The Natural History of Human Papillomavirus Infection and Cervical Intraepithelial Neoplasia Among Young Women in the Guanacaste Cohort Shortly After Initiation of Sexual Life

In Brief Objective: Cross-sectional analyses of our 10,000-woman, population-based Guanacaste cohort suggest a lag of ≥10 years between the peak of human papillomavirus (HPV) infection and the later peak of cervical intraepithelial neoplasia grade 3 (CIN 3). We wanted to explore early HPV natural history and CIN 3 prospectively. Study Design: As part of the Guanacaste cohort, we followed 206 initially virginal women aged 18 to 26 semiannually for a median of 3.6 years after initiation of sexual life. Results: A total of 53.4% of women tested positive during the study for ≥1 HPV type. Very few infections persisted for >1 to 2 years. Three women had histologically confirmed CIN 3, of which 2 showed persistent HPV 16. The other had serologic evidence of HPV 31. Conclusions: HPV infection occurs frequently and clears rapidly in most young women initiating sexual intercourse. Persistent HPV 16 can cause early CIN 3. The peak age for CIN 3 will decline with the increased screening intensity and sensitivity typical of longitudinal studies. Human papillomavirus infection was very common in women shortly after their sexual debut. Most infections cleared rapidly; however, a few caused cervical intraepithelial neoplasia 3 lesions within 4 years (3 in 110 infections).