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American Journal of Epidemiology Advance Access originally published online on January 18, 2006
American Journal of Epidemiology 2006 163(6):534-543; doi:10.1093/aje/kwj077
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American Journal of Epidemiology Copyright © 2006 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

Modeling the Sexual Transmissibility of Human Papillomavirus Infection using Stochastic Computer Simulation and Empirical Data from a Cohort Study of Young Women in Montreal, Canada

Ann N. Burchell1,2, Harriet Richardson1,3, Salaheddin M. Mahmud1,4, Helen Trottier1, Pierre P. Tellier5, James Hanley2, François Coutlée6 and Eduardo L. Franco1,2

1 Department of Oncology, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
2 Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
3 Division of Cancer Care and Epidemiology, Faculty of Medicine, Queen's University, Kingston, Ontario, Canada
4 Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
5 Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
6 Département de Microbiologie, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada

Correspondence to Dr. Eduardo Franco, Division of Cancer Epidemiology, McGill University, 546 Pine Avenue West, Montreal, Quebec, Canada H2W 1S6 (e-mail: eduardo.franco{at}mcgill.ca).

The authors estimated plausible ranges of the probability of human papillomavirus (HPV) transmission per coital act among newly forming couples by using stochastic computer simulation. Comparative empirical data were obtained in 1996–2001 from a cohort study of female university students in Montreal, Canada. Female prevalence and frequency of sexual intercourse and condom use were set equal to those in the cohort. Simulations included 240 combinations of male prevalence, the relative risk for protected versus unprotected sex, and per-act transmission probabilities. Those that produced expected HPV incidence within the 95% confidence interval observed in the cohort were selected. The observed 6-month cumulative incidence following acquisition of a new partner was 17.0% (95% confidence interval: 11.4, 23.0). Expected incidences consistent with those from cohort findings occurred in 54/240 simulations. The range of per-act transmission probabilities was 5–100% (median, 40%). Male HPV prevalence was the same as or greater than that for women in all consistent simulations. Varying condom effectiveness did not produce better-fitting data. This simulation suggests that HPV transmissibility is several-fold higher than that for other viral sexually transmitted infections such as human immunodeficiency virus or herpes simplex virus 2. With high transmissibility, any potential protective effect of condoms would disappear over multiple intercourse acts, underlining the need for an effective HPV vaccine.

disease transmission; papillomavirus, human; sexually transmitted diseases; uterine cervical neoplasms

Abbreviations: HIV, human immunodeficiency virus; HPV, human papillomavirus; STI, sexually transmitted infection


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