Risk factors for genital HPV DNA in men resemble those found in women: a study of male attendees at a Danish STD clinic.

OBJECTIVES: Genital infection with certain types of human papillomavirus (HPV) is the most important risk factor for cervical cancer. The male sexual partner is supposed to be the vector of the infection. However, the knowledge of risk factors for genital HPV DNA in men is limited. The objective of this paper is to study the risk factors for HPV infection in men and to compare them with those found in women, including the study of whether there are different risk profiles for oncogenic and non-oncogenic HPV types. METHODS: From a sexually transmitted diseases (STD) clinic in Denmark, 216 men were consecutively included. A personal interview was done and material for genital HPV DNA detection was obtained with swabs. HPV DNA was detected by polymerase chain reaction (PCR). Odds ratios (OR) for HPV as well as for oncogenic and non-oncogenic types separately were computed with a 95% confidence interval (CI) by means of unconditional multiple logistic regresssion. RESULTS: The most important predictors of any HPV were lifetime number of sex partners (OR = 4.3; 95% CI 1.4 to 13.1 for 25-39 v 1-9 partners), young age, and being uncircumcised. The most important risk factor for oncogenic HPV types was lifetime number of partners, whereas number of partners in the past year and ever having genital warts were risk factors for the non-oncogenic HPV types. Young age predicted risk of both oncogenic and non-oncogenic HPV types. CONCLUSIONS: Most risk factors for HPV DNA detection in men resemble those found in women. As in women, the risk factor profile for the oncogenic HPV types was different from that of the non-oncogenic HPV types.

High-risk human papillomavirus is sexually transmitted: evidence from a follow-up study of virgins starting sexual activity (intercourse).

Genital human papillomavirus (HPV) infection is generally considered to be sexually transmitted. However, nonsexual spread of the virus has also been suggested. The goal of this study was to assess: (a) the role of sexual intercourse in the transmission of HPV; (b) the determinants for seroconversion; and (c) the correlation between HPV DNA, abnormal cervical cytology, and serological response to HPV16. One hundred virgins and 105 monogamous women were randomly selected from a population-based cohort study in Copenhagen, Denmark, in which the women were examined twice with 2-year interval (interview, cervical swabs, Pap smear, blood samples). The presence of HPV DNA was determined by GP5+/6+ primers based HPV-PCR-EIA. HPV 16 virus-like particles (VLP) antibodies were detected by ELISA. All of the virgins were both HPV DNA negative and seronegative to VLP16, except for one woman who was weakly HPV 6 DNA positive. Only those virgins who initiated sexual activity became HPV DNA positive and/or VLP16 positive. The most important determinant of HPV DNA acquisition was the number of partners between the two examinations. The only significant risk factor for HPV 16 VLP seroconversion among women acquiring HPV DNA was HPV type. Our results show that sexual intercourse is important in the transmission of HPV, and that HPV 16 VLP seroconversion and the development of cervical lesions only occur after HPV transmission. Remarkably, no cervical lesions were found in HPV 16 DNA positive women who had seroconverted. Although based on small numbers, this may suggest that the development of antibodies had a protective effect.

Human papillomavirus infection in Danish female sex workers. Decreasing prevalence with age despite continuously high sexual activity.

BACKGROUND: The prevalence of the human papillomavirus (HPV) has been found to decrease with age, but whether this applies to all populations is not clear. Knowledge about the generalizability of this age dependency is important to understand the natural history of the infection, but may also have implications in relation to the use of HPV testing in cervical cancer screening. GOAL: To study the prevalence and risk factors for HPV infection in a selected population of female sex workers and to compare the results with persons with different sexual habits from two other populations in the same geographic area. STUDY DESIGN: A case-control study among 188 female sex workers from Copenhagen. Data were obtained by personal interviews. Cervical material was collected by a self-administered lavage kit, and HPV testing was done by means of GP5+/6+ primers based on HPV, polymerase chain reaction, enzyme immunoassay. RESULTS: Among sex workers, age was the most important risk factor for HPV infection. Number of private sex partners in the last 4 months was also a significant risk factor, and a protective effect of condom use was indicated. CONCLUSION: The HPV prevalence is declining in sex workers with age despite continuously high sexual activity, most likely indicating that an immune response is acquired over time.

Risk factors for HPV detection in archival Pap smears. A population-based study from Greenland and Denmark.

The most important risk factor for cervical cancer is genital infection with certain types of human papillomavirus (HPV). The presence of HPV was studied in archival smears from a random sample of women living in Greenland (GW) and Denmark (DW) having, respectively, a high risk and an intermediate risk for cervical cancer. Risk factors were also examined of the original 126 Danish and 129 Greenlandic archived smears collected during October and November 1988. 125 were located from each country including all abnormal smears. HPV DNA was isolated from the smears and detected by means of a consensus polymerase chain reaction (PCR) detecting a broad spectrum of genital HPV types. HPV was detected in all the abnormal smears and in 22 and 33% respectively of the cytological normal smears from DW and GW. Risk of HPV was significantly higher in smears from women who started sexual life relatively recently (respectively, < or = 4 and < or = 6 years ago in DW and GW) compared with > or = 10 years ago (adjusted prevalence-OR: 9.3; 95% CI: 2.2-39.2 in DW and 5.9; 95% CI: 1.4-25.3 in GW). Among other important risk factors were age in both areas, lifetime number of sex partners and current smoking in DW and ever and gonorrhoea in GW. This study confirms the usefulness of the method as all abnormal smears were positive and, furthermore, the predictors for HPV presence in the normal smears corroborate with those found in recent studies of HPV in fresh cervical swabs. Thus, this method can be useful for large-scale epidemiological studies of HPV DNA in already sampled material.

Different risk factor patterns for high-grade and low-grade intraepithelial lesions on the cervix among HPV-positive and HPV-negative young women.

Risk factors for cervical intraepithelial neoplasia have most often been studied in high-grade lesions. Furthermore, in a high proportion of the studies, human papillomavirus (HPV), the most significant risk determinant of cervical neoplasia, was not taken into account when evaluating other risk factors. To compare risk factors for ASCUS (atypical cells of undetermined significance), LSIL (low-grade squamous intraepithelial lesion) and HSIL (high-grade squamous intraepithelial lesion), we conducted a case-control study among 20 to 29 year-old women participating in a prospective cohort study in Copenhagen. It included 131 women with ASCUS, 120 women with LSIL, 79 women with HSIL and 1,000 randomly chosen, cytologically normal, control women. All participants had a personal interview and a gynecological examination including a Pap smear and cervical swabs for HPV DNA detection using general primer-mediated polymerase chain reaction. The most significant risk determinant of all 3 disease categories was the presence of genital HPV DNA. The risk factor pattern was nearly identical for ASCUS and LSIL, but differed significantly from that for HSIL. Stratified analysis by HPV-status showed that, apart from, respectively, smoking and parity among HPV-positive women, and smoking and number of sex partners among HPV-negative women, no additional risk factors were observed for ASCUS and LSIL. In contrast, among HPV-negative women with HSIL, long-term use of oral contraceptives was the most important risk factor. However, our result should be taken with great caution as it is based on very small numbers, and as it is unknown whether the HPV-negative lesions constitute a true entity. Among HPV-positive women, the risk of HSIL was associated with e.g., years of sex life without barrier contraceptive use, early age at first genital warts and smoking. Whether the risk factors that are applicable only to HSIL represent factors related to progression remains unknown.

Risk factors for HPV infection in women from sexually transmitted disease clinics: comparison between two areas with different cervical cancer incidence.

We have compared risk factors for human papillomavirus (HPV) infection in very sexually active women [attenders of clinics for sexually transmitted diseases (STDs)] living in 2 areas with a 4-fold difference in cervical cancer incidence, i.e., Greenland and Denmark. The results were compared with findings of HPV infection in men attending the STD clinics during the same period. Overall, 204 Greenlandic women (GW), 187 Danish women (DW), 103 Greenlandic men and 216 Danish men were included. A similar age distribution was found in the 2 female populations. The GW reported significantly more sexual partners, earlier first intercourse and more STDs, but HPV was less frequently detected in the GW (25%) than in the DW (35%). However, this could be explained by a difference in the age pattern of HPV prevalence seen in the 2 areas. In each geographical area, the age pattern of HPV prevalence in men was very similar to that seen in women. The most important risk factors for HPV detection were the same in both female populations, i.e., age, years since first sexual intercourse and number of partners in the last years. In conclusion, the pattern of risk factors for HPV infection was the same in STD women from a high-risk area and a low-risk area for cervical cancer. Our results also show that the use of an overall HPV prevalence for comparing populations is meaningless, even in populations with similar age distribution.

History of genital warts in 10,838 women 20 to 29 years of age from the general population. Risk factors and association with Papanicolaou smear history.

BACKGROUND AND OBJECTIVES: The most important risk factor for cervical neoplasia is genital infection with certain types of human papillomavirus (HPV). Genital warts (GW) are an easily recognizable condition caused by HPV. Although only a fraction of HPV infections are clinical, a history of ever having had GW could serve as a marker for exposure to HPV. GOALS: To study the risk factors for ever having had GW. The association of GW with abnormal Papanicolaou (Pap) smear and relation to cervical neoplasia is also discussed. STUDY DESIGN: A case-control study among 10,838 women aged 20 to 29 years and reporting at least one lifetime sexual partner. The women were participants in a prospective cohort study on the relationship between HPV and cervical neoplasia in Copenhagen, Denmark. Data were obtained by means of personal interviews using structured questionnaires. RESULTS: In all, 1,820 women (17%) reported ever having had GW. The most important risk factor was the number of lifetime of sexual partners (adjusted odds ratio 5.2; 95% confidence interval: 3.4-8.0) for at least 40 partners vs. 1 to 2 partners). The number of regular partners, sexually active years, a history of chlamydial infection, and smoking were also associated with the risk of ever having had GW. Women who had had GW were 1.9 times more likely than other women to report an abnormal Pap smear. CONCLUSIONS: The study confirms the sexual transmission of the infection. There is also good concordance between risk factors for ever having had GW and cervical neoplasia. A close relationship between having had GW and an abnormal Pap smear was observed.

Seroreactivity to human papillomavirus type 16 virus-like particles is lower in high-risk men than in high-risk women.

Seroreactivity to human papillomavirus type 16 (HPV-16) virus-like particles (VLPs) in men attending clinics for sexually transmitted diseases (STDs) in Denmark (n = 219) and Greenland (n = 88) was compared with seroreactivity in women attending the same clinics and was furthermore related to epidemiologic variables and concurrent HPV DNA detection. Risk factors for male seropositivity in Denmark were lifetime number of sex partners, a history of STDs, and sexual preference and in Greenland were ever having had syphilis and years at school. Although men reported significantly more sex partners, the mean seroreactivity was significantly lower in men than in women: 0.50 and 0.75, respectively, in Denmark and 0.53 and 0.86 in Greenland (P = .0001). Male seropositivity was not correlated with concurrent HPV DNA detection, but only 15 Danish and 6 Greenlandic men had HPV-16 DNA. Presence of HPV-16 VLP antibodies appears to be a biomarker for exposure to genital HPVs in men but is less sensitive than in women.

Determinants for contraceptive use in young, single, Danish women from the general population.

Determinants for contraceptive use were studied in 5031, non-pregnant women aged 20-29 years from the general population in Denmark. Most women (72%) had never been pregnant, 34% had a history of a sexually transmitted disease, and 22% had ever had a legal abortion. Current contraception was most frequently condoms (60%) or oral contraceptives (33%). Among the women who used OCs or IUD, 32% reported additional condom use (double contraception). Important predictors of using one contraceptive method were lifetime number of sexual partners, parity, and age at first sexual intercourse for condoms and age for oral contraceptives. Also, women with a previous legal abortion were more likely to use condoms currently and women with a history of STDs were less likely to use condoms, but more likely to use OCs. Lifetime number of sexual partners was the only predictor of double contraception. Our data suggest a potential for reducing the number of unintended pregnancies and STDs in single women by increasing the information about the double principle in contraception.

PIP: The determinants of contraceptive use were investigated in a cohort study of 5031 sexually active, unmarried/non-cohabitating, non-pregnant women 20-29 years of age from Copenhagen, Denmark, identified through the Central Population Register. High proportions of these women reported a previous pregnancy (28%), abortion (22%), or sexually transmitted disease (STD) (34%). Current contraceptive use was reported by 4528 women (90%); the most frequently used methods were condoms (60%) and oral contraceptives (OCs) (33%). Among the 2066 women who used OCs or the IUD, 665 (32%) reported additional condom use (double contraception). Condom-only users were significantly more likely to have had first intercourse at age 17 or older, used condoms at first coitus, never have had an STD, and to have completed 11 or more years of education; also in this category were significant numbers of women with 15 or more life-time sexual partners and a prior legal abortion. Young age (20-23 years) was the most significant determinant of OC-only use. The only significant determinant of double contraceptive use was 15 or more life-time sex partners. The association between multiple sex partners and use of double contraception suggests that acquired immunodeficiency syndrome prevention messages are reaching the target population in Denmark.

Seroreactivity to HPV16 virus-like particles as a marker for cervical cancer risk in high-risk populations.

Sexually transmitted genital human papillomavirus (HPV) infection, most often HPV 16, is considered the major etiologic determinant of cervical cancer. However, some studies have found relatively low prevalences of genital tract HPV DNA in some geographical areas, such as Greenland, that have high rates of cervical cancer. We sought to evaluate HPV 16 infection in high-risk cohorts using a serologic assay that assesses prior exposure as well as current infection and to compare the results with those obtained using a sensitive PCR-based HPV DNA assay. An ELISA based on HPV 16 virus-like particles was used to detect IgG serum antibodies in women attending sexually transmitted disease (STD) clinics in Nuuk, Greenland and Copenhagen, Denmark. Using a preassigned cut-off, 56% of Greenlandic and 41% of Danish women were seropositive (p = 0.02). In Greenlandic women, there was a non-significant increase in seropositivity with age, and odds ratios for seropositivity were similar for women with more than 5 lifetime sex partners. Seropositivity in the Danish women, however, increased linearly with increases in these 2 factors, which are likely correlates of lifetime exposure to genital HPVs. In contrast, any genital HPV DNA (HPV16 specifically) was detected in 24% and 36% of Greenlandic and Danish women, respectively and was most frequently detected in women below 20. The finding that HPV DNA prevalences, unlike seroprevalences, tended to decrease with increased lifetime risk of infection, provides an explanation for the lack of correlation between HPV DNA prevalences and cervical cancer risk in previous studies of high-risk populations.

Divergent human papillomavirus type 16 variants are serologically cross-reactive.

It is not known whether DNA sequence variants of human papillomavirus type 16 (HPV-16) are distinct serotypes. To examine this question, the reactivities of women's sera from Zaire (n = 97) and Denmark (n = 123) were compared in IgG-specific ELISAs based on virus-like particles (VLPs) composed of the L1 major capsid protein derived from an HPV-16 variant common in central Africa (Z-1194) or one common in northern Europe (114K). These L1s differ in seven amino acids. There was a strong correlation between reactivity in the two assays for both sets of sera (correlation coefficients, 0.73 and 0.85 for Zairian and Danish sera, respectively). In only 1 serum was there evidence for a specific reaction to one but not the other VLP variant. The results support the conclusion that the virions of strains Z-1194 and 114K are serologically cross-reactive.

[Relationship between diet, nutritional status and prostatic cancer]. / Sammenhaengen mellem kost, ernaeringstilstand og prostatacancer.

Several epidemiological investigations suggest an association between diet and prostatic cancer. The most consistent finding has been a risk-enhancing effect of a diet rich in fat, especially animal fat. There is some evidence that dietary fat acts in late prostatic carcinogenesis by promoting the progression from focal to clinical disease, and that this effect may be due to an influence on the hormonal system. Data on other dietary factors, especially vitamin A and beta-carotene, are equivocal. This is probably partly due to the fact that most of the epidemiological studies have been based on limited dietary information. It is unclear whether the nutritional status influences the development of prostatic cancer, and if so, which anthropometric measurements are associated with an increased risk. Future studies should aim at estimating dietary exposures more precisely than hitherto by using calibrated dietary assessment methods that permit adjustment for total energy intake and combining these with biochemical methods. It will also be important to further investigate relations between diet, nutritional status and the hormonal system.

The influence of nitrous oxide on recovery of bowel function after abdominal hysterectomy.

The influence of nitrous oxide on the recovery of bowel function was studied in 36 patients anaesthetised for elective abdominal hysterectomy with or without salpingo-oophorectomy. Patients were randomly assigned to receive either isoflurane in nitrous oxide and 30% oxygen (N2O group) or isoflurane in air and 30% oxygen (Air group). Anaesthetic management included thiopentone, fentanyl, suxamethonium and atracurium. The lungs were not ventilated prior to intubation. Before closing the abdomen, the surgeon assessed the degree of distension of the intestines and the closing conditions. Postoperative nausea and vomiting was assessed 2, 6, 12 and 24 h after recovery from anaesthesia. The lapse of time before mobilisation and passing of flatus and faeces was recorded. The patients in the Air group were significantly older than the patients in the N2O group (48.9 years versus 44.0 years, P = 0.04); otherwise, there were no differences in the demographic data of the patients. We found no significant differences between the groups with respect to nausea and vomiting, distension of the intestines before closure of the abdomen, closing conditions, time elapsing before mobilisation, constipation before recovery of bowel function or time elapsing before passing of flatus. We found a statistically significant delay of 10.3 h in time elapsing before passing of faeces in the N2O group compared to the Air group (P = 0.04), suggesting a potentially adverse effect of nitrous oxide.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraobserver and interobserver variation in measurement of the pelvic diameter using DeLee's internal pelvimeter in Cesarean section]. / Intra- og interobservatørvariation ved måling af conjugata vera obstetrica med DeLee's interne pelviometer ved sectio caesarea.

The method of measuring the true conjugata with DeLee's Internal Pelviometer at caesarean section was evaluated. In 58 women the true conjugata were blindly measured three times by the surgeon and also, in fifty cases, three times by the assistant. Only a slight intraobserver difference was found: median range was 0.42 cm. There was no significant interobserver variation. We conclude that DeLee's Internal Pelviometer can be used to measure the true conjugata at caesarean section, but the use of pelviometry in modern obstetrics is questioned.

[Difficulties in early differential diagnosis of intra/extrauterine pregnancy]. / Differentialdiagnostiske vanskeligheder ved tidlig intra/ekstrauterin graviditet.

Employing the new very sensitive pregnancy tests, pregnancy can be confirmed several weeks before it can be visualized by ultrasonic scanning or can be seen at laparoscopy or laparotomy. This involves the risk that unnecessary diagnostic interventions are performed in early pregnancy with symptoms suggestive of extrauterine pregnancy. Three case reports are quoted to illustrate the problems involved.

Contraceptive use in random samples of Greenlandic and Danish women--changes from 1986 to 1988.

As part of a study of risk factors for cervical cancer, the possible change was assessed in the use of condoms after AIDS campaigns. In 1986, samples of 800 women aged 20-39 years were drawn at random from Nuuk/Godthåb (Greenland) and Nykøbing Falster (Denmark). A total of 586 and 661 women were interviewed in Greenland and Denmark, respectively. In 1988, new random samples of 150 women were drawn from the same areas. Totally, 129 Greenlandic and 126 Danish women were included in the study. From 1986 to 1988 the prevalence of ever having used condoms increased significantly among Greenlandic women aged 20-29, whereas no statistically significant changes were observed in Denmark. This pattern was independent of the lifetime number of sexual partners. Neither in Greenland nor in Denmark did the mean lifetime number of sexual partners change from 1986 to 1988.