Concurrent Partnerships And High-Risk HPV: Link Varies by Race, Ethnicity
Women who have concurrent sexual partners have an increased prevalence of infection with types of human papillomavirus (HPV) that may cause cervical cancer in women and other anogenital cancers in women and men, but the association appears to vary by race and ethnicity.1 Nearly one-quarter of Los Angeles women who were screened for HPV as part of a sentinel surveillance project in 2004–2005 tested positive for at least one high-risk type of the virus. Results of multivariate analyses revealed an association between concurrency and elevated odds of high-risk HPV for Hispanic women, but the relationship was reversed for black women and was nonsignificant for Asians.
The surveillance project, conducted at clinics in six U.S. cities from 2003 through 2005, enrolled women who were aged 18–65, underwent routine cervical screening at a study site and had not had a Pap test in the previous year. Participants completed questionnaires asking about demographic and behavioral characteristics, and provided cervical specimens to be tested for HPV. Beginning in 2004, questionnaires in three cities asked about women’s sexual partners, whether women had had concurrent partners during their most recent partnership and whether they thought their most recent partner had had concurrent partners. Some 812 participants at study sites in Los Angeles completed the expanded questionnaire; researchers analyzed data from this group to explore associations between concurrency and high-risk HPV. Because the prevalence of both is thought to vary among racial and ethnic groups, multivariate analyses were stratified by race and ethnicity.
Participants were 34 years old, on average; most were Asian, black or Hispanic (33%, 32% and 28%, respectively). Their median age at first sex was 17, and their median lifetime number of partners was four. Twenty-three percent said that they had been nonmonogamous during their most recent partnership, and 37% thought that their partner had been. Black women were the most likely, and Asians the least likely, to report that either they or their partner had had other partners.
Overall, 22% of women tested positive for at least one of 13 types of high-risk HPV. The prevalence of infection was negatively related to women’s age at first sex and positively related to their lifetime and recent number of partners; it was elevated among those who also had another STD and those who had had concurrent partners.
Multivariate analyses identified different predictors of high-risk HPV infection for the different racial and ethnic groups. Hispanic women had significantly elevated odds of infection if they had been nonmonogamous or if they were not sure whether their partner had been (odds ratios, 1.7 and 2.1, respectively), but not if they believed he had been. Additionally, the odds of infection were negatively associated with Hispanic women’s age (0.95–0.96), and were reduced if they had had fewer than three lifetime partners (0.3–0.4). By contrast, black women had reduced odds of having high-risk HPV if they had had concurrent partners (0.6); the only other predictor for black women was their age (0.93). For Asian women, neither having been nonmonogamous nor perceiving that their partner had been was associated with high-risk HPV infection; those who had had only one lifetime partner had a reduced likelihood of infection (0.4), and the older the partner, the lower the likelihood (0.95).
The researchers acknowledge that a number of study features limit the generalizability of the findings. For example, partners’ concurrency was based on women’s perceptions, the women attending study clinics were not representative of all women in Los Angeles and the questions about concurrency were not asked at all project sites. Despite these shortcomings, they conclude that the analyses suggest that both sexual networks and individuals’ own behaviors contribute to the association between concurrent sex partners and high-risk HPV infection. Thus, they emphasize that the behavior of both partners influences the transmission of high-risk HPV.
1. Javanbakht M et al., Concurrency, sex partner risk, and high-risk human papillomavirus infection among African American, Asian, and Hispanic women, Sexually Transmitted Diseases, 2010, 37(2):68–74.