Adolescents are the primary cohort for routine human papillomavirus (HPV) vaccination, but unvaccinated adults may also benefit. A lack of consensus on which adults to target and the presence of reimbursement barriers likely contribute to the lag in adult vaccinations, highlighting missed prevention opportunities. Understanding factors contributing to risk of HPV infection and disease could help in decision making on vaccination at an individual level. This review summarizes existing literature on risk factors for HPV infection and disease and includes 153 studies reporting relative risks or odds ratios for factors associated with HPV infection or disease in adults, published between 2009 and 2020. Despite inconsistent design and reporting of risk factors across studies, this review confirmed several risk factors associated with adult infection, including HIV positivity, number of sex partners, and smoking. These findings can support policymaking, guideline development, and clinical decision making for HPV vaccination and screening of high-risk adult groups.

Objective: To build the population-based norms for the Human-Papillomavirus-Quality-of-Life (HPV-QoL) questionnaire, which measures the impact of HPV on Health-Related Quality of Life (HR-QoL). Design: A cross-sectional, nationwide, multicenter study Setting: Spain Population: Women from outpatient clinics ranging from 25 to 65 years of age, with past or active HPV infection diagnosis Methods: Central tendency, dispersion and percentiles were calculated for the total score and its dimensions in age groups. Construct validity was tested with the analysis of age strata groups and correlations with other related scales (12-Item General Health Questionnaire (GHQ-12, Female Sexual Function Index (FSFI) and Hospital Anxiety and Depression Scale (HADS)). Main outcome measures: Validity of the population-based norms for the HPV-QoL questionnaire. Results: We recruited 1,352 women. The norms showed moderate and significant coefficients of correlation with other related scales. Significant differences between age strata groups were found according to educational level, sexual dysfunction, sexual activity, mental deterioration, and severity of anxiety and depression symptoms (p<0.001 in all cases). Total score differed significantly between those groups (p=0.006). Significant differences in contagiousness, health and sexuality dimensions (p<0.05) were found among age groups. HPV infection impaired women’s QoL. Dimensions within all test age groups (p<0.001 in all cases) had significant differences, being health-dimension the highest contributor to women’s QoL impairment, while social well-being was the main determinant improving QoL. Conclusions: Population-based norms for the novel HPV-QoL questionnaire show adequate validity, a valid tool for assessment of the impact of HPV infection in women QOL in Spain.

Objective: To evaluate whether E7 mRNA can predict the risk of progression in women with HPV16 infection. Design: prospective observational study Setting: Tertiary university hospital Population: A cohort of 139 women referred to colposcopy for an abnormal screening result fulfilling the following inclusion criteria: 1) a positive test result confirming HPV16 infection; 2) a biopsy sample with a histological diagnosis of absence of lesion or low-grade SIL/CIN grade1 (LSIL/CIN1); 3) no previous HPV vaccination; 4) no pregnancy; and 5) no previous cervical treatments; and 6) no immunosuppression. Methods: At the first visit all women underwent a cervical sample for liquid-based cytology, HPV testing and genotyping, and HPV16 E7 mRNA analysis and a colposcopy with at least one colposcopy-guided biopsy. Follow-up visits were scheduled every six months. In each control a liquid-based Pap smear, HPV testing, as well as a colposcopy examination with biopsy if necessary were performed. Main outocome measures: Histological diagnosis of HSIL/CIN2+ at any time during follow-up Results: E7 mRNA expression was positive in 55/127 (43.3%) women included in the study and seven (12.7%) progressed to HSIL/CIN2+. In contrast, only 1/72 (1.4%) women with no HPV16 E7 mRNA expression progressed (p=0.027). HPV16 E7 mRNA expression was associated with a 10-fold increased risk of progression (HR 10.0; 95%CI 1.2-81.4). Conclusions: HPV16 E7 mRNA could be useful for risk stratification of women with HPV16 infection in whom a HSIL/CIN2+ has been ruled out.