Rates of New Human Papillomavirus Detection and Loss of Detection in Middle-aged Women by Recent and Past Sexual Behavior

Proma Paul, Anne Hammer, Anne F. Rositch, Anne E. Burke, Raphael P. Viscidi, Michelle I. Silver, Nicole Campos, Ada O. Youk, Patti E. Gravitt

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Understanding the source of newly detected human papillomavirus (HPV) in middle-aged women is important to inform preventive strategies, such as screening and HPV vaccination. METHODS: We conducted a prospective cohort study in Baltimore, Maryland. Women aged 35-60 years underwent HPV testing and completed health and sexual behavior questionnaires every 6 months over a 2-year period. New detection/loss of detection rates were calculated and adjusted hazard ratios were used to identify risk factors for new detection. RESULTS: The new and loss of detection analyses included 731 women, and 104 positive for high-risk HPV. The rate of new high-risk HPV detection was 5.0 per 1000 woman-months. Reporting a new sex partner was associated with higher detection rates (adjusted hazard ratio, 8.1; 95% confidence interval, 3.5-18.6), but accounted only for 19.4% of all new detections. Among monogamous and sexually abstinent women, new detection was higher in women reporting ≥5 lifetime sexual partners than in those reporting <5 (adjusted hazard ratio, 2.2; 95% confidence interval, 1.2-4.2). CONCLUSION: Although women remain at risk of HPV acquisition from new sex partners as they age, our results suggest that most new detections in middle-aged women reflect recurrence of previously acquired HPV.

Original languageEnglish (US)
Pages (from-to)1423-1432
Number of pages10
JournalThe Journal of infectious diseases
Issue number8
StatePublished - Apr 23 2021


  • cervical cancer screening
  • cervical neoplasia
  • epidemiology
  • human papillomavirus
  • sexual behavior

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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