Predictors of human papillomavirus infection in women undergoing routine cervical cancer screening in Spain: the CLEOPATRE study.
BACKGROUND
Human papillomavirus (HPV) is a sexually transmitted infection that may lead to development of precancerous and cancerous lesions of the cervix. The aim of the current study was to investigate socio-demographic, lifestyle, and medical factors for potential associations with cervical HPV infection in women undergoing cervical cancer screening in Spain.


METHODS
The CLEOPATRE Spain study enrolled 3 261 women aged 18-65 years attending cervical cancer screening across the 17 Autonomous Communities. Liquid-based cervical samples underwent cytological examination and HPV testing. HPV positivity was determined using the Hybrid Capture II assay, and HPV genotyping was conducted using the INNO-LiPA HPV Genotyping Extra assay. Multivariate logistic regression was used to identify putative risk factors for HPV infection.


RESULTS
A lifetime number of two or more sexual partners, young age (18-25 years), a history of genital warts, and unmarried status were the strongest independent risk factors for HPV infection of any type. Living in an urban community, country of birth other than Spain, low level of education, and current smoking status were also independent risk factors for HPV infection. A weak inverse association between condom use and HPV infection was observed. Unlike monogamous women, women with two or more lifetime sexual partners showed a lower risk of infection if their current partner was circumcised (P for interaction, 0.005) and a higher risk of infection if they were current smokers (P for interaction, 0.01).


CONCLUSIONS
This is the first large-scale, country-wide study exploring risk factors for cervical HPV infection in Spain. The data strongly indicate that variables related to sexual behavior are the main risk factors for HPV infection. In addition, in non-monogamous women, circumcision of the partner is associated with a reduced risk and smoking with an increased risk of HPV infection.
Cancer Epidemiology Research Program, Institut Català d'Oncologia -IDIBELL, CIBER-ESP, RTICC, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain.
Esther
E
Roura
Thomas
T
Iftner
José Antonio
JA
Vidart
Susanne Krüger
SK
Kjaer
F Xavier
FX
Bosch
Nubia
N
Muñoz
Santiago
S
Palacios
Maria San Martin
MS
Rodriguez
Carmen
C
Morillo
Laurence
L
Serradell
Laurence
L
Torcel-Pagnon
Javier
J
Cortes
Xavier
X
Castellsagué
D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D055088:Early Detection of Cancer; D005260:Female; D005838:Genotype; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D012307:Risk Factors; D012725:Sexual Behavior / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D055815:Young Adult