Sequential Acquisition of Human Papillomavirus Infection at Genital and Anal Sites, Liuzhou, China

Emerg Infect Dis. 2020 Oct;26(10):2387-2393. doi: 10.3201/eid2610.191646.


Little is known about the risk for acquiring a concordant human papillomavirus (HPV) infection in a genital (or anal) site after an anal (or genital) HPV infection. We collected 3 sets of anogenital specimens at 6-month intervals from 2,309 men and 2,378 women in Liuzhou, China, and tested these specimens for HPV. The risk for sequential anal HPV infection in participants with a previous genital HPV infection was higher than for participants without an infection (hazard ratio [HR] 4.4, 95% CI 3.4-5.8 for women and HR 2.6, 95% CI 1.4-4.6 for men). For sequential genital HPV infection, women with a previous anal infection had a higher risk (HR 1.9, 95% CI 1.2-3.1), but no major difference was found for men (HR 0.7, 95% CI 0.2-1.9). Our study indicates that autoinoculation might play a major role in anogenital HPV transmission, in addition to direct sexual intercourse, especially for anal infection in women.

Keywords: China; HPV; anal sites; autoinoculation; genital sites; human papillomavirus; infection; observational cohort study; sequential infection; sexually transmitted infections; viruses.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anal Canal
  • China / epidemiology
  • Female
  • Genitalia
  • Humans
  • Male
  • Papillomaviridae / genetics
  • Papillomavirus Infections* / epidemiology
  • Prevalence
  • Risk Factors
  • Sexually Transmitted Diseases*