Background: Human papillomavirus infection is a sexually transmitted disease associated with cervical dysplasia and carcinoma.
Goal of this study: To determine prevalence rates of cervical human papillomavirus infection compared with other sexually transmitted diseases and risk factors associated with human papillomavirus infection among adolescent women, we evaluated 634 patients attending three urban adolescent clinics.
Study design: Patient evaluation included Pap smears; screening for chlamydia, gonorrhea, and trichomoniasis; and testing of cervical swab samples for human papillomavirus DNA.
Results: Cervical human papillomavirus was the most common STD in our population (15.6%), followed by infection with Chlamydia trachomatis (11.0%), Neisseria gonorrhoeae (7.1%), and Trichomonas vaginalis (5.4%). The most prevalent human papillomavirus types were 16/18 (7.3%), followed by 31/33/35 (4.7%) and 6/11 (3.5%). When genital warts on exam, low-grade squamous intraepithelial lesions on cytology, or cervical human papillomavirus DNA were considered as indicators of genital human papillomavirus infection, 24% of patients had any manifestation of infection, including 15% with clinically apparent infection (genital warts), 36% with cytologically apparent infection without warts, and 49% with subclinical infection only (cervical human papillomavirus DNA without low-grade squamous intraepithelial lesions or warts). Factors associated with detection of cervical human papillomavirus DNA by multivariate analysis included number of lifetime sexual partners and genital warts on exam.
Conclusion: Cervical human papillomavirus infection was the most prevalent sexually transmitted disease among an ethnically diverse group of urban adolescent females, with a large proportion of infections neither clinically nor cytologically apparent. The strong association with lifetime sexual partners substantiates that cervical human papillomavirus is acquired predominantly by sexual contact and often soon after the onset of sexual activity.
PIP: The study was conducted at three urban adolescent clinics administered by the Denver Department of Health and Hospitals.The population was derived predominantly from inner city, low-income adolescents 12-18 years old during the period of May 1989 to January 1990. A questionnaire regarding sexual and STD history, contraceptive use, and substance use was administered to each patient. Specimens for laboratory studies included collection of vaginal fluid swabs for pH determination and wet mount microscopy; sequential cervical swabs for testing for Neisseria gonorrhea, Chlamydia trachomatis, and HPV DNA; and endocervical swabs and ectocervical scrapes for cytology. A total of 634 were included. The population was ethnically mixed: 167 (26%) were Black, 287 (45%) were Hispanic, 174 (28%) were White, 1 (0.2%) was Asian, and 3 (10.5%) were of other ethnic groups. The mean age was 16.8 years, with a range of 12-18 years. Cervical HPV infection was the most prevalent STD in the population, detected in 99 (15.6%) subjects, followed by infection with C. trachomatis in 69 (11.0%), N. gonorrhea in 45 (7.1%), and T. vaginalis in 34 (5.3%). Overall, 188 (30.3%) subjects had any of the 4 STDs detected. The most prevalent, higher-risk HPV types were 16/18, either as single or mixed infections, which were detected in 46 (7.2%) patients. Infection with HPV types 31/33/35 or 6/11 occurred in an additional 31 (4.9%) and 23 (3.6%) subjects, respectively. Overall, 152 (24%) patients had any manifestation of genital HPV infection, 23 (15%) with clinically apparent infection (external genital warts), an additional 54 (36%) with cytologically apparent infection (low-grade squamous intraepithelial lesions or LSIL) without warts, and 69 (49%) with subclinical cervical infection (with neither warts nor LSIL). The relative risk of cervical HPV DNA for those with 2 or more partners was 2.7 (p 0.001). By multivariate analysis, the independent predictors of cervical HPV DNA included the number of lifetime sexual partners (2 or more partners: OR, 1.9) and current genital warts (OR, 5.1).