{"id":788,"date":"2013-02-11T15:15:44","date_gmt":"2013-02-11T15:15:44","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=788"},"modified":"2013-02-07T14:16:39","modified_gmt":"2013-02-07T14:16:39","slug":"hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2013\/02\/11\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\/","title":{"rendered":"HPV re-activation in older women:  an increased cancer risk unrelated to sexual behaviour?"},"content":{"rendered":"<p>Older women who have had \u22655 lifetime sexual partners could turn out to be a relatively high-risk group for Human Papilloma Virus (HPV) and associated cervical lesions \u2013 regardless of declining sexual activity.\u00a0 If \u2013 that is \u2013 Gravitt, Viscidi et al. (<a href=\"http:\/\/jid.oxfordjournals.org\/content\/207\/2\/272.full.pdf+html?sid=4bc8141c-9b7c-4a13-8a43-451d6fa85fcf\">http:\/\/jid.oxfordjournals.org\/content\/207\/2\/272.full.pdf+html?sid=4bc8141c-9b7c-4a13-8a43-451d6fa85fcf<\/a>; <a href=\"http:\/\/jid.oxfordjournals.org\/content\/207\/2\/211.full.pdf+html?sid=4bc8141c-9b7c-4a13-8a43-451d6fa85fcf\">http:\/\/jid.oxfordjournals.org\/content\/207\/2\/211.full.pdf+html?sid=4bc8141c-9b7c-4a13-8a43-451d6fa85fcf<\/a>) are correct to see the results of their cohort study of Baltimore women attending obstetric-gynaecology clinic as supportive of the hypothesis that the HPV experienced by these older high-risk women is a <i>reactivated<\/i> form of the infection.\u00a0 The virus, they suggest, may remain undetectable in the body for years in order to emerge in later years with immune-senescence \u2013 like the <i>varicella zoster<\/i> virus that reactivates as shingles.\u00a0 This would explain the double peak in age-specific HPV prevalence (debut and menopause) in some cultures; while the absence of this pattern in the US and N. Europe, they hypothesize, may be an effect of the more restrictive sexual mores of the pre-sixties generation.<\/p>\n<p>What is the evidence?\u00a0 When the results are stratified according to number of lifetime sexual partners, it is discovered that the Population Attributable Risk (PAR) of high-risk (HR) variants of HPV (i.e. those causing cancerous lesions) due to \u22655 lifetime partners is 87% among the older study participants, and 28% among the younger ones; while the PAR of HR-HPV due to a new sex partner is 7.7% among the older group and 28% among the younger.\u00a0 This, as the authors argue, is consistent with reactivation of the virus in later life, though they admit reactivation is difficult to prove.<\/p>\n<p>If this hypothesis is supported by further research, it will certainly impact on a number of issues that have been a concern for our readers and contributors.\u00a0 <b>First, the question of women\u2019s perceived risk of cervical cancer<\/b> \u2013 important because it has been shown to predict cancer screening attendance and has been associated with HPV vaccination uptake (<a href=\"http:\/\/sti.bmj.com\/content\/88\/6\/400.abstract?sid=2f5a46a3-43d9-4648-a3f6-9f1a46384f61\">http:\/\/sti.bmj.com\/content\/88\/6\/400.abstract?sid=2f5a46a3-43d9-4648-a3f6-9f1a46384f61<\/a>, pp.1-2).\u00a0 If Gravitt et al. are right, then currently less sexually active older women, who are nevertheless in the higher-risk group on account of past sexual activity, are in serious danger of underestimating their risk; furthermore, that risk could, in reality, be greater that we imagined owing to the behavioural impact of the sexual revolution.\u00a0 <b>Second, the question of stigmatization<\/b>, especially in relation to HPV testing at routine \u201csmear\u201d tests (<a href=\"http:\/\/sti.bmj.com\/content\/82\/2\/169.abstract?sid=2f5a46a3-43d9-4648-a3f6-9f1a46384f61\">http:\/\/sti.bmj.com\/content\/82\/2\/169.abstract?sid=2f5a46a3-43d9-4648-a3f6-9f1a46384f61<\/a>). \u00a0If HPV is often present, but undetected, and, when detected, may turn out to have no relation to current sexual activity, then the stigmatizing link between HPV status and current sexual behaviour is, at least, weakened \u2013 which ought to have a de-stigmatizing effect. \u00a0<b>Third, HPV vaccination<\/b>, and the concern of certain parents that it might lead to sexual disinhibition (<a href=\"http:\/\/sti.bmj.com\/content\/87\/4\/349.abstract?sid=44f0f0a6-c872-4cb1-9ca1-afa0aa8db872\">http:\/\/sti.bmj.com\/content\/87\/4\/349.abstract?sid=44f0f0a6-c872-4cb1-9ca1-afa0aa8db872<\/a>).\u00a0 Here, again, the idea that sexually inactive, or less active, people can be at serious risk runs counter to the public perception of a direct link between current sexual behaviour and cervical cancer risk \u2013 which ought to make HPV vaccination easier to justify to a public concerned about sexual disinhibition.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Older women who have had \u22655 lifetime sexual partners could turn out to be a relatively high-risk group for Human Papilloma Virus (HPV) and associated cervical lesions \u2013 regardless of declining sexual activity.\u00a0 If \u2013 that is \u2013 Gravitt, Viscidi et al. (http:\/\/jid.oxfordjournals.org\/content\/207\/2\/272.full.pdf+html?sid=4bc8141c-9b7c-4a13-8a43-451d6fa85fcf; http:\/\/jid.oxfordjournals.org\/content\/207\/2\/211.full.pdf+html?sid=4bc8141c-9b7c-4a13-8a43-451d6fa85fcf) are correct to see the results of their cohort study of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2013\/02\/11\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[151,2316],"tags":[],"class_list":["post-788","post","type-post","status-publish","format-standard","hentry","category-epidemiology","category-hpv"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>HPV re-activation in older women: an increased cancer risk unrelated to sexual behaviour? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2013\/02\/11\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HPV re-activation in older women: an increased cancer risk unrelated to sexual behaviour? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"Older women who have had \u22655 lifetime sexual partners could turn out to be a relatively high-risk group for Human Papilloma Virus (HPV) and associated cervical lesions \u2013 regardless of declining sexual activity.\u00a0 If \u2013 that is \u2013 Gravitt, Viscidi et al. (http:\/\/jid.oxfordjournals.org\/content\/207\/2\/272.full.pdf+html?sid=4bc8141c-9b7c-4a13-8a43-451d6fa85fcf; http:\/\/jid.oxfordjournals.org\/content\/207\/2\/211.full.pdf+html?sid=4bc8141c-9b7c-4a13-8a43-451d6fa85fcf) are correct to see the results of their cohort study of [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2013\/02\/11\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2013-02-11T15:15:44+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/02\\\/11\\\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/02\\\/11\\\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"HPV re-activation in older women: an increased cancer risk unrelated to sexual behaviour?\",\"datePublished\":\"2013-02-11T15:15:44+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/02\\\/11\\\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\\\/\"},\"wordCount\":591,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"Epidemiology\",\"HPV\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/02\\\/11\\\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/02\\\/11\\\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2013\\\/02\\\/11\\\/hpv-re-activation-in-older-women-an-increased-cancer-risk-unrelated-to-sexual-behaviour\\\/\",\"name\":\"HPV re-activation in older women: an increased cancer risk unrelated to sexual behaviour? 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