Impact of human papillomavirus-related genital diseases on quality of life and psychosocial wellbeing: results of an observational, health-related quality of life study in the UK

Abstract

Background: Data on the psychosocial burden of human papillomavirus (HPV)-related diseases other than cervical cancer are scarce. The objectives of this study were to measure and compare the psychosocial burden and the impact on health-related quality of life (HRQoL) of HPV-related lower genital tract diseases and genital warts (GW) using several generic and disease-specific instruments.

Methods: Overall, 842 individuals with normal cervical cytology (n = 241), borderline nuclear abnormalities and/or mild dyskaryosis (n = 23), cervical intraepithelial neoplasia (CIN)1 (n = 84), CIN2/3 (n = 203), vulval intraepithelial neoplasia (VIN)2/3 (n = 43), GW (n = 186) and a history of GW (non-current) (n = 62) were included. The generic European Quality of Life Index Version 5D (EQ-5D) questionnaire was completed by patients with GW and VIN2/3. Sexual functioning was evaluated using the Change in Sexual Functioning Questionnaire (CSFQ). Psychosocial impact was measured in women using the HPV Impact Profile (HIP) questionnaire. HRQoL was assessed using a GW-specific questionnaire, the Cuestionario Especifico en Condilomas Acuminados (CECA) (completed by patients with GW and history of GW). For each instrument, scores were compared between groups using the Student's t-test. In addition, utility loss due to GW and VIN2/3 was evaluated by comparing mean EQ-5D scores weighted by age and sex with the UK general population normal values.

Results: A significant psychosocial impact was found in women diagnosed with HPV-related genital diseases, particularly in those with GW. The health state of younger adults with GW was significantly impaired compared with UK normal values (mean EQ-5D index score 0.86 vs 0.94, p < 0.001 for 18-24-year-olds; 0.87 vs 0.93, p = 0.030 for 25-34-year-olds). VIN2/3 was found to have a significant negative impact on sexual functioning, and women with VIN2/3 had a highly impaired health state compared with women in the UK general population (weighted mean EQ-5D index score 0.72 vs 0.89, p < 0.001; weighted mean Visual Analogue Scale score 62 vs 85, p < 0.001).

Conclusions: HPV-related lower genital tract lesions and GW significantly impair psychosocial wellbeing and HRQoL. The psychosocial aspects of HPV-related diseases need to be considered when evaluating the potential benefit of HPV vaccination.

Figure 1

Flow chart of study populations. CECA, Cuestionario Especifico en Condilomas Acuminados; CIN, cervical intraepithelial neoplasia; CSFQ, Change in Sexual Functioning Questionnaire; EQ-5D, European Quality of Life Index Version 5D; GW, genital warts; HIP, Human Papillomavirus Impact Profile; VIN, vulval intraepithelial neoplasia. * Of the 43 patients in the VIN2/3 group, one patient did not complete at least one item of the HIP/CSFQ questionnaires; a different patient did not complete at least one item of the CECA/EQ-5D questionnaires.

Figure 2

Analysis of psychosocial burden and sexual function assessments (crude data, women only). (a) Comparison of mean total HIP scores. Higher scores indicate greater psychosocial impact. (b) Comparison of mean total CSFQ scores. Higher scores indicate better sexual functioning. p value is from analysis of variance. Borderline, borderline nuclear abnormalities and/or mild dyskaryosis; CIN, cervical intraepithelial neoplasia; CSFQ, Change in Sexual Functioning Questionnaire; GW, genital warts; HIP, Human Papillomavirus Impact Profile; Normal, normal cervical cytology; SEM, standard error of the mean; VIN, vulval intraepithelial neoplasia.

Figure 3

Comparison of EQ-5D health domains in participants with VIN2/3 and GW versus UK population norms (weighted data). (a) Percentage of women with VIN2/3 reporting some or extreme problems with EQ-5D dimensions compared with a sex-matched sample from the UK general population. p values are from χ² tests and compare the VIN2/3 group with the UK general population. (b) Percentage of participants (men and women) with GW reporting some or extreme problems with EQ-5D dimensions compared with the UK general population. p values are from χ² tests and compare the GW group with the UK general population. Error bars represent 95% confidence intervals. EQ-5D, European Quality of Life Index Version 5D; GW, genital warts; VIN, vulval intraepithelial neoplasia.

Figure 4

Analysis of CECA scores (crude data). (a) Comparison of mean CECA scores for male and female participants with GW versus those with a history of GW. (b) Comparison of mean CECA scores for women and (c) for men with GW versus those with a history of GW. Higher scores indicate a better health-related quality of life. p values are from the Student’s t-test and compare the GW group with the history of GW group. Error bars represent standard error of the mean. CECA, Cuestionario Especifico en Condilomas Acuminados; GW, genital warts.