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The Natural History of Human Papillomavirus Infection and Cervical Intraepithelial Neoplasia Among Young Women in the Guanacaste Cohort Shortly After Initiation of Sexual Life

Rodriguez, Ana Cecilia MD*†; Burk, Robert MD; Herrero, Rolando MD, PhD; Hildesheim, Allan PhD*; Bratti, Concepcion MD, MPH; Sherman, Mark E. MD*; Solomon, Diane MD§; Guillen, Diego MD; Alfaro, Mario MD; Viscidi, Raphael MD; Morales, Jorge MD; Hutchinson, Martha MD; Wacholder, Sholom PhD*; Schiffman, Mark MD, MPH*

Sexually Transmitted Diseases: July 2007 - Volume 34 - Issue 7 - p 494-502
doi: 10.1097/01.olq.0000251241.03088.a0

Objective: Cross-sectional analyses of our 10,000-woman, population-based Guanacaste cohort suggest a lag of ≥10 years between the peak of human papillomavirus (HPV) infection and the later peak of cervical intraepithelial neoplasia grade 3 (CIN 3). We wanted to explore early HPV natural history and CIN 3 prospectively.

Study Design: As part of the Guanacaste cohort, we followed 206 initially virginal women aged 18 to 26 semiannually for a median of 3.6 years after initiation of sexual life.

Results: A total of 53.4% of women tested positive during the study for ≥1 HPV type. Very few infections persisted for >1 to 2 years. Three women had histologically confirmed CIN 3, of which 2 showed persistent HPV 16. The other had serologic evidence of HPV 31.

Conclusions: HPV infection occurs frequently and clears rapidly in most young women initiating sexual intercourse. Persistent HPV 16 can cause early CIN 3. The peak age for CIN 3 will decline with the increased screening intensity and sensitivity typical of longitudinal studies.

Human papillomavirus infection was very common in women shortly after their sexual debut. Most infections cleared rapidly; however, a few caused cervical intraepithelial neoplasia 3 lesions within 4 years (3 in 110 infections).

From the *Division of Cancer Epidemiology and Genetics and the §Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, DHHS, Rockville, Maryland; †Proyecto Epidemiológico Guanacaste, INCIENSA Foundation, San José, Costa Rica; ‡Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York; ∥Johns Hopkins Medical Institutions, Baltimore, Maryland; and ¶Womens and Infants Hospital, Providence, Rhode Island

The authors acknowledge John Schussler from Information Management Services (Silver Spring, MD) for his excellence in data management and analytic support for this manuscript and the Guanacaste project in general. The authors also thank the Guanacaste project field staff for their dedication in pursuit of the study goals as well as their care for the well-being of the women in the project.

The Guanacaste cohort enrollment and follow up were supported by the National Cancer Institute, National Institutes of Health, Department of Health and Human Services contracts N01-CP-21081, N01-CP-33061, N01-CP-40542, N01-CP-50535, N01-CP-81023 and by the intramural program. Dr. Burk was supported by National Cancer Institute grant CA 78527. Dr. Rodríguez was supported by an appointment to the Senior Fellowship Program at the National Institutes of Health. The program is administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and the National Institutes of Health. This research was supported in part by the intramural program at NIH/CI.

Correspondence: Ana Cecilia Rodríguez, MD, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS, 6120 Executive Blvd., EPS, Suite 550, Rockville, MD 20859. E-mail:

Received for publication July 19, 2006, and accepted October 5, 2006.

© Copyright 2007 American Sexually Transmitted Diseases Association