Epidemiology of Genital Human Papillomavirus Infection

  • Laura Koutsky, PhD
    Laura Koutsky, PhD, Department of Epidemiology HPV Research Group, University of Washington, Seattle, Washington 98195.
    Department of Epidemiology, University of Washington, HPV Research Group, Seattle, WashingtonUSA
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      Although it is difficult to estimate the overall prevalence of genital human papillomavirus (HPV) infection, current figures suggest that visible genital warts are present in approximately 1% of sexually active adults in the United States and that at least 15% have subclinical infection, as detected by HPV DNA assays. Genital HPV infection is thus extremely common. The highest rates of genital HPV infection are found in adults 18–28 years of age. Although risk factors for infection are difficult to assess because of the high frequency of subclinical infection, it is clear that major risk factors for acquiring genital HPV infection involve sexual behavior, particularly multiple sex partners. Other possible risk factors for acquisition of genital HPV infection include oral contraceptive use, pregnancy, and impairment of cell-mediated immunity. Strong epidemiologic and molecular data link HPV infection to cervical and other anogenital cancers. The types of HPV most commonly detected in cancers are HPV-16 and HPV-18. In summary, genital HPV infection is common among sexually active populations and causes both benign and malignant neoplasms of the genital tract.
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        • Koutsky LA
        • Galloway DA
        • Holmes KK
        Epidemiology of genital human papillomavirus infection.
        Epidemiol Rev. 1988; 10: 122-163
        • Becker TM
        • Stone KM
        • Alexander ER
        Genital human papillomavirus infection: a growing concern.
        Obstet Gynecol Clin North Am. 1987; 14: 389-396
        • Chuang T-Y
        • Perry HO
        • Kurland LT
        • Ilstrup DM
        Condyloma acuminatum in Rochester, Minn, 1950–1978. I: Epidemiology and clinical features.
        Arch Dermatol. 1984; 120: 469-475
        • Ismail SM
        • Colclough AB
        • Dinnen JS
        • et al.
        Observer variation in histopathological diagnosis and grading of cervical intraepithelial neoplasia.
        BMJ. 1989; 298: 707-710
        • Shah KV
        • Howley PM
        in: Fields BN Knipe DM Virology. 2nd ed. Raven Press, New York1990: 1654-1676
        • Syrjänen KJ
        Human papillomavirus lesions in association with cervical dysplasias and neoplasias.
        Obstet Gynecol. 1983; 62: 617-624
        • Syrjänen K
        • Syrjänen S
        Epidemiology of human papilloma virus infections and genital neoplasia.
        Scand J Infect Dis. 1990; 69: 7-17
        • Hippeläinen M
        • Syrjänen S
        • Hippeläinen M
        • et al.
        Prevalence and risk factors of genital human papillomavirus (HPV) infections in healthy males: a study on Finnish conscripts.
        Sex Transm Dis. 1993; 20: 321-328
        • Kiviat NB
        • Koutsky LA
        • Paavonen JA
        • et al.
        Prevalence of genital papillomavirus infection among women attending a college student health clinic or a sexually transmitted disease clinic.
        J Infect Dis. 1989; 159: 293-302
        • Martinez J
        • Smith R
        • Farmer M
        • et al.
        High prevalence of genital tract papillomavirus infection in female adolescents.
        Pediatrics. 1988; 82: 604-608
        • Bauer HM
        • Ting Y
        • Greer CE
        • et al.
        Genital human papillomavirus infection in female university students as determined by a PCR-based method.
        JAMA. 1991; 265: 472-477
        • Grussendorf-Conen E-I
        • de Villiers E-M
        • Gissmann L
        Human papillomavirus genomes in penile smears of healthy men. (Letter.).
        Lancet. 1986; ii: 1092
        • Figueroa JP
        • Ward E
        • Luthi TE
        • Vermund SH
        • Brathwaite AR
        • Burk RD
        Prevalence of human papillomavirus among STD clinic attenders in Jamaica: association of younger age and increased sexual activity.
        Sex Transm Dis. 1995; 22: 114-118
        • Meisels A
        Cytologic diagnosis of human papillomavirus. Influence of age and pregnancy stage.
        Acta Cytol. 1992; 36: 480-482
        • Kataja V
        • Syrjänen S
        • Yliskoski M
        • et al.
        Risk factors associated with cervical human papillomavirus infections: a case-control study.
        Am J Epidemiol. 1993; 138: 735-745
        • Syrjänen K
        • Väyrynen M
        • Castrén O
        • et al.
        Sexual behaviour of women with human papillomavirus (HPV) lesions of the uterine cervix.
        Br J Vener Dis. 1984; 60: 243-248
        • Daling JR
        • Sherman KJ
        • Weiss NS
        Risk factors for condyloma acuminatum in women.
        Sex Transm Dis. 1986; 13: 16-18
        • Brisson J
        • Roy M
        • Fortier M
        • Bouchard C
        • Meisels A
        Condyloma and intraepithelial neoplasia of the uterine cervix: a case-control study.
        Am J Epidemiol. 1988; 128: 337-342
        • Kjaer SK
        • Engholm G
        • Teisen C
        • et al.
        Risk factors for cervical human papillomavirus and herpes simplex virus infections in Greenland and Denmark: a population-based study.
        Am J Epidemiol. 1990; 131: 669-682
        • Slattery ML
        • Overall Jr, JC
        • Abbott TM
        • French TK
        • Robison LM
        • Gardner J
        Sexual activity, contraception, genital infections, and cervical cancer: support for a sexually transmitted disease hypothesis.
        Am J Epidemiol. 1989; 130: 248-258
        • Schiffman MH
        • Brinton LA
        The epidemiology of cervical carcinogenesis.
        Cancer. 1995; 76: 1888-1901
        • WHO Collaborative Study of Neoplasia and Steroid Contraceptives
        Invasive squamous-cell cervical carcinoma and combined oral contraceptives: results from a multinational study.
        Int J Cancer. 1993; 55: 228-236
        • Franceschi S
        • Doll R
        • Gallwey J
        • La Vecchia C
        • Peto R
        • Spriggs AI
        Genital warts and cervical neoplasia: an epidemiological study.
        Br J Cancer. 1983; 48: 621-628
        • Negrini BP
        • Schiffman MH
        • Kurman RJ
        • et al.
        Oral contraceptive use, human papillomavirus infection, and risk of early cytological abnormalities of the cervix.
        Cancer Res. 1990; 50: 4670-4675
        • Schneider A
        • Hotz M
        • Gissmann L
        Increased prevalence of human papillomaviruses in the lower genital tract of pregnant women.
        Int J Cancer. 1987; 40: 198-201
        • Peng TC
        • Searle III, CP
        • Shah KV
        • Repke JT
        • Johnson TRB
        Prevalence of human papillomavirus infections in term pregnancy.
        Am J Perinatol. 1990; 7: 189-192
        • de Roda Husman AM
        • Walboomers JMM
        • Hopman E
        • et al.
        HPV prevalence in cytomorphologically normal cervical scrapes of pregnant women as determined by PCR: the age-related pattern.
        J Med Virol. 1995; 46: 97-102
        • Halpert R
        • Fruchter RG
        • Sedlis A
        • Butt K
        • Boyce JG
        • Sillman FH
        Human papillomavirus and lower genital neoplasia in renal transplant patients.
        Obstet Gynecol. 1986; 68: 251-258
        • Matorras R
        • Ariceta JM
        • Rementeria A
        • et al.
        Human immunodeficiency virus-induced immunosuppression: a risk factor for human papillomavirus infection.
        Am J Obstet Gynecol. 1991; 164: 42-44
        • Ho GYF
        • Burk RD
        • Fleming I
        • Klein RS
        Risk of genital human papillomavirus infection in women with human immunodeficiency virus-induced immunosuppression.
        Int J Cancer. 1994; 56: 788-792
        • Bosch FX
        • Manos MM
        • Muñoz N
        • et al.
        Prevalence of human papillomavirus in cervical cancer: a worldwide perspective.
        J Natl Cancer Inst. 1995; 87: 796-802
      1. Kosary CL, Ries LAG, Miller BA, Hankey BF, Harras A, Edwards BK, eds. SEER Cancer Statistics Review, 1973–1992: Tables and Graphs, National Cancer Institute. NIH Pub. No. 96-2789. Bethesda, MD, 1995.

        • zur Hausen H
        Condylomata acuminata and human genital cancer.
        Cancer Res. 1976; 36: 794
        • Lowy DR
        • Kirnbauer R
        • Schiller JT
        Genital human papillomavirus infection.
        Proc Natl Acad Sci USA. 1994; 91: 2436-2440
        • Mitchell H
        • Drake M
        • Medley G
        Prospective evaluation of risk of cervical cancer after cytological evidence of human papillomavirus infection.
        Lancet. 1986; i: 573-575
        • Bosch FX
        • Manos MM
        • Muñoz N
        • et al.
        Prevalence of human papillomavirus in cervical cancer: a worldwide perspective.
        J Natl Cancer Inst. 1995; 87: 796-802
        • Völter C
        • He Y
        • Delius H
        • et al.
        Novel HPV types present in oral papillomatous lesions from patients with HIV infection.
        Int J Cancer. 1996; 66: 453-456
        • Lorincz AT
        • Reid R
        • Jenson AB
        • Greenberg MD
        • Lancaster W
        • Kurman RJ
        Human papillomavirus infection of the cervix: relative risk associations of 15 common anogenital types.
        Obstet Gynecol. 1992; 79: 328-337
        • Kurman RJ
        • Schiffman MH
        • Lancaster WD
        • et al.
        Analysis of individual human papillomavirus types in cervical neoplasia: a possible role for type 18 in rapid progression.
        Am J Obstet Gynecol. 1988; 159: 293-296
        • Arends MJ
        • Donaldson YK
        • Duvall E
        • Wyllie AH
        • Bird CC
        Human papillomavirus type 18 associates with more advanced cervical neoplasia than human papillomavirus type 16.
        Hum Pathol. 1993; 24: 432-437