title: The impact of smoking on HPV infection and the development of anogenital warts.
abstract: OBJECTIVE
  The worldwide prevalence of human papillomavirus (HPV) infection is estimated at 9-13 %. Persistent infection can lead to the development of malignant and nonmalignant diseases. Low-risk HPV types are mostly associated with benign lesions such as anogenital warts. In the present systematic review, we examined the impact of smoking on HPV infection and the development of anogenital warts, respectively.
  
  
  METHODS
  A systematic literature search was performed using MEDLINE database for peer-reviewed articles published from January 01, 1985 to November 30, 2013. Pooled rates of HPV prevalence were compared using the χ (2) test.
  
  
  RESULTS
  In both genders, smoking is associated with higher incidence and prevalence rates for HPV infection, whereas the latter responds to a dose-effect relationship. The overall HPV prevalence for smoking patients was 48.2 versus 37. 5 % for nonsmoking patients (p < 0.001) (odds ratio (OR) = 1.5, 95 % confidence interval (CI) 1.4-1.7). Smoking does also increase persistence rates for high-risk HPV infection, while this correlation is debatable for low-risk HPV. The incidence and recurrence rates of anogenital warts are significantly increased in smokers.
  
  
  CONCLUSIONS
  Most current data demonstrate an association between smoking, increased anogenital HPV infection, and development of anogenital warts. These data add to the long list of reasons for making smoking cessation a keystone of patient health.
authors.affiliation: Department of Visceral Surgery and Medicine, Bern University Hospital, University of Bern, 3010, Bern, Switzerland, reto.kaderli@insel.ch.
authors.forename: Reto
authors.initials: R
authors.lastname: Kaderli
authors.forename: Beat
authors.initials: B
authors.lastname: Schnüriger
authors.forename: Lukas E
authors.initials: LE
authors.lastname: Brügger
mesh_terms: D003218:Condylomata Acuminata / Q000821:virology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D012907:Smoking / Q000009:adverse effects*