Objective: To investigate the prevalence of multiple infections of human papillomavirus (HPV) and its relationship with cervical neoplasia among Chinese women in urban areas.
Methods: A population-based cross-sectional study was performed among 1712 women (1027 in Shenzhen, Guangdong province and 685 in Shenyang, Liaoning province, respectively) aged 15 - 59 years in China. One community was chosen by cluster sampling in each city. Exfoliated cervical cell was collected and HPV types were detected.
Results: The total HPV prevalence of multiple infections was 4.73% (81/1712). There was no significant difference of HPV infection between two cities (Shenzhen vs Shenyang: 4.38% (45/1027) vs 5.26% (36/685); chi(2) = 0.70, P = 0.404). Among all multiple infections, HPV16-related infection was the most common one, accounting for 23.46% (19/81), followed by HPV52 and 58 (19.75% for each, 16/81). HPV prevalence of multiple infections were 3.42% (55/1606), 17.39% (12/69) and 37.84% (14/37) among the women with normal cervix, low-grade lesion and high-grade lesion, respectively. The HPV prevalence of multiple infections increased with the severity of cervical neoplasia (Z = 9.38, P = 0.01). The risk of high-grade lesion increased more dramatically among the women with multiple infections than single infections (adjusted OR = 96.61, 95%CI: 32.07 - 291.06 vs adjusted OR = 34.60, 95%CI: 12.59 - 95.02 for multiple and single infections, respectively). However, the risk of low-grade lesion increased relatively similarly among the women with the multiple and single infections (OR = 15.00, 95%CI: 6.89 - 32.65 vs OR = 12.04, 95%CI: 6.88 - 21.08 for multiple and single infections, respectively). Multiple-sexual-partner was the key risk factor for multiple infection of HPV (OR = 2.04, 95%CI: 1.19 - 3.49).
Conclusion: Multiple infections may play a higher role than single infection in the development of cervical neoplasia. Multiple HPV infections could be introduced into the strategy for cervical cancer prevention as a possible biomarker.