The association between viral load and concurrent human papillomavirus infection at the genital and anal sites of young women and the impact of vaccination

PHS Fryslân, PHS Twente, PHS Hart voor Brabant, PHS Amsterdam, PHS Gelderland-Midden, ETZ Hospital Tilburg: A. Buiting, Erasmus Medical Center, University Medical Center Utrecht, Public Health Laboratory Amsterdam, Maastricht University Medical Center, Jeroen Bosch Hospital, Radboud University Medical Center, LabMicTA, Medical Laboratory dr. Stein and Collegae, Canisius Wilhelmina Hospital, Public Health Services: PHS Drenthe, PHS IJsselland, PHS Gelderland-Zuid, PHS Rotterdam-Rijnmond, PHS GroningenPHS Zuid Limburg

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Concurrent genital-anal human papillomavirus (HPV) infections may impose an increased anal cancer risk in women with HPV-related genital lesions. High viral load may facilitate genital-anal HPV concurrence. Genital and anal HPV is reduced by a bivalent HPV16/18 vaccine, yet the effect on concurrent genital-anal HPV remains unclear. This study analyzed viral load in concurrent genital-anal HPV infections, relative to genital-only and anal-only HPV infections and the impact of vaccination in young women. We included 1074 women, who provided both genital and anal swabs. HPV detection and genotyping was performed using the SPF10-DEIA-LiPA25. HPV copy numbers were measured with type-specific qPCRs and corrected for cellular content to obtain the viral load. Concurrent genital-anal HPV often had significantly higher genital viral load (0.09–371 c/cell) than genital-only HPV (3.17E-04-15.9 c/cell, p < 0.0001 to p < 0.05). Moreover, nearly all concurrent genital-anal HPV types had higher genital copy numbers per PCR reaction (157-416E04 c/rxn) than anal copy numbers (0.90–884E01 c/rxn, p < 0.0001 to p < 0.001). Vaccinated women had significantly less infections with HPV16/18 vaccine-types (2.8% vs 13.7%, p < 0.0001) and HPV31/35/45 cross-protective types (7.4% vs 21.1%, p < 0.0001) than unvaccinated women. In conclusion, particularly high genital viral load is found in concurrent genital-anal HPV infections, which are effectively reduced by vaccination.

Original languageEnglish
Article number200233
JournalTumour virus research
Early online date24 Dec 2021
Publication statusPublished - 1 Jun 2022


  • Anal
  • Concurrent
  • Genital
  • Human papillomavirus
  • Vaccination
  • Viral load

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