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. 2021 Apr 23;223(8):1423-1432.
doi: 10.1093/infdis/jiaa557.

Rates of New Human Papillomavirus Detection and Loss of Detection in Middle-aged Women by Recent and Past Sexual Behavior

Proma Paul  1   2 , Anne Hammer  3   4   5 , Anne F Rositch  6 , Anne E Burke  7 , Raphael P Viscidi  8 , Michelle I Silver  9 , Nicole Campos  10 , Ada O Youk  11 , Patti E Gravitt  6   12
Affiliations

Rates of New Human Papillomavirus Detection and Loss of Detection in Middle-aged Women by Recent and Past Sexual Behavior

Proma Paul et al. J Infect Dis. .

Abstract

Background: Understanding the source of newly detected human papillomavirus (HPV) in middle-aged women is important to inform preventive strategies, such as screening and HPV vaccination.

Methods: We conducted a prospective cohort study in Baltimore, Maryland. Women aged 35-60 years underwent HPV testing and completed health and sexual behavior questionnaires every 6 months over a 2-year period. New detection/loss of detection rates were calculated and adjusted hazard ratios were used to identify risk factors for new detection.

Results: The new and loss of detection analyses included 731 women, and 104 positive for high-risk HPV. The rate of new high-risk HPV detection was 5.0 per 1000 woman-months. Reporting a new sex partner was associated with higher detection rates (adjusted hazard ratio, 8.1; 95% confidence interval, 3.5-18.6), but accounted only for 19.4% of all new detections. Among monogamous and sexually abstinent women, new detection was higher in women reporting ≥5 lifetime sexual partners than in those reporting <5 (adjusted hazard ratio, 2.2; 95% confidence interval, 1.2-4.2).

Conclusion: Although women remain at risk of HPV acquisition from new sex partners as they age, our results suggest that most new detections in middle-aged women reflect recurrence of previously acquired HPV.

Keywords: cervical cancer screening; cervical neoplasia; epidemiology; human papillomavirus; sexual behavior.

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Figures

Figure 1.
Figure 1.
Number of human papillomavirus (HPV) serotypes detected among women aged 35–60 years in Baltimore, Maryland, stratified by the number of lifetime sexual partners.
Figure 2.
Figure 2.
Conceptual model for estimating proportion of new human papillomavirus (HPV) detections attributed to new acquisition versus detection of recurrent, previously acquired infection (ie, reactivation).
Figure 3.
Figure 3.
Rates of new human papillomavirus (HPV) detection by recent and past sexual behavior among women aged 35–60 years in Baltimore, Maryland. Kaplan-Meier curves illustrating new detection rates for women who reported having sex with the same partner or no sex, stratified by the number of lifetime sexual partners (LTSPs).
See this image and copyright information in PMC

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