An investigation of the natural history of early cervical human papillomavirus infection and its relationship to the acquisition of epithelial abnormalities of the cervix

Cervical human papillomavirus (HPV) infection is a very common sexually transmitted disease which is now considered to be a necessary, but not sufficient, cause of cervical cancer. It has been suggested that the association between HPV infection and cervical neoplasia can be exploited to improve the efficiency and effectiveness of primary- and secondary-prevention programmes for cervical cancer. However, whether this aspiration can be realized in practice requires a greater understanding of the natural history of early cervical HPV infection and its role in the acquisition of epithelial abnormalities of the cervix. In this thesis, a longitudinal study of young women who had recently embarked on sexual activity has provided sequential observations on the natural history of cervical HPV infection. This thesis addresses four aspects of this natural history: the association between HPV infection and the proximity of first sexual intercourse to menarche; the association between smoking, cervical HPV infection and high-grade cervical disease; the validation of a neutralising antibody assay and its use in defining the kinetics of the humoral immune response to cervical HPV16 and HPV18 infections; and the analysis of measurements of the viral load of HPV16 and HPV18, and their association with epithelial abnormalities of the cervix