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Original article
Epidemiology of, and behavioural risk factors for, sexually transmitted human papillomavirus infection in men and women in Britain
  1. Anne M Johnson1,
  2. Catherine H Mercer1,
  3. Simon Beddows2,
  4. Natasha de Silva2,
  5. Sarika Desai2,
  6. Rebecca Howell-Jones2,
  7. Caroline Carder3,
  8. Pam Sonnenberg1,
  9. Kevin A Fenton1,
  10. Catherine Lowndes2,
  11. Kate Soldan2
  1. 1Research Department of Infection and Population Health, University College London, Mortimer Market Centre, London, UK
  2. 2Health Protection Agency, London, UK
  3. 3Clinical Microbiology, University College Hospitals NHS Foundation Trust, The Windeyer Institute of Medical Sciences, London, UK
  1. Correspondence to Dr Catherine H Mercer, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK; c.mercer{at}


Objectives Persistent infection with high-risk sexually transmitted human papillomaviruses (HR-HPVs) can lead to development of cervical and other cancers, while low-risk types (low-risk HPV) may cause genital warts. We explored the epidemiology of different HPV types in men and women and their association with demographic and behavioural variables.

Methods We analysed data collected for the British National Survey of Sexual Attitudes and Lifestyles, a cross-sectional survey undertaken in 1999–2001. Half of all sexually experienced male and female respondents aged 18–44 years were invited to provide a urine sample. We tested 3123 stored urine samples using an in-house Luminex-based HPV genotyping system.

Results HPV DNA was detected in 29.0% (95% CI 26.7% to 31.3%) of samples from women and 17.4% (95% CI 15.1% to 19.8%) from men. Any of 13 HR-HPV types was detected in 15.9% (95% CI 14.1% to 17.8%) of women and 9.6% (95% CI 8.0% to 11.6%) of men. HPV types 16/18 were found in 5.5% (95% CI 4.5% to 6.8%) of women and 3.0% (95% CI 2.1% to 4.3%) of men; and types 6/11 in 4.7% (95% CI 1.8% to 5.9%) of women and 2.2% (95% CI 1.5% to 3.1%) of men. In multivariate analysis, HR-HPV was associated with new partner numbers, in women with younger age, single status and partner concurrency, and in men with number of partners without using condom(s) and age at first intercourse.

Conclusions HPV DNA was detectable in urine of a high proportion of the sexually active British population. In both genders, HR-HPV was strongly associated with risky sexual behaviour. The minority of HPV infections were of vaccine types. It is important to monitor HPV prevalence and type distribution following the introduction of vaccination of girls.

  • Human papillomavirus
  • genital warts
  • sexually transmitted infection
  • epidemiology
  • sexual practices
  • sexual behaviour
  • risk behaviours
  • heterosexuals
  • sexual health
  • HPV
  • virology HIV
  • virology general laboratory
  • laboratory diagnosis
  • genital infection
  • chlamydia
  • std surveillance
  • women's issues
  • std control
  • epidemiology
  • cervix
  • chlamydia

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  • The data in this manuscript were presented as an oral presentation at the 19th meeting of the International Society for Sexually Transmitted Disease Research (ISSTDR) held in Québec City, Canada, 10–13 July 2011 (

  • Funding The Natsal-2 study was funded by the UK Medical Research Council (grant number: G99811620) with funds from the Department of Health, the Scottish Executive and the National Assembly for Wales. HPV testing was funded by the Department of Health Policy Research Programme (grant number: 039/0030). The views expressed are not necessarily those of the Department of Health or Medical Research Council. The authors' work was independent of the funders, who had no role in the design, collection, analysis or interpretation of the data or the decision to submit for publication.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Natsal-2 study obtained ethical approval from University College Hospital, North Thames Multicentre, and all local research ethics committees in Britain. Approval for HPV testing of the stored urine samples was obtained from St Mary's Research Ethics Committee (Ref: 07/Q0403/9).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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