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Type-Specific HPV Infection and Multiple HPV Types: Prevalence and Risk Factor Profile in Nearly 12,000 Younger and Older Danish Women

Nielsen, Ann MSc*; Kjaer, Susanne Krüger MD*†; Munk, Christian MD*; Iftner, Thomas PhD

Sexually Transmitted Diseases: March 2008 - Volume 35 - Issue 3 - p 276-282
doi: 10.1097/OLQ.0b013e31815ac5c7

Objectives: Human papillomavirus (HPV) is considered a necessary cause of cervical cancer. The aim of the current study was to determine the burden of HPV infection among randomly sampled Danish women before the vaccine against HPV is implemented. Further we assessed the risk factor profile for prevalent high risk (HR) HPV infection and infection with multiple HR HPV types.

Methods: In the present cross-sectional study, we used baseline data from a population-based cohort study where participants were interviewed and had a gynecological examination. Cervical samples were analyzed for HR HPV using Hybrid capture 2 in 10,544 women aged 20–29 years and 1443 women aged 40–50 years. Genotyping was performed using LiPA.

Results: The prevalence of HR HPV was 17.9% and 4.4% in women aged 20–29 years and 40–50 years, respectively. HPV16 was the most common HR type overall and among women with abnormal cytology. Multiple HPV types were highly prevalent, notably in the younger cohort. Lifetime number of sexual partners was the main risk factor for HR HPV infection (adj. OR = 2.8 and OR = 3.4 for ≥15 partners vs. ≤4 in respectively younger and older women), whereas number of recent sexual partners was only associated with risk in younger women. Number of partners, oral contraceptive use and self-reported chlamydia infection increased the risk of having multiple HR HPV types (compared to having a single HR HPV type).

Conclusions: HR HPV infection was common among younger women, with HPV16 as the predominant type. We confirmed the importance of sexual activity for the risk of HR HPV infection. In addition, we found that sexual behavior also play an important role for the risk of having multiple HR HPV types.

HPV prevalence was high in a Danish cohort study, in particular the prevalence of HPV16. The risk factor profile confirmed the association between number of sexual partners and HPV infection.

From the *Department of Virus, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Demark; †Department of Obstetrics and Gynaecology, Rigshospitalet, Copenhagen, Denmark; and ‡Sektion Experimentelle Virologie, Universitaetsklinikum Tuebingen, Germany

The authors thank Betti Schopp, Nazife Kilic, Nurgül Düzenli, Anette Rothe, and Barbara Holz for technical assistance with HPV testing.

Supported by the National Cancer Institute, Bethesda (RO1 CA47812). In addition, this work was supported by funding under the Sixth Research Framework Programme of the European Union; project INCA (LSHC-CT-2005-018704). Innogenetics supported this study through a grant for the LiPa kits.

Correspondence: Susanne Krüger Kjær, Department of Virus, Hormones and Cancer, Institute of Cancer Epidemiology, Danish Cancer Society, DK-2100 Copenhagen, Denmark. E-mail:

Received for publication June 7, 2007, and accepted September 9, 2007.

© Copyright 2008 American Sexually Transmitted Diseases Association