Factors associated with human papillomavirus infection in women encountered in community-based offices

Abstract

Objective: To assess risk factors for cervical human papillomavirus (HPV) infection in women presenting to community-based offices because of vaginal symptoms or for preventive screening.

Design: Cross-sectional analysis of history, physical examination, and microbiological infection variables.

Setting: Two community-based family practice offices in southeastern Michigan.

Patients: Two hundred seventy-three women, 18 to 50 years of age, presenting to the study sites because of vaginal symptoms or for a pelvic examination for preventive screening.

Main outcome measure: Human papillomavirus infection of the uterine cervix as determined by polymerase chain reaction testing.

Results: Human papillomavirus infection was detected in 21.2% of the women (24.9% and 13.1% of women with and without vaginal symptoms, respectively); 34% of these infections were HPV types 16 or 18. Fifty-four percent of the women with HPV infection who underwent colposcopy had condyloma or cervical intraepithelial neoplasia verified on biopsy. Independent associations were found between HPV infection and the following female risk factors: the presence of vaginal itching, odor, or swelling; knowing the current sexual partner less than 24 months; age less than 40 years; household income of $14,000 or less; and ever having had six or more sexual partners.

Conclusions: In addition to three previously described risk factors for genital HPV infection, two previously unrecognized risk factors were identified in this lower-risk population. These risk factors included the presence of vaginal symptoms of itching, odor, or swelling and having known the current sexual partner less than 24 months. Nevertheless, using risk factors alone, two thirds of the women infected with HPV in this population were not identified as being at high risk of infection. No subset of sexually active women was identified who were at no risk of HPV infection.