title: Reproductive and genital health and risk of cervical human papillomavirus infection: results from the Ludwig-McGill cohort study.
abstract: BACKGROUND
  There are inconsistencies in the literature on reproductive and genital health determinants of human papillomavirus (HPV) infection, the primary cause of cervical cancer. We examined these factors in the Ludwig-McGill Cohort Study, a longitudinal, repeated-measurements investigation on the natural history of HPV infection.
  
  
  METHODS
  We analyzed a cohort subset of 1867 women with one complete year of follow-up. We calculated odds ratios (OR) and 95% confidence intervals (CI) for reproductive and genital health characteristics from questionnaire and laboratory data in relation to 1-year period prevalence of HPV infection. Two outcomes were measured; the first based on phylogenetic grouping of HPV types based on tissue tropism and oncogenicity (Alphapapillomavirus Subgenus 1: species 1, 8, 10 and 13; Subgenus 2: species 5, 6, 7, 9, 11; Subgenus 3: species 3, 4 and 14) and the second based on transient or persistent HPV infections.
  
  
  RESULTS
  Lifetime (Subgenus 3 OR = 2.00, CI: 1.23-3.24) and current (Subgenus 3 OR =2.00, CI: 1.15-3.47) condom use and use of contraceptive injections (Subgenus 1 OR = 1.96, CI: 1.22-3.16, Subgenus 2 OR = 1.34, CI: 1.00-1.79) were associated with increased risk of HPV infection. Intrauterine device use was protective (Subgenus 1 OR = 0.48, CI: 0.30-0.75, Subgenus 2 OR = 0.78, CI: 0.62-0.98). These factors were not associated with persistence of HPV infection. Tampon use, previous gynecologic infections and cervical inflammation were associated with an overall increased risk of HPV infection.
  
  
  CONCLUSIONS
  Cervical HPV infection was associated with reproductive and genital health factors. Further studies are necessary to confirm the low to moderate associations observed.
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada. eileen.shaw@gmail.com.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada. eileen.shaw@gmail.com.
authors.forename: Eileen
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada. raman.agnihotram@mcgill.ca.
authors.forename: Agnihotram V
authors.initials: AV
authors.lastname: Ramanakumar
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada. mariam.elzein@mcgill.ca.
authors.forename: Mariam
authors.initials: M
authors.lastname: El-Zein
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada. sdasilva@icao.int.
authors.forename: Flavia R
authors.initials: FR
authors.lastname: Silva
authors.affiliation: Ludwig Institute for Cancer Research, São Paulo, Brazil. lenicegalan@gmail.com.|Molecular Biology Laboratory, Centre of Translational Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil. lenicegalan@gmail.com.
authors.forename: Lenice
authors.initials: L
authors.lastname: Galan
authors.affiliation: Ludwig Institute for Cancer Research, São Paulo, Brazil. izamlbaggio@gmail.com.|Molecular Biology Laboratory, Centre of Translational Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil. izamlbaggio@gmail.com.
authors.forename: Maria L
authors.initials: ML
authors.lastname: Baggio
authors.affiliation: Ludwig Institute for Cancer Research, São Paulo, Brazil. luisapvilla@gmail.com.|Molecular Biology Laboratory, Centre of Translational Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil. luisapvilla@gmail.com.
authors.forename: Luisa L
authors.initials: LL
authors.lastname: Villa
authors.affiliation: Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, Canada. eduardo.franco@mcgill.ca.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 546 Pine Avenue West, Montreal, QC, H2W 1S6, Canada. eduardo.franco@mcgill.ca.
authors.forename: Eduardo L
authors.initials: EL
authors.lastname: Franco
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000472:pathogenicity; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D010802:Phylogeny; D015995:Prevalence; D012098:Reproduction; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D016387:Women's Health; D055815:Young Adult