Importance of Lifetime Sexual History on the Prevalence of Genital Human Papillomavirus (HPV) Among Unvaccinated Adults in the National Health and Nutrition Examination Surveys: Implications for Adult HPV Vaccination

Abstract

Abstract Background Although the United States Food and Drug Administration recently approved the human papillomavirus (HPV) vaccine for individuals aged 27–45 years, the Centers for Disease Control and Prevention did not change its guidelines for routine HPV vaccination. Since recommendations for adult vaccination emphasize shared clinical decision-making based on risk of new infections, we examined the relationship between HPV prevalence and sexual behavior. Methods This study was conducted among 5093 HPV-unvaccinated, sexually experienced adults aged 18–59 years in the National Health and Nutrition Examination Surveys (2013–2016). For each sex and age group, adjusted prevalences of 9-valent vaccine–specific, high-risk, and any HPV infection were estimated by number of lifetime sexual partners (LTSPs) using logistic regression. An analysis restricted to persons who did not have a new sexual partner in the past year (ie, removing those at highest risk of newly acquired HPV) was also conducted. Results In each age group, genital HPV prevalence was higher among persons with >5 LTSPs compared with 1–5 LTSPs in both males and females. There were only slight reductions in HPV prevalence after removing participants who reported a new sexual partner in the past year. For example, among females aged 27–45 years with >5 LTSPs, the adjusted prevalence of 9-valent vaccine–type HPV infection was 13.4% (95% confidence interval [CI], 9.9%–17.0%) in the full population compared to 12.1% (95% CI, 8.8%–15.4%) among those with no new sexual partners. Conclusions Prevalent HPV infection was primarily reflective of cumulative exposures over time (higher LTSPs). New exposures had limited impact, emphasizing the need to consider sexual history in the decision-making process for adult HPV vaccination.