Most new detections of human papillomavirus (HPV) in mid-adult women reflect the recurrence of previously acquired HPV, according to data published in The Journal of Infectious Diseases. Despite this, women still remain at risk of infections from new sexual partners as they age. A better understanding of the sources of new infections is important for preventive strategies such as screening and HPV vaccination.

To determine the source of newly detected HPV in middle-aged women, investigators conducted a prospective cohort study in Baltimore, Maryland. The participants were aged 35 to 60 years, underwent HPV testing, and completed health and sexual behavior questionnaires every 6 months over a 2-year period. New detection and loss of detection rates were calculated, and adjusted hazard ratios (aHR) were used to identify risk factors for new detection.

The study enrolled 731 women in the new detection analyses and 104 high-risk HPV-positive women in the loss of detection analyses. The rate of new high-risk HPV detection was 5.0/1000 woman-months. Women reporting a new sex partner was associated with higher detection rates (aHR, 8.1; 95% CI, 3.5, 18.6), though this only accounted for 19.4% of all new detections. New detection was higher among monogamous and sexually abstinent women reporting more than or equal to five lifetime sexual partners compared to women reporting fewer than five partners (aHR, 2.2; 95% CI, 1.2, 4.2).

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Investigators were able to conclude that “the within-woman natural history of HPV infection appears to include dynamic transitions between detection and non-detection of immunologically controlled infections.” Women at higher risk of harboring latent infections, such as those with more lifetime sexual partners, will have a higher risk of newer detection in screening. Sexual history may be an important consideration in deciding when to perform exit screening since other studies have suggested the risk of cervical precancer from recurrent HPV detection is similar to that from presumed newly acquired infections.

HPV detection assay used was not a clinical assay, which may have slightly increased detection rates. The results were based on a low-risk, well-screened population and may not be representative of higher-risk populations. Investigators could not exclude recall or social desirability bias in that women who reported no new sex partner may have in fact had a new partner. This could have led to an underestimation of new detection rates among women who reported having a new sexual partner and an overestimation of rates among women reporting no new partner. It was also not possible to rule out underreporting of lifetime sexual partners, which may have resulted in an underestimation of rates among women with more than or equal to five lifetime partners and an overestimation of women with less than five partners.

In terms of the benefits of HPV vaccination, researchers noted “randomized trials are needed to more directly estimate the impact of prophylactic vaccination on control of latent infections and reduced risk of persistence and progression to cervical precancer.”

Disclosure: A study author has declared affiliations with a pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Paul P, Hammer A, Rositch AF, et al. Rates of new human papillomavirus detection and loss of detection in middle-aged women by recent and past sexual behavior [published online September 1, 2020]. J Infect Dis. doi:10.1093/infdis/jiaa557