Long term persistency of HPV-HR infections is an essential step in the genesis of cervical cancer. Persistency seems to be rare in young women but the type specific clinical course of HR-infections in young women is still not fully understood.
WOLVES (Wolfsburg HPV epidemiological study) invited all women born 1988/89 with a first residency in Wolfsburg to participate. Participants were followed with annual examinations from 2009/10 till 2014/15.
Between Oct 2009 and Mar 2014, 990 women were recruited, the HC2 prevalence was 308/1181 (26.1%). Among HC2- women the rate of new infections (HC2+) was 15.7 % (98/623) in the first, 13.4% (52/389) in the second, 10.0% (22/219) in the third and 8.4% (10/119) in the fourth year of follow-up. Overall HPV persistency occurred in 17.3% (148/857) in the first, 13.2% (84/638) in the second, 9.5% (42/441) in the third and 7.5% (19/253) in the fourth year of follow up.
In women with initially negative HPV result (n=848) 182 were tested HPV positive once in 5 year follow up with biopsy proven CIN2+ (0.36%). In HPV positive women (n=308) the risk for CIN2+ into 5 years was 11.7% (n=36). In infections that persisted for one or more follow up visits (n=149), HPV 16 (n=37) / HPV 51 (n=20) / HPV 31 (13) showed the highest numbers and resembled the type distribution among CIN2 cases, while all CIN3 cases were linked to HPV 16.
Spontaneous clearance was lower than reported by others, while HC2- and type specific persistency were more common than expected. Only less than one in two prevalent HPV infections was cleared within two years. We conclude that the risk of HPV persistency in young women may be higher than assumed.