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Our understanding of the epidemiology of cervical HPV infection is derived from long interval sampled assessment of the presence of viral nucleic acid in cervical swab samples. Studies which employ more frequent sampling of the genital tract have discovered a far more dynamic natural history of HPV, which is more closely associated with microenvironmental influences of sex hormones, the microbiome, and mucosal immune function than sexual behavior. Control of highly prevalent HPV infections (with and without carcinogenic potential) may play a previously underappreciated role in overall lower genital tract health beyond the risk of neoplasia.
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