男女性伴侣之间 HPV 的手到生殖器和生殖器到生殖器传播（HITCH）：一项前瞻性队列研究。
Hand-to-genital and genital-to-genital transmission of human papillomaviruses between male and female sexual partners (HITCH): a prospective cohort study.
机构信息
Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC, Canada.
Department of Obstetrics and Gynaecology, Turku University Hospital, University of Turku, Turku, Finland.
出版信息
Lancet Infect Dis. 2019 Mar;19(3):317-326. doi: 10.1016/S1473-3099(18)30655-8. Epub 2019 Feb 10.
BACKGROUND
Hand-to-genital contact is hypothesised to be a transmission mode of human papillomavirus (HPV) of the Alphapapillomavirus genus. We compared the relative importance of hand-to-genital and genital-to-genital HPV transmission between sexual partners.
METHODS
In this prospective cohort study, we recruited and followed up female university students aged 18-24 years and their male sexual partners in Montreal, QC, Canada (2005-11). Participants were eligible if they had initiated sexual activity within the past 6 months. Women were examined at clinic visits at baseline and every 4-6 months for up to 24 months. Men had a baseline visit and a single follow-up visit approximately 4 months later. Partners provided hand and genital swab samples, which we tested for DNA of 36 HPV types using PCR. We assessed predictors of incident type-specific HPV detections using Cox proportional hazards models.
FINDINGS
Participants were recruited between June 5, 2006, and April 4, 2013. 264 women and 291 men had valid hand samples. The hazard ratio (HR) of incident detection of HPV in genital samples from women was 5·0 (95% CI 1·5-16·4) when her partner was positive for the same HPV type on his hand versus negative, but adjustment for his genital HPV status reduced the HR to 0·5 (0·1-1·8). Similarly, the HR of incident detection of HPV on men's genitals was 17·4 (95% CI 7·9-38·5) when his partner was positive for the same HPV type on her hand versus negative, but adjustment for her genital HPV status reduced the HR to 2·3 (0·9-6·2). Conversely, the HR of type-specific incident detection of HPV in genital samples associated with partner genital HPV positivity was 19·3 (95% CI 11·8-31·8) for women and 28·4 (15·4-52·1) for men after adjustment for their hand HPV status.
INTERPRETATION
Clinicians can reassure their patients that HPV transmission is unlikely to occur through hand-to-genital contact. The majority of genital HPV infections are likely to be caused by genital-to-genital sexual transmission.
FUNDING
Canadian Institutes for Health Research, National Institutes of Health, Fonds de la Recherche en Santé du Québec, and Merck & Co.
背景
手上的人乳头瘤病毒（HPV）与生殖器接触被假设为α乳头瘤病毒属 HPV 的一种传播方式。我们比较了性伴侣之间手到生殖器和生殖器到生殖器 HPV 传播的相对重要性。
方法
在这项前瞻性队列研究中，我们招募并随访了加拿大魁北克省蒙特利尔的 18-24 岁女性大学生及其男性性伴侣（2005-11 年）。如果参与者在过去 6 个月内开始性行为，则有资格参加。女性在基线和每 4-6 个月进行一次诊所检查，最长 24 个月。男性进行了基线检查和大约 4 个月后的一次后续检查。伴侣提供手部和生殖器拭子样本，我们使用 PCR 检测了 36 种 HPV 类型的 DNA。我们使用 Cox 比例风险模型评估了特定 HPV 检测的预测因素。
结果
参与者于 2006 年 6 月 5 日至 2013 年 4 月 4 日期间招募。264 名女性和 291 名男性有有效的手部样本。当女性生殖器样本中 HPV 的检出率与她的伴侣在手部相同 HPV 类型阳性而阴性时，她的伴侣的 HR 为 5.0（95%CI 1.5-16.4），但调整他的生殖器 HPV 状态后，HR 降至 0.5（0.1-1.8）。同样，当男性的 HPV 在他的生殖器上检测到阳性时，他的伴侣在她的手上检测到相同的 HPV 类型时，HR 为 17.4（95%CI 7.9-38.5），而当他的伴侣在她的生殖器上检测到 HPV 状态时，HR 为 2.3（0.9-6.2）。相反，调整伴侣生殖器 HPV 阳性状态后，女性 HPV 生殖器样本中特定类型 HPV 检测的 HR 为 19.3（95%CI 11.8-31.8），男性为 28.4（15.4-52.1）。
解释
临床医生可以让他们的患者放心，HPV 不太可能通过手到生殖器接触传播。大多数生殖器 HPV 感染可能是由生殖器到生殖器的性传播引起的。
资金
加拿大卫生研究院、美国国立卫生研究院、魁北克健康研究基金会和默克公司。
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