Human papillomavirus infection and cervical cytology in women screened for cervical cancer in the United States, 2003-2005.

BACKGROUND

Millions of women in the United States receive cervical screening in sexually transmitted disease (STD), family planning, and primary care clinical settings.

OBJECTIVE

To inform current cervical screening programs.

DESIGN

Measurement of abnormal Papanicolaou (Pap) tests and high-risk human papillomavirus (HPV) infection among demographically diverse women who received routine cervical screening from January 2003 to December 2005 in the United States.

SETTING

26 STD, family planning, and primary care clinics in 6 U.S. cities.

PATIENTS: 9657 women age 14 to 65 years receiving routine cervical screening.

MEASUREMENTS: Pap test results and high-risk HPV prevalence by Hybrid Capture 2 assay (Digene, Gaithersburg, Maryland).

RESULTS

Among 9657 patients, overall high-risk HPV prevalence by Hybrid Capture 2 testing was 23% (95% CI, 22% to 24%). Prevalence was highest among women age 14 to 19 years (35% [CI, 32% to 38%]) and lowest among women age 50 to 65 years (6% [CI, 4% to 8%]). Prevalence by clinic type (adjusted for age and city) ranged from 26% (CI, 24% to 29%) in STD clinics to 17% (CI, 16% to 20%) in primary care clinics. Women younger than 30 years of age whose Pap test showed atypical squamous cells of undetermined significance had a high-risk HPV prevalence of 53%; women 30 years of age or older with normal Pap tests had a 9% prevalence. Values did not vary substantially by clinic type.

LIMITATION: Hybrid Capture 2 and Pap testing were noncentralized, and consent was required for enrollment.

CONCLUSION

High-risk HPV was widespread among women receiving cervical screening in the United States. Many women 30 years of age or older with normal Pap tests would need follow-up if Hybrid Capture 2 testing is added to cytology screening.