Sexual behaviour and HPV in young women. The pre-vaccine era.

Abstract

Worldwide mass vaccination with HPV vaccines will most certainly change HPV epidemiology. Monitoring these changes on a population level may prove crucial in assessing overall HPV vaccine efficacy. To provide a basis for understanding possible future shifts in genotypes, as well as to provide insight in the HPV epidemiology of a target group for vaccination now and in the future, the prevalence, incidence and clearance rates of specific HPV types must be determined before vaccination takes place. Chapter 2 describes the Dutch situation of HPV prevalence and related risk factors among young women prior to mass vaccination. Chapter 3 assesses risk factors for acquiring new HPV infections as well as factors associated with clearance of HPV infections. As women age, they are more likely to have engaged in sexual activity resulting in exposure to HPV. Therefore, their clinical benefit of HPV vaccination is likely to be less than that of younger sexually naïve women. Advising women on their personal benefit from vaccination will result in estimating ones individual risk of already being HPV 16/18 positive. To provide a guideline to estimate ones individual risk, a decision-aid based on young women’s risk factors and prevalent HPV infections is designed and discussed in Chapter 6. Children in the primary target group for vaccination are under age and parental consent will be required. Assessing predictors of intention to receive the vaccine as well as assessing knowledge about HPV will be important to create effective vaccination campaigns and reach high vaccine coverage. These issues are addressed in chapter 4 and 5. To meet the new post-vaccination screening requirements, the CSP may need transformation. Cervico-vaginal self-sampling may be an easy accessible, user-friendly and timesaving alternative for the physician-based collection of material. Chapter 7 reports the efficiency of HPV detection using a new method of sample storage, transportation and processing.