. We integrated concordance data using random-effects meta-analysis.

Results: Thirty studies (33 study populations) that met inclusion criteria reported concordance data for 2,972 couples. Most studies were cross-sectional cohort studies conducted in Europe or Asia that used DNA hybridization to test for HPV, sometimes in conjunction with PCR. Overall, 25.5% (95% confidence interval, 17.2-36.1%) of couples were infected with 1 or more of the same HPV types. Among couples with both members HPV-positive, 63.2% (95% confidence interval, 49.1-75.3%) were infected with 1 or more of the same viral types. Positive concordance was higher for female partners of men with HPV infections than for male partners of women with HPV infections. Positive concordance was also higher for studies using PCR and for the few studies that recruited men with HPV-related disease.

Conclusions: Sexual partners of HPV-infected individuals had high rates of HPV infection, suggesting a need for increased attention to this group.

Impact: Our refined estimates of HPV concordance can inform clinical encounters and public health planning. Future HPV concordance studies should use more rigorous research designs, characterize their participants in greater detail, and study more meaningful populations.

Figure 1

Study flow diagram

Figure 2

Forest plot of percent of men with the same HPV types (1 or more types) as their HPV-positive female partners. Analyses included all men, regardless of HPV status, whose female partners were HPV-positive and for whom studies reported appropriate concordance data. Results stratified by whether the study recruited couples that included men with HPV-related disease.

Figure 3

Forest plot of percent of women with the same HPV types (1 or more types) as their HPV-positive male partners. Analyses included all women, regardless of HPV status, whose male partners were HPV-positive and for whom studies reported appropriate concordance data. Results stratified by whether the study recruited couples that included women with HPV-related disease.