HPV Infections May Return to Haunt Older Women

Reactivation of latent human papillomavirus (HPV) infection in older women could obscure an age-related increase in HPV detection at menopause, data from a prospective cohort study suggested.

The age-specific prevalence of 14 high-risk HPV genotypes decreased in women with fewer than 5 lifetime sexual partners but not women with five or more partners, as reported online in Journal of Infectious Diseases.

The population-attributable risk (PAR) associated with five or more lifetime sexual partners was three times greater in older women. However, older women had a fourfold lower PAR associated with a new sexual partner than younger women.

Taken together, the findings suggest that the low probability of HPV infection in women who became sexually active before the sexual revolution of the 1960s and '70s could be obscuring an age-related increase in the rate of HPV reactivation, according to Patti E. Gravitt, PhD, of the Johns Hopkins School of Public Health, and colleagues.

"Our data raise the possibility that reactivation risk may increase around age 50 years and contribute to a larger fraction of HPV detection at older ages, compared with new acquisition," Gravitt and colleagues wrote of their findings.

"Long-term follow-up of previously highly exposed women who will transition through menopause in the next decade is urgently needed to accurately estimate the potential risk of postmenopausal invasive cervical cancer in the U.S. Baby Boom population and guide prevention strategies," they concluded.

The absence of a second peak in HPV prevalence at menopause in the U.S. has led to speculation that few older women have new sexual partners and are not at risk of reactivating infection acquired decades earlier. To investigate the validity of the speculation, Gravitt and colleagues studied an older HPV screening population in the Baltimore area.

From March 2008 through March 2011 they recruited women ages 35 to 60 who were attending clinics for routine gynecologic assessment. Eligible women had an intact cervix, no plans to become pregnant, no history of organ transplantation, and documented HIV seronegativity.

The baseline evaluation consisted of a gynecologic examination (including testing for genotype-specific HPV) and a questionnaire that elicited information about social and demographic status, reproductive and menstrual history, medication use (including hormonal therapies), and past and current sexual history.

Statistical analysis was completed for 882 women, mean age 47. Whites constituted 74% of the population, more than half had a college degree, more than 90% had a history of hormonal contraceptive use (including 22% current users), and 8% reported a history of hormone replacement therapy.

All of the women had a history of Pap smear, 49% had a history of an abnormal Pap test, 21.5% had a history of colposcopy, and 19% had a history of cervical intraepithelial neoplasia. Fewer than 5% of the study population had current abnormal cervical cytology.