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Risk Factors for Cervical Human Papillomavirus Infection and High-Grade Intraepithelial Lesion in Women Aged 20 to 31 Years in Germany
  1. Cornelius Remschmidt, MD*,
  2. Andreas M. Kaufmann, PhD,
  3. Ingke Hagemann, MD,
  4. Elena Vartazarova, MS,
  5. Ole Wichmann, MD, PhD* and
  6. Yvonne Deleré, MD*
  1. *Immunization Unit, Robert Koch Institute, Berlin, Germany;
  2. Clinic for Gynecology, Charité, University Medicine Berlin, Germany; and
  3. Gynecological office, Kronshagen, Germany.
  1. Address correspondence and reprint requests to Cornelius Remschmidt, MD, Department of Infectious Disease Epidemiology, Robert Koch Institute, DGZ-Ring 1, 13086 Berlin, Germany. E-mail: RemschmidtC{at}


Background Persistent infection with high-risk human papillomaviruses (HPVs) can lead to cervical intraepithelial lesion and cervical cancer. Sexual behavior and smoking have been identified as risk factors for HPV infection. However, it is unclear which factors account for the persistence of HPV infection and for high-grade squamous intraepithelial lesions (HSIL). Therefore, we conducted a study to identify epidemiological risk factors for the following: (1) the presence of HPV among women without a recent diagnosis of HSIL and (2) HSIL.

Materials and Methods Participants aged 20 to 31 years were recruited at 2 study sites. All women received a cervical Papanicolaou test, were tested for HPV, and categorized into 1 of 3 different groups: The women of the first group had negative cytological test results and a negative HPV test result (HPV-negative group), and the women of the second group had negative cytological test result but positive HPV test result (HPV-positive group). The third group consisted of women with a diagnosis of HSIL (HSIL group). We first compared the HPV-negative group with the HPV-positive group, and then the HPV-positive group with the HSIL group.

Results One hundred forty-seven women were included: 53 women in the HPV-negative group, 46 women in the HPV-positive group, and 48 women in the HSIL group. Comparing the HPV-negative with the HPV-positive group, we found that more than 5 sexual partners during a lifetime were independently associated with cervical HPV infection, whereas the chance of being infected decreased with older age. Irregular condom use during one-night stands or smoking was associated with HPV infection only in univariable but not multivariable analysis. In contrast, older age and having had genital warts were independently associated with an HSIL diagnosis when comparing the HPV-positive group with the HSIL group.

Discussion Although the study was hampered by its relatively small sample size, our data suggest that main risk factors for the acquisition of HPV infection are a higher number of sexual partners and younger age, whereas older age and genital warts may be epidemiological cofactors in the development of HSIL.

  • Human papillomavirus
  • HPV
  • Cervical cancer
  • Risk factors
  • Germany

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  • This study was funded by internal funds of the Robert Koch Institute.

  • The authors declare no conflicts of interest.