Advertisement

The effect of intrauterine devices on acquisition and clearance of human papillomavirus

Published:December 13, 2016DOI:https://doi.org/10.1016/j.ajog.2016.11.1053

      Background

      Previous studies have shown a decrease in cervical cancer associated with intrauterine device use. It has been hypothesized that intrauterine device use may alter the natural history of human papillomavirus infections, preempting development of precancerous lesions of the cervix and cervical cancer, but the effect of intrauterine devices on the natural history of human papillomavirus infection and subsequent development of cervical cancer is poorly understood.

      Objective

      The purpose of this study was to evaluate the association between intrauterine device use and cervical high-risk human papillomavirus acquisition and clearance.

      Study Design

      This is a prospective cohort study conducted from October 2000 through June 2014 among 676 sexually active young women and girls enrolled from family planning clinics in San Francisco, CA. Data were analyzed using a Cox proportional hazards model, including time-varying indicators of intrauterine device use, and adjusting for fixed and time-dependent predictor variables.

      Results

      A total of 85 women used an intrauterine device at some time during follow-up. Among 14,513 study visits, women reported intrauterine device use at 505 visits. After adjusting for potential behavioral confounders, there was no association between intrauterine device use and human papillomavirus acquisition (hazard ratio, 0.50; 95% confidence interval, 0.20–1.23; P = .13) or clearance of human papillomavirus infection (hazard ratio, 1.44; 95% confidence interval, 0.76–2.72; P = .26).

      Conclusion

      Current intrauterine device use is not associated with acquisition or persistence of human papillomavirus infection. Intrauterine device use is safe among women and girls with human papillomavirus infections and at risk for human papillomavirus acquisition. Intrauterine device use may play a role further downstream in the natural history of cervical cancer by inhibiting the development of precancerous lesions of the cervix in human papillomavirus–infected women, or enhancing clearance of established precancerous lesions.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dunne E.F.
        • Markowitz L.E.
        • Saraiya M.
        • et al.
        CDC grand rounds: reducing the burden of HPV-associated cancer and disease.
        MMWR Morb Mortal Wkly Rep. 2014; 63: 69-72
        • Bosch F.X.
        • Lorincz A.
        • Munoz N.
        • Meijer C.J.
        • Shah K.V.
        The causal relation between human papillomavirus and cervical cancer.
        J Clin Pathol. 2002; 55: 244-265
        • Future II Study Group
        Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions.
        N Engl J Med. 2007; 356: 1915-1927
        • Castellsague X.
        • Diaz M.
        • Vaccarella S.
        • et al.
        Intrauterine device use, cervical infection with human papillomavirus, and risk of cervical cancer: a pooled analysis of 26 epidemiological studies.
        Lancet Oncol. 2011; 12: 1023-1031
        • Ortiz M.E.
        • Croxatto H.B.
        Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action.
        Contraception. 2007; 75: S16-S30
        • Scott M.E.
        • Shvetsov Y.B.
        • Thompson P.J.
        • et al.
        Cervical cytokines and clearance of incident human papillomavirus infection: Hawaii HPV cohort study.
        Int J Cancer. 2013; 133: 1187-1196
        • Fernandes J.V.
        • De Medeiros Fernandes T.A.
        • De Azevedo J.C.
        • et al.
        Link between chronic inflammation and human papillomavirus-induced carcinogenesis (review).
        Oncol Lett. 2015; 9: 1015-1026
        • Moscicki A.B.
        • Shiboski S.
        • Hills N.K.
        • et al.
        Regression of low-grade squamous intra-epithelial lesions in young women.
        Lancet. 2004; 364: 1678-1683
        • Farhat S.
        • Scott M.E.
        • Ma Y.
        • Moscicki A.B.
        Development of a novel liquid bead array human papillomavirus genotyping assay (PGMY-LX) and comparison with linear array for continuity in longitudinal cohort studies.
        J Clin Microbiol. 2015; 53: 1270-1276
        • Hernan M.A.
        • Alonso A.
        • Logan R.
        • et al.
        Observational studies analyzed like randomized experiments: an application to postmenopausal hormone therapy and coronary heart disease.
        Epidemiology. 2008; 19: 766-779
        • Molano M.
        • Van den Brule A.
        • Plummer M.
        • et al.
        Determinants of clearance of human papillomavirus infections in Colombian women with normal cytology: a population-based, 5-year follow-up study.
        Am J Epidemiol. 2003; 158: 486-494
        • Nielsen A.
        • Kjaer S.K.
        • Munk C.
        • Osler M.
        • Iftner T.
        Persistence of high-risk human papillomavirus infection in a population-based cohort of Danish women.
        J Med Virol. 2010; 82: 616-623
        • Silins I.
        • Ryd W.
        • Strand A.
        • et al.
        Chlamydia trachomatis infection and persistence of human papillomavirus.
        Int J Cancer. 2005; 116: 110-115
        • Stensen S.
        • Kjaer S.K.
        • Jensen S.M.
        • et al.
        Factors associated with type-specific persistence of high-risk human papillomavirus infection: a population-based study.
        Int J Cancer. 2016; 138: 361-368
        • Lekovich J.P.
        • Amrane S.
        • Pangasa M.
        • et al.
        Comparison of human papillomavirus infection and cervical cytology in women using copper-containing and levonorgestrel-containing intrauterine devices.
        Obstet Gynecol. 2015; 125: 1101-1105
        • Johannisson E.
        Mechanism of action of intrauterine devices: biochemical changes.
        Contraception. 1987; 36: 11-22