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Multiple-Type Human Papillomavirus (HPV) Infections: A Cross-Sectional Analysis of the Prevalence of Specific Types in 309,000 Women Referred for HPV Testing at the Time of Cervical Cytology
  1. Elizabeth Louise Dickson, MD*,
  2. Rachel Isaksson Vogel, MS,
  3. Robin L. Bliss, MS and
  4. Levi S. Downs, MS, MD*
  1. *Department of Obstetrics, Gynecology and Women’s Health, and Masonic Cancer Center, University of Minnesota, and
  2. Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN.
  1. Address correspondence and reprint requests to Levi S. Downs Jr, MS, MD, 420 Delaware St, SE, MMC 395, Minneapolis, MN 55455. E-mail: downs008{at}


Objectives To determine the frequency of multiple-type cervical human papillomavirus (HPV) infections, and whether any types are involved in multiple-type infections more or less frequently than might be expected if these infections occur randomly.

Methods In this retrospective analysis of type-specific HPV testing, results from women 18 to 65 years old with samples collected between July 2007 and May 2011 were considered.

Multivariate logistic regression analysis was used to model the presence of each of the 24 most prevalent HPV types, adjusting for one other HPV type, age, laboratory region, and age-by-region interactions.

Results Human papillomavirus infection was present in 74,543 (24.1%) of 309,471 women and 65,492 (21.1%) were positive for one of the top 24 most prevalent HPV types. The most common HPV type was type 16, occurring in 4.1% of the entire sample. A total of 14,181 women were positive for 2 or more HPV types (4.6% of entire sample and 19.0% of HPV-positive sample). Two-way HPV type comparisons were analyzed. Types 52, 53, 81, and 83 were more likely to occur in multiple infections with other types; and types 16, 58, and 66 were less likely to occur in multiple infections with other types. Human papillomavirus types 72 and 81 have the strongest positive relationship (odds ratio, 5.2; 95% confidence interval, 3.6–7.4). Human papillomavirus types 33 and 66 have the strongest negative relationship (odds ratio, 0.4; 95% confidence interval, 0.2–0.6).

Conclusions In this population, multiple-type HPV infections were present in 4.6% of all women. Our findings suggest that there may be both competitive and cooperative interactions between HPV types.

  • DNA probes
  • HPV
  • Epidemiology

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  • Levi S Downs Jr receives research support from GlaxoSmithKline for HPV vaccine clinical trials and receives honoraria for being in its advisory board; likewise, he receives honoraria from Merck Corporation for being in its advisory board. Elizabeth L Dickson, Rachel Isaksson Vogel, and Robin L. Bliss declare no conflicts of interest.

  • Authors’ contributions: Dickson wrote the research paper, with edits from Vogel and Downs. Vogel and Bliss performed the statistical analysis for the research project. Downs is the guarantor of the research project and has overseen all portions of the project’s fruition.