To Örebro University

BACKGROUND: Users of intrauterine devices (IUDs) have been found to have a lower incidence of cervical cancer in meta-analyses, but these studies have not been able to examine the influence of IUD type. The aim of this study is to investigate the incidence of de novo high-risk human papillomavirus (HPV) infections in relation to the reported use of contraceptive methods, with special regard to different types of IUDs.

METHODS: A sample of participants in the national screening program for cervical cancer (n = 11,702) with a negative HPV test in 2017-2018 were included. Their subsequent HPV test results in 2020-2023 were analyzed in relation to their reported contraceptive method.

RESULTS: Participants who reported use of hormonal contraception had higher incidence of a positive HPV screening test (5.6%) compared with women with no reported contraception (4.2%) (OR 1.29; 95% CI 1.01-1.64). There was no significant difference in HPV incidence among women who reported use of hormonal IUD (HIUD) or copper-containing IUD (CU-IUD). Women who reported use of the same contraceptive method in both screening rounds showed no significant differences in HPV incidence, regardless of the contraceptive method they had used.

CONCLUSION: The incidence of de novo HPV infections is not significantly different in users of different types of IUD.

OBJECTIVE: To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods.

METHODS: A cross-sectional register-based study including 16,181 women aged 30-49 years participating in the screening programme for cervical cancer in a Swedish County in 2017-2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test.

RESULTS: There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04-1.41, and aOR 1.41; 95% CI 1.22-1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02-2.06, and aOR 1.56; 95% CI 1.13-2.16, respectively). No significant differences were found in HPV clearance rates.

CONCLUSIONS: Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception.

The screening program for cervical cancer in Sweden, recommends screening with HPV test primarily for women over 30 years, but at the first screening test that is performed after the age of 40, both HPV test and cytology is recommended, so-called co-testing. The aim of this study was to examine how many cases of HPV negative cervical dysplasia that were found in this age-group, to be able to estimate the value of adding a co-test in an HPV screening program. A retrospective study of all abnormal cytological samples found in the cytology based screening program in the age group 41-45 years during the years 2012-2016 in the Region of center dot Orebro County was performed. Out of the 10,511 women included in the study, 468 had an abnormal cytology screening test and 255/468 were HPV negative. The vast majority of the HPV negative cases had a normal cytology test as first follow-up. Of cases with remaining cytological abnormality, only four cases had histologically confirmed highgrade cervical dysplasia (CIN2) and no cases of HPV negative adenocarcinoma in situ or invasive cancer were found. Conclusion: With adding a single co-test to a HPV-based screening program, only a few extra cases of highgrade cervical dysplasia were found and the clinical significance of these cases is unclear.