Transmission of HPV

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.