Immunization Unit, Robert Koch Institute, Berlin, Germany.
Int J Gynecol Cancer. 2013 Mar;23(3):519-26. doi: 10.1097/IGC.0b013e318285a4b2.
Persistent infection with high-risk human papillomaviruses (HPVs) can lead to cervical intraepithelial lesion and cervical cancer. Sexual behavior and smoking have been identified as risk factors for HPV infection. However, it is unclear which factors account for the persistence of HPV infection and for high-grade squamous intraepithelial lesions (HSIL). Therefore, we conducted a study to identify epidemiological risk factors for the following: (1) the presence of HPV among women without a recent diagnosis of HSIL and (2) HSIL.
Participants aged 20 to 31 years were recruited at 2 study sites. All women received a cervical Papanicolaou test, were tested for HPV, and categorized into 1 of 3 different groups: The women of the first group had negative cytological test results and a negative HPV test result (HPV-negative group), and the women of the second group had negative cytological test result but positive HPV test result (HPV-positive group). The third group consisted of women with a diagnosis of HSIL (HSIL group). We first compared the HPV-negative group with the HPV-positive group, and then the HPV-positive group with the HSIL group.
One hundred forty-seven women were included: 53 women in the HPV-negative group, 46 women in the HPV-positive group, and 48 women in the HSIL group. Comparing the HPV-negative with the HPV-positive group, we found that more than 5 sexual partners during a lifetime were independently associated with cervical HPV infection, whereas the chance of being infected decreased with older age. Irregular condom use during one-night stands or smoking was associated with HPV infection only in univariable but not multivariable analysis. In contrast, older age and having had genital warts were independently associated with an HSIL diagnosis when comparing the HPV-positive group with the HSIL group.
Although the study was hampered by its relatively small sample size, our data suggest that main risk factors for the acquisition of HPV infection are a higher number of sexual partners and younger age, whereas older age and genital warts may be epidemiological cofactors in the development of HSIL.
高危型人乳头瘤病毒（HPV）的持续感染可导致宫颈上皮内瘤变和宫颈癌。性行为和吸烟已被确定为 HPV 感染的危险因素。然而，尚不清楚哪些因素导致 HPV 感染的持续存在以及高级别鳞状上皮内病变（HSIL）的发生。因此，我们进行了一项研究，以确定以下方面的流行病学危险因素：（1）在最近未诊断出 HSIL 的女性中 HPV 的存在，以及（2）HSIL。
在两个研究地点招募了年龄在 20 至 31 岁的参与者。所有女性均接受宫颈巴氏涂片检查、HPV 检测，并分为以下 3 组之一：第一组女性的细胞学检查结果和 HPV 检测结果均为阴性（HPV 阴性组），第二组女性的细胞学检查结果为阴性，但 HPV 检测结果为阳性（HPV 阳性组）。第三组由诊断为 HSIL 的女性组成（HSIL 组）。我们首先比较了 HPV 阴性组与 HPV 阳性组，然后比较了 HPV 阳性组与 HSIL 组。
共纳入 147 名女性：HPV 阴性组 53 名，HPV 阳性组 46 名，HSIL 组 48 名。与 HPV 阴性组相比，HPV 阳性组发现，一生中超过 5 个性伴侣与宫颈 HPV 感染独立相关，而年龄越大，感染的机会越低。一夜情时不规律使用避孕套或吸烟仅在单变量分析中与 HPV 感染相关，而多变量分析中则不相关。相比之下，当比较 HPV 阳性组与 HSIL 组时，年龄较大和患有生殖器疣与 HSIL 诊断独立相关。
尽管该研究受到样本量相对较小的限制，但我们的数据表明，HPV 感染的主要危险因素是性伴侣数量较多和年龄较小，而年龄较大和生殖器疣可能是 HSIL 发展的流行病学伴随因素。
