Primary prevention of human papillomavirus-dependent neoplasia: No condom, no sex

Epidemiological trends and burden analysis of cervical cancer attributable to unsafe sex: A population-based study from 1990 to 2019

BACKGROUND

Unsafe sex is recognized as an important risk factor for cervical cancer (CC). Understanding the global disease burden of CC attributable to unsafe sex can assist policymakers in allocating healthcare resources.

METHODS

Data were obtained from the 2019 global burden of disease database (GBD). We examined global, regional, and national levels of CC mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) caused by unsafe sex. ASRs were evaluated using estimated annual percentage changes (EAPCs).

RESULTS

Attributable to unsafe sex, there were 280,479 CC-related deaths in 2019 and 8,955,013 CC-related DALYs. In the period 1990-2019, the global ASRs of CC due to unsafe sex decreased around the world; for age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR), the EAPCs were -0.93 and -0.95. The highest ASMRs and ASDRs were found in central sub-Saharan Africa and the lowest in Australasia.

CONCLUSION

In the past few decades, the ASMR and ASDR of CC caused by unsafe sexual practices have decreased over time, with significant variations observed among different countries and regions. Increased focus is needed on spreading awareness about sexual health and promoting CC prevention and screening, particularly in low- and middle-income nations.

Global disease burden attributed to unsafe sex in 204 countries and territories from 1990 to 2019: results from the Global Burden of Disease Study 2019

Unsafe sex has become a public safety problem that endangers society, and research on deaths and disability-adjusted life years (DALYs) related to unsafe sex is valuable for global policy-making. We aimed to estimate the deaths and DALYs attributable to unsafe sex by country, gender, age group, and sociodemographic status from 1990 to 2019. We extracted data on disease burden from the Global Disease Burden 2019 (GBD 2019) database for unsafe sex, including deaths, DALYs and age-standardized rates (ASRs). Comparative analyses were performed on data about deaths, DALYs and the responding ASRs attributable to unsafe sex in different countries and regions using the Social Demographic Index (SDI). The global age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) attributable to unsafe sex were 11.98 (95% uncertainty intervals (UI): 10.97-13.52) per 100,000 people and 570.78 (95% UI: 510.24-658.10) per 100,000 people, respectively. Both the ASMRs and ASDRs were the highest in southern sub-Saharan Africa and lowest in Australasia and decreased with increasing SDI levels. About unsafe-sex-related disease, HIV/AIDS has the highest ASMR [8.48 (95% UI: 7.62-9.95)/100,000 people] and ASDR [447.44 (95% UI: 394.82-533.10)/100,000 people], followed by Cervical cancer [ASMR: 3.40 (95% UI: 2.90-3.81)/100,000 people and ASDR: 107.2 (95% UI: 90.52-119.43)/100,000 people] and sexually transmitted infections excluding HIV [ASMR: 0.10 (95% UI: 0.08-0.11)/100,000 people and ASDR: 16.14 (95% UI: 10.51-25.83)/100,000 people]. The death and DALY burden caused by these three diseases were more serious in the over 75 years old age group. The 40-44 age group for men and the 35-39 age group for women had the highest population of unsafe sex-related deaths and DALYs, respectively. In addition, the burden of unsafe sex in women was more serious than those in men. Unsafe sex is an important risk factor for global disease burden and a leading cause of substantial health loss. We found that the risk of ASMRs and ASDRs attributable to unsafe sex had negative correlation with SDI levels. These results demonstrate that the need for revised policies that focus on efforts to reduce overall unsafe sex worldwide.

Human Immunodeficiency Virus Status Differentially Associated With Genital and Anal Human Papillomavirus Infection Among Chinese Men Who Have Sex With Men: A Cross-Sectional Survey

BACKGROUND

Little is known about human papillomavirus (HPV) infection and genotypes when considering both anatomic site and human immunodeficiency virus (HIV) status among men who have sex with men (MSM) in low- and middle-income countries.

METHODS

A cross-sectional study was conducted among MSM in Beijing, China. HIV serostatus was determined, and genital and anal HPV genotyping were performed from respective swabs.

RESULTS

Of 1155 MSM, 817 (70.7%) had testing for genital (611; 52.9%) and/or anal (671; 58.1%) HPV. Preference for insertive anal sex (adjusted odds ratio [aOR], 2.60; 95% confidence interval [CI], 1.42-4.75) and syphilis (aOR, 1.50; 95% CI, 1.01-2.23) were associated with genital HPV. Inconsistent condom use during receptive anal sex (aOR, 1.82; 95% CI, 1.17-2.84), and HIV seropositivity (aOR, 2.90; 95% CI, 1.91-4.42) were associated with anal HPV. Among 465 (40.3%) MSM with specimens from both anatomic sites, anal HPV (68%) was more common than genital HPV (37.8%). Prevalence of anal HPV was higher among HIV-infected than uninfected MSM (P < 0.01). Some oncogenic HPV types were more commonly found at the anal site of HIV-infected MSM (P < 0.01).

CONCLUSIONS

Human papillomavirus is highly prevalent among Chinese MSM. Anal HPV was more common than genital HPV, and HIV seropositivity was associated with oncogenic HPV types at the anal site.

Mediation by peer violence victimization of sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors: pooled youth risk behavior surveys

OBJECTIVES

We examined the role of adolescent peer violence victimization (PVV) in sexual orientation disparities in cancer-related tobacco, alcohol, and sexual risk behaviors.

METHODS

We pooled data from the 2005 and 2007 Youth Risk Behavior Surveys. We classified youths with any same-sex sexual attraction, partners, or identity as sexual minority and the remainder as heterosexual. We had 4 indicators of tobacco and alcohol use and 4 of sexual risk and 2 PVV factors: victimization at school and carrying weapons. We stratified associations by gender and race/ethnicity.

RESULTS

PVV was related to disparities in cancer-related risk behaviors of substance use and sexual risk, with odds ratios (ORs) of 1.3 (95% confidence interval [CI] = 1.03, 1.6) to 11.3 (95% CI = 6.2, 20.8), and to being a sexual minority, with ORs of 1.4 (95% CI = 1.1, 1.9) to 5.6 (95% CI = 3.5, 8.9). PVV mediated sexual orientation disparities in substance use and sexual risk behaviors. Findings were pronounced for adolescent girls and Asian/Pacific Islanders.

CONCLUSIONS

Interventions are needed to reduce PVV in schools as a way to reduce sexual orientation disparities in cancer risk across the life span.

Natural history of human papillomavirus infections involving anal, penile, and oral sites among HIV-positive men

AIM

The aim of this study was to characterize the natural history of human papillomavirus (HPV) infection at anal canal, penile, and oral sites in HIV-positive men based on their sexual behavior.

METHODS

This is a single-center, prospective cohort study. The prevalence, clearance, and incidence of HPV infection at anal, penile, and oral sites were studied in HIV-positive men who have sex with men (MSM) and heterosexual individuals using multiplex polymerase chain reaction. Risk factors associated with HPV infection were analyzed.

RESULTS

In total, 733 patients (538 MSM, 195 heterosexual) were included in the study between 2005 and 2009. The prevalence, clearance, and incidence of HPV infection were 73%, 30%, and 36% at anal site; 26%, 56%, and 17% at penile site; and 16%, 44%, and 11% at oral site, respectively. At anal site, MSM had a higher HPV prevalence (84% vs. 42%; odds ratio,7.3; 95% confidence interval [CI], 5.2-10.6) mainly for multiple (≥3) HPV types, higher incidence rate (324 vs. 92 new HPV-infected person per 1000 person-years [hazard ratio, 8.1; 95% CI, 3.8-17.3]), and a lower clearance rate (125 vs. 184 cleared HPV-infected person per 1000 person-years [hazard ratio, 0.5; 95% CI, 0.3-0.9]) than did heterosexuals. Similar prevalence, clearance, and incidence rates of penile and oral HPV infection were found between groups. The most common high-risk HPV type for the 3 body sites studied was the HPV-16. Finally, a similar proportion of heterosexuals (7%) and MSM (6%) presented concurrent HPV infections (anal-penile-oral sites). History of anal warts was associated with higher HPV prevalence in the 3 body parts.

CONCLUSIONS

Although MSM presented the highest risk of anal HPV infection, heterosexual men also showed a remarkable prevalence of anal HPV infection and a comparable risk to MSM for penile and oral HPV infection. Taking into account all these results, the careful inspection of the anal canal, penile, and oral sites should at least be routine in each clinic visit of HIV-infected men independently of their sexual behavior.

Incomplete knowledge--unclarified roles in sex education: results of a national survey about human papillomavirus infections

The purpose of this study was to evaluate the awareness of human papillomavirus (HPV) infections both in male and female adults in Hungary. A self-administered, anonymous questionnaire was completed by 785 college students and parents between January and May, 2009. The results were analysed by gender and age. Participants' knowledge about HPV and HPV-associated conditions was relatively incomplete. One-third of the respondents had never heard about HPV prior to the survey. Almost half of the respondents (42%) thought that the only sexual way of spreading HPV was vaginal intercourse, while the role of skin-to-skin contact was disregarded (6%). More than one-third of the participants (38%) believed that condoms give full protection from HPV infection. Encouragingly, the majority of respondents (64%) were open to further information about sexually transmitted diseases. The most trusted sources of information were health professionals. When talking about children, parents attributed the major role in delivering information about sexually transmitted diseases to schools. Primary prevention through carefully planned educational programmes may further raise the awareness about HPV-associated conditions, thus reducing the comparatively high mortality of cervical carcinoma in Hungary.

Cervical cancer: does our message promote screening? A pilot study in a South African context

PURPOSE

The purpose of the study was to explore if cervical cancer information presented in a non-stigmatizing manner could promote screening in women living in a resource poor environment in Tshwane, South Africa.

METHODS

An exploratory, contextual, quantitative door-to-door survey was conducted. The sampling method was convenience (n = 105). Structured interviews were used to gather self-reported data. Chi-square tests were used for secondary data analyses.

RESULTS

The study provided evidence that presenting information on cervical cancer in a non-stigmatizing manner based on the theme of self protection promoted cervical screening. The study further provided evidence that women preferred a cervical cancer message that does not focus on the sexual risk factors of this disease. More than a third of the sample preferring a message introducing cervical cancer as a sexually transmitted infection (n = 32) were of the opinion that this message were stigmatizing, blameful and displayed misunderstanding of their lives.

CONCLUSIONS

Cervical cancer screening is indeed not simple. The screening rate not only in South Africa but many other countries serves as proof. It can therefore not be afforded to add to the barriers by presenting information on cervical cancer in a way perceived as stigmatizing and blameful. Presenting information in way that women prefer might not only promote cervical screening, but might motivate them in such a way that they are screened.

Factors influencing familial decision-making regarding human papillomavirus vaccination

OBJECTIVE

The purpose of this review is to summarize the research regarding Human Papillomavirus (HPV) vaccination uptake among families with adolescent/preadolescent daughters.

METHODS

Literature searches (utilizing PubMed and PsychInfo databases) were conducted and research examining psychological and environmental factors which relate to HPV vaccine uptake and intentions was reviewed.

RESULTS

Factors such as physician recommendations, perceptions of the beliefs of peers and significant others, history of childhood immunizations, and communication with adolescents regarding sexual topics appear to influence HPV vaccination outcomes.

CONCLUSIONS

Although primary prevention of cervical and other cancers is available for preadolescent and adolescent girls, rates of HPV vaccine uptake are low. Future interventions should target vaccine intent and physician/family communication as a means to increasing HPV vaccination.

HPV infection in women: psychosexual impact of genital warts and intraepithelial lesions

INTRODUCTION

Genital Human Papillomavirus (HPV) infection is the most commonly occurring sexually transmitted viral infection in humans. HPV is a wide family of DNA viruses, which may cause benign skin and mucosal tumors (genital, anal, or oral warts), intraepithelial neoplasias, and/or malignant cancers in different organs. Women are more susceptible to the oncogenic effect of HPVs, mostly at the genital site on the uterine cervix.

AIMS

This review analyzes the impact of: (i) genital warts (GWs) and their treatment; (ii) HPV-related genital, oral, and anal precancerous lesions on women's sexual function.

METHODS

A Medline search was carried out. Search terms were HPV, GWs, intraepithelial neoplasia, cervical cancer, anal cancer, oral cancer, epidemiology, HPV risk factors, sexual dysfunctions, desire disorders, arousal disorders, dyspareunia, vulvar vestibulitis, vulvodynia, orgasmic difficulties, sexual repertoire, couple sexual problems, depression, anxiety, pap smear, screening program, therapy, and vaccines.

MAIN OUTCOME MEASURES

Sexual consequences of HPV infection in women, specifically GWs and intraepithelial HPV-related neoplasia.

RESULTS

Psychosexual vulnerability increases with number of recurrences of HPV infections. Depression, anxiety, and anger are the emotions most frequently reported. However, to date, there is no conclusive evidence of a specific correlation between HPV infection and a specific female sexual disorder. The relationship between HPV and vulvar vestibulitis/vulvodynia-related dyspareunia seems not to be direct. Counseling problems, the role of anti-HPV vaccine, and the concept of the high-risk partner are discussed. The reader is offered a practical approach with clinically relevant recommendations that may prove useful in his/her daily practice when dealing with HPV-infected women and couples.

CONCLUSION

The evidence of psychosexual consequences of HPV-related GWs and intraepithelial lesions is limited. Specific research on the sexual impact of GWs and intraepithelial HPV-related lesion in women is urgently needed.

High prevalence of human papillomavirus infection in the anus, penis and mouth in HIV-positive men

Human papillomavirus (HPV) types are associated with squamous cell cancers. HIV infection is linked with a higher prevalence of anal HPV infection. It is important to assess whether HPV is present in other body parts involved in sexual practices to establish a cancer prevention program. A high prevalence of high-risk HPV types was present in the anus, penis and mouth (78, 36 and 30%, respectively) in a cohort of HIV-infected males (men who have sex with men and heterosexual), without evidence of pathology in these areas.