Smoking increases the risk of papillomavirus infection in women

Two studies confirm the harmful effect of smoking in women on the frequency and progression of human papillomavirus (HPV) infections. The risk of papillomavirus infection is one third higher in smokers, and they eliminate the virus more slowly from the cervix. Avoiding 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 papillomavirus infection. Among the 4,500 chemical compounds contained in tobacco smoke, several dozen are carcinogenic, including benzopyrenes and nitrosamines. At the same time, cotinine, which is the main metabolite of nicotine, has a local immunosuppressive effect, and seems to be particularly concentrated in cervical mucus, which suggests its possible effect on the persistence of papillomavirus infection.[1].

Smoking increases the risk of HPV 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 with unexposed women, and this frequency was 70% higher in active smokers.

The second study involves 80 women followed for two years at the Shanghai General Hospital, and carriers, at the start of the study, of a genital papillomavirus infection, including 20 smokers and 60 non-smokers.[3]After adjusting for other known risk factors, genital viral shedding 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 insist on the interest of prevention and treatment of smoking; for L. Jiang et al “ It is evident that active and passive exposure to smoke should be prevented to reduce the risk of high-risk HPV infection ", and for K Ma et al The two main risk factors for 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

M.F.

[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.