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Sexually Transmitted Diseases and Other Risk Factors for Cervical Dysplasia Among Southwestern Hispanic and Non-Hispanic White Women

Thomas M. Becker, MD; Cosette M. Wheeler, PhD; Nancy S. McGough, CNP; Cheryl A. Parmenter; Scott W. Jordan, MD; Christine A. Stidley, PhD; R. Sue McPherson, PhD; Maxine H. Dorin, MD
JAMA. 1994;271(15):1181-1188. doi:10.1001/jama.1994.03510390051029.
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Objective.  —To assess risk factors for high-grade cervical dysplasia among southwestern Hispanic and non-Hispanic white women.

Design.  —Clinic-based case-control study.

Setting.  —University-affiliated gynecology clinics.

Subjects.  —Cases were Hispanic and non-Hispanic white women with biopsy-proven high-grade cervical dysplasia (n=201). Controls were Hispanic and non-Hispanic white women from the same clinics with normal cervical epithelium (n=337).

Methods.  —Study design included interviews focused on histories of sexually transmitted diseases, sexual behavior, reproductive histories, hygienic practices, contraceptive use, cigarette smoking, and diet. Laboratory studies included bacterial and protozoal cultures of the cervix; hybridization tests to identify human papillomavirus (HPV) genome with commercial (ViraPap and ViraType) and polymerase chain reaction—based assays; and serum antibody tests for herpes simplex virus, Chlamydia trachomatis, syphilis, hepatitis B, and hepatitis C.

Results.  —For both ethnic groups combined, after adjustment for ethnicity, age, and sexual behavior, the strongest risks for cervical dysplasia were associated with cervical HPV infection as identified by ViraPap (odds ratio [OR], 12.8; 95% confidence interval [Cl], 8.2 to 20.0) or with polymerase chain reaction (OR, 20.8; 95% Cl, 10.8 to 40.2). Other factors associated with dysplasia included cigarette smoking at the time of diagnosis (OR, 1.8; 95% Cl, 1.2 to 2.8); low income (OR, 2.2; 95% Cl, 1.2 to 4.0); low educational level (OR, 6.2; 95% Cl, 3.4 to 11.1); history of any sexually transmitted disease (OR, 1.9; 95% Cl, 1.3 to 2.7); and seroprevalence of antibodies to hepatitis B (OR, 1.8; 95% Cl, 0.9 to 3.5). For Hispanic women, HPV 16/18 identified by ViraType was strongly associated with cervical dysplasia (OR, 171.0; 95% Cl, 22.8 to 1280.5). Antibodies to herpes simplex virus type 2 were not associated with dysplasia in Hispanic women but were significantly associated with dysplasia among non-Hispanic whites. Risks associated with cigarette smoking also varied by ethnic group.

Conclusions.  —The strongest risk factor associated with high-grade cervical dysplasia among clinic attendees was HPV infection. Although most of the risk factors we examined showed similar associations for dysplasia for both ethnic groups, our data suggest that several different risk factors may be relevant to the development of cervical dysplasia in Hispanics compared with non-Hispanic whites who attend the same clinics.(JAMA. 1994;271:1181-1188)


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