Open Access Highly Accessed Research article

Predictors of human papillomavirus infection in women undergoing routine cervical cancer screening in Spain: the CLEOPATRE study

Esther Roura1, Thomas Iftner2, José Antonio Vidart3, Susanne Krüger Kjaer45, F Xavier Bosch1, Nubia Muñoz6, Santiago Palacios7, Maria San Martin Rodriguez8, Carmen Morillo8, Laurence Serradell9, Laurence Torcel-Pagnon9, Javier Cortes10, Xavier Castellsagué1* and , for the CLEOPATRE Spain Study Group

Author Affiliations

1 Cancer Epidemiology Research Program, Institut Català d’Oncologia (ICO)-IDIBELL, CIBER-ESP, RTICC, L’Hospitalet de Llobregat, Barcelona, Catalonia, Spain

2 Medical Virology, Section Experimental Virology, University Hospital of Tübingen, Tübingen, Germany

3 Gynaecology Department, Hospital Clínico San Carlos, Madrid, Spain

4 Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark

5 Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

6 Emeritus Professor at the National Cancer Institute, Bogotá, Colombia

7 Instituto Palacios, Madrid, Spain

8 Medical Department, Sanofi Pasteur MSD, Madrid, Spain

9 Epidemiology Department, Sanofi Pasteur MSD, Lyon, France

10 Senior Consultant in Gynaecology Oncology, Spanish Society of Obstetrics and Gynaecology, Palma de Mallorca, Islas Baleares, Spain

For all author emails, please log on.

BMC Infectious Diseases 2012, 12:145  doi:10.1186/1471-2334-12-145

Published: 26 June 2012



Human papillomavirus (HPV) is a sexually transmitted infection that may lead to development of precancerous and cancerous lesions of the cervix. The aim of the current study was to investigate socio-demographic, lifestyle, and medical factors for potential associations with cervical HPV infection in women undergoing cervical cancer screening in Spain.


The CLEOPATRE Spain study enrolled 3 261 women aged 18–65 years attending cervical cancer screening across the 17 Autonomous Communities. Liquid-based cervical samples underwent cytological examination and HPV testing. HPV positivity was determined using the Hybrid Capture II assay, and HPV genotyping was conducted using the INNO-LiPA HPV Genotyping Extra assay. Multivariate logistic regression was used to identify putative risk factors for HPV infection.


A lifetime number of two or more sexual partners, young age (18–25 years), a history of genital warts, and unmarried status were the strongest independent risk factors for HPV infection of any type. Living in an urban community, country of birth other than Spain, low level of education, and current smoking status were also independent risk factors for HPV infection. A weak inverse association between condom use and HPV infection was observed. Unlike monogamous women, women with two or more lifetime sexual partners showed a lower risk of infection if their current partner was circumcised (P for interaction, 0.005) and a higher risk of infection if they were current smokers (P for interaction, 0.01).


This is the first large-scale, country-wide study exploring risk factors for cervical HPV infection in Spain. The data strongly indicate that variables related to sexual behavior are the main risk factors for HPV infection. In addition, in non-monogamous women, circumcision of the partner is associated with a reduced risk and smoking with an increased risk of HPV infection.

HPV infection; Prevalence; Risk factors; Sexual behavior; Questionnaire; Spain