Smoking increases the risk of human papillomavirus infection in women

Two studies confirm the harmful effects of smoking in women on the frequency and progression of human papillomavirus (HPV) infections. The risk of HPV infection is one-third higher in female smokers, and they clear the virus from the cervix more slowly. Preventing smoking initiation and encouraging smoking and nicotine cessation are the first steps in prevention.

Human papillomavirus (HPV) infection is extremely common. It can cause several types of cancer, particularly cervical cancer (3,000 new cases with 1,000 deaths per year in France), but also ENT, penile, and anal cancers.

Smoking is a known factor in HPV infection. Among the 4,500 chemical compounds in tobacco smoke, several dozen are carcinogenic, including benzopyrenes and nitrosamines. Meanwhile, cotinine, the main metabolite of nicotine, has a local immunosuppressive effect and appears to be particularly concentrated in cervical mucus, suggesting its possible effect on the persistence of HPV infection.[1].

Smoking increases the risk of human papillomavirus infection

Two studies have recently highlighted the impact of tobacco on HPV infection. The first, based on the National Health and Nutrition Examination Survey (NHANES), analyzed data collected between 2011 and 2016 on 3,833 women representative of US women aged 18 to 59, of whom approximately 65 were exposed to active and/or passive smoking.[2]Overall, after taking into account other known risk factors, the observed frequency of papillomavirus infection was 32 % higher in the latter compared to unexposed women, and this frequency was 70 % higher in active smokers.

The second study involved 80 women followed for two years at the Shanghai General Hospital, and who, at the start of the study, had a genital papillomavirus infection, including 20 smokers and 60 non-smokers.[3]After adjustment for other known risk factors, genital virus clearance was half as common among female smokers.[4] than in non-smokers, and this negative effect was a function of the duration of smoking in years, the frequency of days of smoking per month and the number of cigarettes smoked per day.

Smoking cessation recommended for prevention of HPV infections

The authors of these two studies emphasize the importance of preventing and treating smoking; for L. Jiang et al " It is evident that active and passive smoke exposure should be prevented to reduce the risk of high-risk HPV infection. ", and for K Ma et al the two main risk factors for the occurrence of cervical cancer being HPV infection and tobacco, it is desirable to "reiterate to HPV-positive women the advice to reduce or stop smoking ".

Keywords: human papillomavirus, HPV, tobacco, nicotine, cotinine

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[1] Mergui JL, Tobacco and HPV: an aggravating factor?, Gynéco Online, October 2023, consulted on 1^er February 2024.

[2] Jiang, L., Ma, S., Zhang, G. et al. Analysis of tobacco exposures and high-risk HPV infection in American women: National Health and Nutrition Examination Survey. Environ Sci Pollut Res, 2023, 30, 110489–110498.

[3] Ma K, Li S, Wu S, Zhu J, Yang Y. Impact of smoking exposure on human papillomavirus clearance among Chinese women: A follow-up propensity score matching study. Tob Induc Dis. 2023 Mar 20;21:42. doi:10.18332/tid/161026. PMID: 36949733; PMCID: PMC10026377.

[4] The body's ability to eliminate a substance.