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Association of Condom Use, Sexual Behaviors, and Sexually Transmitted Infections With the Duration of Genital Human Papillomavirus Infection Among Adolescent Women
Marcia L. Shew, MD, MPH;
J. Dennis Fortenberry, MD, MS;
Wanzhu Tu, PhD;
Beth E. Juliar, MA, MS;
Byron E. Batteiger, MD;
Brahim Qadadri, BS;
Darron R. Brown, MD
Arch Pediatr Adolesc Med. 2006;160:151-156.
Objective To examine the association of potentially modifiable factors such as condom use, sexual behaviors, and concurrent sexually transmitted infections with duration of genital human papillomavirus (HPV) infections among adolescent women.
Design Longitudinal observational study.
Setting Study conducted at 3 inner-city clinics in Indianapolis, Ind.
Participants Forty-nine HPV-positive adolescents were tested frequently for HPV infection and provided sexual behavior diaries.
Main Exposures Condom use, sexual behaviors, number of partners, and concurrent infections with Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis.
Main Outcome Measures Time from onset to clearance of type-specific HPV infections was analyzed with proportional hazard models. Adjusted hazard ratios (AHRs) were used to assess the effects of risk factors on the duration of HPV infection. Because viral clearance is a preferred outcome, a variable with an AHR less than 1 was considered a risk factor (ie, associated with reduced chance of viral clearance and prolonged infection).
Results Prolonged HPV infection was associated with oncogenic HPV types (AHR, 0.58 [95% confidence interval (CI), 0.39-0.84]) less than median level of condom use during an HPV infection (AHR, 0.53 [95% CI, 0.33-0.84]) and coinfection with C trachomatis (AHR, 0.58 [95% CI, 0.31-0.89]) or T vaginalis (AHR, 0.32 [95% CI, 0.16-0.64]). Not having multiple sexual partners during an HPV infection was associated with early HPV clearance (AHR, 5.52 [95% CI, 3.28-9.30]).
Conclusions These findings support public health messages of reducing the number of sexual partners, promoting routine condom use, and frequent sexually transmitted infection screening that may be beneficial with HPV infections.
Author Affiliations: Division of Adolescent Medicine, Department of Pediatrics (Drs Shew and Fortenberry), Divisions of Biostatistics (Dr Tu and Ms Juliar) and Infectious Diseases (Drs Batteiger and Brown and Mr Qadadri), Department of Medicine, Department of Microbiology and Immunology (Drs Batteiger and Brown), and Regenstrief Institute (Dr Tu), Indiana University School of Medicine, Indianapolis.
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