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Prevalence and Risk Factors for Oncogenic Human Papillomavirus Infections in High-Risk Mid-Adult Women

Winer, Rachel L. PhD*; Hughes, James P. PhD; Feng, Qinghua PhD; Xi, Long Fu MD, PhD*‡; Lee, Shu-Kuang MS; O’Reilly, Sandra F. BS*; Kiviat, Nancy B. MD; Koutsky, Laura A. PhD*

doi: 10.1097/OLQ.0b013e3182641f1c
Original Study

Background: The epidemiology of high-risk (hr) human papillomavirus (HPV) infections in mid-adult women with new sex partners is undefined.

Methods: We analyzed baseline data from 518 25- to 65-year-old women online daters. Women were mailed questionnaires and kits for self-collecting vaginal specimens for polymerase chain reaction–based hrHPV testing. Risk factors for infection were identified using Poisson regression models to obtain prevalence ratios (PRs).

Results: The prevalence of hrHPV infection was 35.9%. In multivariate analysis restricted to sexually active women, the likelihood of hrHPV infection was associated with abnormal Papanicolaou test history (PR = 1.42, 95% confidence interval [CI]: 1.10–1.84), lifetime number of sex partners >14 (compared with 1–4; PR = 2.13, 95% CI: 1.13–4.02 for 15–24 partners; and PR = 1.91, 95% CI: 1.00–3.64 for ≥25 partners), male partners with ≥1 concurrent partnership (PR = 1.34, 95% CI: 1.05–1.71), and male partners whom the subject met online (PR = 1.39, 95% CI: 1.08–1.79). Age was inversely associated with infection only in women who were sexually inactive (PR = 0.67 per 5-year age difference, adjusted for Papanicolaou history and lifetime number of partners). Compared with sexually inactive women, the likelihood of infection increased with increasing risk level (from low-risk to hr partners; P < 0.0001 by trend test). In multivariate analysis, infection with multiple versus single hrHPV types was inversely associated with ever having been pregnant (PR = 0.64, 95% CI: 0.46–0.90) and recent consistent condom use (PR = 0.56, 95% CI: 0.32–0.97), and positively associated with genital wart history (PR = 1.43, 95% CI: 1.03–1.99).

Conclusions: Measures of both cumulative and recent sexual history were associated with prevalent hrHPV infection in this hr cohort of mid-adult women.

In high-risk mid-adult women, prevalent high-risk HPV infections were common and associated with both cumulative and recent sexual history.

From the Departments of *Epidemiology, †Biostatistics, and ‡Pathology, University of Washington, Seattle, WA

Supported by the Developmental Awards Program of the National Institutes of Health NIAID Sexually Transmitted Infections and Topical Microbicide Cooperative Research Centers (STI-TM CRC) grant (AI 31448, to the University of Washington), and by a National Institutes of Health K01 grant (AI 079270, to R.L.W.) L.A.K. has received honoraria from Roche Diagnostics and Dana-Farber Cancer Institute.

Correspondence: Rachel L. Winer, PhD, HPV Research Group, University of Washington, Box 359933, 325 9th Ave, Seattle, WA 98104. E-mail:

Received for publication March 20, 2012, and accepted June 11, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association