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. 2013 Jan 15;207(2):272-80.
doi: 10.1093/infdis/jis660. Epub 2012 Dec 12.

A cohort effect of the sexual revolution may be masking an increase in human papillomavirus detection at menopause in the United States

Patti E Gravitt  1 , Anne F Rositch, Michelle I Silver, Morgan A Marks, Kathryn Chang, Anne E Burke, Raphael P Viscidi
Affiliations

A cohort effect of the sexual revolution may be masking an increase in human papillomavirus detection at menopause in the United States

Patti E Gravitt et al. J Infect Dis. .

Abstract

Background: Cohort effects, new sex partnerships, and human papillomavirus (HPV) reactivation have been posited as explanations for the bimodal age-specific HPV prevalence observed in some populations; no studies have systematically evaluated the reasons for the lack of a second peak in the United States.

Methods: A cohort of 843 women aged 35-60 years were enrolled into a 2-year, semiannual follow-up study. Age-specific HPV prevalence was estimated in strata defined by a lower risk of prior infection (<5 self-reported lifetime sex partners) and a higher risk of prior infection (≥ 5 lifetime sex partners). The interaction between age and lifetime sex partners was tested using likelihood ratio statistics. Population attributable risk (PAR) was estimated using Levin's formula.

Results: The age-specific prevalence of 14 high-risk HPV genotypes (HR-HPV) declined with age among women with <5 lifetime sex partners but not among women with ≥ 5 lifetime sex partners (P = .01 for interaction). The PAR for HR-HPV due to ≥ 5 lifetime sex partners was higher among older women (87.2%), compared with younger women (28.0%). In contrast, the PAR associated with a new sex partner was 28% among women aged 35-49 years and 7.7% among women aged 50-60 years.

Conclusions: A lower cumulative probability of HPV infection among women with a sexual debut before the sexual revolution may be masking an age-related increase in HPV reactivation in the United States.

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Figures

Figure 1.
Figure 1.
Age-specific patterns of recent and lifetime sexual behaviors among study subjects.
Figure 2.
Figure 2.
Age-specific prevalence proportions of any human papillomavirus (HPV) and high-risk HPV (HR-HPV) among study subjects. See Methods for definitions of any HPV and HR-HPV.
Figure 3.
Figure 3.
A, Age-specific prevalence of high-risk human papillomavirus (HR-HPV), by lifetime number of sex partners (LTSP). B, Age-specific prevalence of any HPV, by LTSP. C, Relative difference in prevalence proportions of any HPV and HR-HPV between subjects with <5 lifetime sex partners and those with ≥5 lifetime sex partners. See Methods for definitions of any HPV and HR-HPV.
Figure 4.
Figure 4.
Simple models to evaluate the impact of the cohort effect of the 1965–1975 US sexual revolution on cross-sectional human papillomavirus (HPV) prevalence surveys conducted in 1998, 2008, and 2018 among 5 successive birth cohorts (1939–1974). Model A assumes no risk of reactivation with increasing age, and model B assumes an age-specific increase in reactivation similar to the observed U-shaped HPV prevalence in Morelos, Mexico [38].
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Comment in

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