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CMAJ • May 27, 2003; 168 (11)
© 2003 Canadian Medical Association or its licensors

Letters
Correspondance

Transmission of HPV

Alice Lytwyn*, Janusz Kaczorowski{dagger}, Attila Lorincz{ddagger} and John W. Sellors§

*Department of Pathology, Joseph Brant Memorial Hospital, Burlington, Ont.; {dagger}Department of Family Medicine, McMaster, University, Hamilton, Ont.; {ddagger}Digene Corporation, Gaithersburg, Md.; §Program for Appropriate Technology in Health, Seattle, Wash.

As Sarah Giles points out, nonpenetrative sexual activity is associated with increased risk of genital HPV infection.1 We did not define sexual activity when we asked women to report the number of their sexual partners.2 However, it is likely that at least some respondents included partners with whom sexual activity was nonpenetrative.3

We also agree with Giles that evidence for the protective effect of condoms against HPV infection is lacking.4

Giles raises an important issue regarding the potential stigmatization of women with genital HPV infection. Approximately 65% of women (or more) have been infected with HPV sometime in their lives, the vast majority of these infections being transient.5 It is reasonable to assume that the same proportion of men are infected, given that the risk factors for genital HPV infection are similar in men and women.6 Such infection is therefore widespread and common, especially at younger ages. To assume that any particular infected individual has had numerous sexual partners is wrong. Although an increasing number of partners does increase the risk of infection, sole contact with one infected partner can lead to acquisition of genital HPV.7

Nevertheless, as research has shown, a certain proportion of women and men with HPV infection have had numerous sexual partners.2,6,7 A MEDLINE search for the period January 1966 to March 2003, using "human papillomavirus" as a subject heading and "promiscuity" as a keyword, identified 7 articles that used the word "promiscuous" in the abstract when referring to such a sexual history in people infected with genital HPV. We believe that terms such as this one are morally charged and judgement laden, and that they should be avoided by physicians and researchers.

Alice Lytwyn Department of Pathology Joseph Brant Memorial Hospital Burlington, Ont. Janusz Kaczorowski Department of Family Medicine McMaster University Hamilton, Ont. Attila Lorincz Digene Corporation Gaithersburg, Md. John W. Sellors Program for Appropriate Technology in Health Seattle, Wash.

References

  1. Winer RL, Lee SK, Hughes JP, Adam DE, Kiviat NB, Koutsky LA. Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol 2003;157:218-26.[Abstract/Free Full Text]
  2. Sellors JW, Karwalajtys TL, Kaczorowski J, Mahony JB, Lytwyn A, Chong S, et al, for the Survey of HPV in Ontario Women (SHOW) Group. Incidence, clearance and predictors of human papillomavirus infection in women. CMAJ 2003;168(4):421-5.[Abstract/Free Full Text]
  3. Sanders SA, Reinisch JM. Would you say you "had sex" if....? JAMA 1999;281:275-7.[Abstract/Free Full Text]
  4. Manhart LE, Koutsky LA. Do condoms prevent genital HPV infection, external genital warts, or cervical neoplasia? A meta-analysis. Sex Transm Dis 2002;29:725-35.[Medline]
  5. Koutsky LA. Epidemiology of human papillomavirus infection. Am J Med 1997;102(5 Suppl 1): 3-8.[Medline]
  6. Svare EI, Kjaer SK, Worm AM, Osterlind A, Meijer CJLM, van den Brule AJC. Risk factors for genital HPV DNA in men resemble those found in women: a study of male attendees at a Danish STD clinic. Sex Transm Infect 2002; 78: 215-8. [Abstract/Free Full Text]
  7. Burk RD, Ho GY, Beardsley L, Lempa M, Peters M, Bierman R. Sexual behavior and partner characteristics are the predominant risk factors for genital human papillomavirus infection in young women. J Infect Dis 1996;174:679-89.[Medline]




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