Predictors of Human Papillomavirus Infection in Women Undergoing Routine Cervical Cancer Screening in Spain: the CLEOPATRE Study

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2012 Jun 28

PMID 22734435

Citations 16

Authors

Esther Roura

Thomas Iftner

Jose Antonio Vidart

Susanne Kruger Kjaer

F Xavier Bosch

Nubia Munoz

Santiago Palacios

Maria San Martin Rodriguez

Carmen Morillo

Laurence Serradell

Laurence Torcel-Pagnon

Javier Cortes

Xavier Castellsague

Affiliations

Soon will be listed here.

Abstract

Background: Human papillomavirus (HPV) is a sexually transmitted infection that may lead to development of precancerous and cancerous lesions of the cervix. The aim of the current study was to investigate socio-demographic, lifestyle, and medical factors for potential associations with cervical HPV infection in women undergoing cervical cancer screening in Spain.

Methods: The CLEOPATRE Spain study enrolled 3 261 women aged 18-65 years attending cervical cancer screening across the 17 Autonomous Communities. Liquid-based cervical samples underwent cytological examination and HPV testing. HPV positivity was determined using the Hybrid Capture II assay, and HPV genotyping was conducted using the INNO-LiPA HPV Genotyping Extra assay. Multivariate logistic regression was used to identify putative risk factors for HPV infection.

Results: A lifetime number of two or more sexual partners, young age (18-25 years), a history of genital warts, and unmarried status were the strongest independent risk factors for HPV infection of any type. Living in an urban community, country of birth other than Spain, low level of education, and current smoking status were also independent risk factors for HPV infection. A weak inverse association between condom use and HPV infection was observed. Unlike monogamous women, women with two or more lifetime sexual partners showed a lower risk of infection if their current partner was circumcised (P for interaction, 0.005) and a higher risk of infection if they were current smokers (P for interaction, 0.01).

Conclusion: This is the first large-scale, country-wide study exploring risk factors for cervical HPV infection in Spain. The data strongly indicate that variables related to sexual behavior are the main risk factors for HPV infection. In addition, in non-monogamous women, circumcision of the partner is associated with a reduced risk and smoking with an increased risk of HPV infection.

Citing Articles

Factors associated with cervical cancer screening among women of reproductive age in Moshi municipality, Kilimanjaro, Tanzania: a cross-sectional study.

Hhera J, Dahaye R, Zakayo W, Kazula Y, Abdul S, Mamseri R BMJ Open. 2025; 15(1):e085223.

PMID: 39855649 PMC: 11758691. DOI: 10.1136/bmjopen-2024-085223.

Population-based age- and type-specific prevalence of human papillomavirus among non-vaccinated women aged 30 years and above in Germany.

Liang L, Tanaka L, Radde K, Bussas U, Ikenberg H, Heideman D BMC Infect Dis. 2024; 24(1):1008.

PMID: 39300354 PMC: 11414300. DOI: 10.1186/s12879-024-09827-7.

Prevalence and genotype distribution of potential high-risk and high-risk human papillomavirus among women attending selected reproductive health clinics in lake victoria basin-kenya: a cross-sectional study.

Akinyi I, Awandu S, Broeck D, Pereira A, Redzic N, Bogers J BMC Womens Health. 2024; 24(1):468.

PMID: 39182068 PMC: 11344458. DOI: 10.1186/s12905-024-03303-9.

Evidence-based circumcision policy for Australia.

Morris B, Katelaris A, Blumenthal N, Hajoona M, Sheen A, Schrieber L J Mens Health. 2022; 18(6).

PMID: 36034719 PMC: 9409339. DOI: 10.31083/j.jomh1806132.

Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands.

Andujar M, Roura E, Torres A, Vega B, Pavcovich M, Sanchez M BMJ Open. 2020; 10(9):e037402.

PMID: 32973061 PMC: 7517562. DOI: 10.1136/bmjopen-2020-037402.

References

Peyton C, Schiffman M, Lorincz A, Hunt W, Mielzynska I, Bratti C . Comparison of PCR- and hybrid capture-based human papillomavirus detection systems using multiple cervical specimen collection strategies. J Clin Microbiol. 1998; 36(11):3248-54. PMC: 105310. DOI: 10.1128/JCM.36.11.3248-3254.1998. View

Herrero R, Castle P, Schiffman M, Bratti M, Hildesheim A, Morales J . Epidemiologic profile of type-specific human papillomavirus infection and cervical neoplasia in Guanacaste, Costa Rica. J Infect Dis. 2005; 191(11):1796-807. DOI: 10.1086/428850. View

Vaccarella S, Herrero R, Snijders P, Dai M, Thomas J, Hieu N . Smoking and human papillomavirus infection: pooled analysis of the International Agency for Research on Cancer HPV Prevalence Surveys. Int J Epidemiol. 2008; 37(3):536-46. DOI: 10.1093/ije/dyn033. View

Almonte M, Albero G, Molano M, Carcamo C, Garcia P, Perez G . Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine. 2008; 26 Suppl 11:L16-36. DOI: 10.1016/j.vaccine.2008.06.008. View

de Sanjose S, Almirall R, Lloveras B, Font R, Diaz M, Munoz N . Cervical human papillomavirus infection in the female population in Barcelona, Spain. Sex Transm Dis. 2003; 30(10):788-93. DOI: 10.1097/01.OLQ.0000080177.82204.E0. View

Iftner T, Villa L . Chapter 12: Human papillomavirus technologies. J Natl Cancer Inst Monogr. 2003; (31):80-8. DOI: 10.1093/oxfordjournals.jncimonographs.a003487. View

Vaccarella S, Herrero R, Dai M, Snijders P, Meijer C, Thomas J . Reproductive factors, oral contraceptive use, and human papillomavirus infection: pooled analysis of the IARC HPV prevalence surveys. Cancer Epidemiol Biomarkers Prev. 2006; 15(11):2148-53. DOI: 10.1158/1055-9965.EPI-06-0556. View

Poppe W, Ide P, Drijkoningen M, LAUWERYNS J, Van Assche F . Tobacco smoking impairs the local immunosurveillance in the uterine cervix. An immunohistochemical study. Gynecol Obstet Invest. 1995; 39(1):34-8. DOI: 10.1159/000292372. View

Vaccarella S, Franceschi S, Herrero R, Munoz N, Snijders P, Clifford G . Sexual behavior, condom use, and human papillomavirus: pooled analysis of the IARC human papillomavirus prevalence surveys. Cancer Epidemiol Biomarkers Prev. 2006; 15(2):326-33. DOI: 10.1158/1055-9965.EPI-05-0577. View

10.

Bosch F, Albero G, Castellsague X . Male circumcision, human papillomavirus and cervical cancer: from evidence to intervention. J Fam Plann Reprod Health Care. 2009; 35(1):5-7. DOI: 10.1783/147118909787072270. View

11.

de Sanjose S, Diaz M, Castellsague X, Clifford G, Bruni L, Munoz N . Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis. 2007; 7(7):453-9. DOI: 10.1016/S1473-3099(07)70158-5. View

12.

Winer R, Hughes J, Feng Q, OReilly S, Kiviat N, Holmes K . Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006; 354(25):2645-54. DOI: 10.1056/NEJMoa053284. View

13.

Castellsague X, Bosch F, Munoz N, Meijer C, Shah K, de Sanjose S . Male circumcision, penile human papillomavirus infection, and cervical cancer in female partners. N Engl J Med. 2002; 346(15):1105-12. DOI: 10.1056/NEJMoa011688. View

14.

Burchell A, Winer R, de Sanjose S, Franco E . Chapter 6: Epidemiology and transmission dynamics of genital HPV infection. Vaccine. 2006; 24 Suppl 3:S3/52-61. DOI: 10.1016/j.vaccine.2006.05.031. View

15.

Parkin D, Bray F . Chapter 2: The burden of HPV-related cancers. Vaccine. 2006; 24 Suppl 3:S3/11-25. DOI: 10.1016/j.vaccine.2006.05.111. View

16.

Munoz N, Bosch F, de Sanjose S, Herrero R, Castellsague X, Shah K . Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003; 348(6):518-27. DOI: 10.1056/NEJMoa021641. View

17.

Poppe W, Peeters R, Drijkoningen M, Ide P, Daenens P, LAUWERYNS J . Cervical cotinine and macrophage-Langerhans cell density in the normal human uterine cervix. Gynecol Obstet Invest. 1996; 41(4):253-9. DOI: 10.1159/000292280. View

18.

Castellsague X, Iftner T, Roura E, Vidart J, Kjaer S, Bosch F . Prevalence and genotype distribution of human papillomavirus infection of the cervix in Spain: the CLEOPATRE study. J Med Virol. 2012; 84(6):947-56. DOI: 10.1002/jmv.23282. View

19.

Bruni L, Diaz M, Castellsague X, Ferrer E, Bosch F, de Sanjose S . Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010; 202(12):1789-99. DOI: 10.1086/657321. View

20.

Kahn J, Rosenthal S, Succop P, Ho G, Burk R . Mediators of the association between age of first sexual intercourse and subsequent human papillomavirus infection. Pediatrics. 2002; 109(1):E5. DOI: 10.1542/peds.109.1.e5. View