The overall aim of the present study was to assess the occurrence and correlates of genital warts in random samples of the general female population in the 4 Nordic countries. In each of the 4 countries Denmark, Iceland, Norway, and Sweden , each citizen has a unique personal identification number PIN , comprising information about sex and date of birth. These PINs are registered in a national, computerized central population registry in each country, together with information on vital status, migration, and current address on the individual level.
By use of these computerized population registries, which cover the entire population in the respective country, a random sample of women 18—45 years of age was drawn from the general female population in each country, using the PIN as the key identifier. Informed consent was obtained from each study participant.
The study was approved in each country by the data protection board and the scientific ethics committee. Our goal was to include at least 14, women in each country. The final number of invited women in each country was mostly dependent on what was logistically feasible in the respective country. From November to June , a total of 28, women were invited to participate in both Denmark and Iceland, whereas 25, women and 25, women were invited from Norway and Sweden, respectively 1 extra woman was erroneously drawn from Norway.
Women who had moved or emigrated, who had died before our contact, or who did not speak the respective Nordic language were ineligible for the study, leaving 27, Danish women, 27, Icelandic women, 24, Norwegian women, and 24, Swedish women as potential participants. A total of Danish women, Icelandic women, Norwegian women, and Swedish women explicitly stated that they did not want to participate in the study, whereas no response was obtained from Danish women, 12, Icelandic women, Norwegian women, and Swedish women.
Thus, we recruited for the study 22, Danish women participation rate, We excluded 81 women who had incomplete questionnaires or a discrepancy between their PIN and the year of birth reported, such that the population in this study consisted of 69, women 22, from Denmark, 15, from Iceland, 16, from Norway, and 15, from Sweden. For this article, we excluded women who did not answer the question about genital warts; consequently, a total of 69, women were available for the present analysis. To guarantee confidentiality for the participants, all invited women were appointed a unique study number by the national study centers.
An invitation letter and a self-administered structured questionnaire were mailed to each woman in Denmark, Iceland, and Norway. It was also possible to answer the questions by means of a Web-based questionnaire, which could be accessed using the unique study number and a personal access code, which were provided in the invitation letter in Sweden, this was initially the only option. In all 4 countries, women who did not respond within 3—4 weeks received a reminder, including the questionnaire, by postal mail.
For those who still did not respond, either the women were contacted by phone and reminded about the study Iceland or a telephone interview was conducted whenever possible Denmark, Norway, and Sweden. The telephone interview comprised the same questions as those included in the self-administered paper-or Web-based questionnaire. Via the survey, we obtained information on sociodemographic variables as well as on smoking history, alcohol intake, reproductive history, contraceptive use, and sexual habits.
In addition, we collected information on ever having had a clinical diagnosis of genital warts, genital warts during the previous 12 months, age at first diagnosis of genital warts, and previous episodes of other STIs genital chlamydial infection, gonorrhea, genital herpes, and trichomoniasis. Variables were selected on the basis of the current literature. The multivariate analysis was initially performed separately for each country; however, because the results were very similar data not shown , we included all 4 countries in 1 analysis, adjusting for country in the final statistical model.
We also examined the results restricted to each mode of response i. On the basis of information on age at first diagnosis of genital warts, the cumulative incidence of having had genital warts up to a certain age was estimated by means of the life table actuarial method, stratified by country and birth cohort. The majority of the women were married or cohabiting The median lifetime number of sex partners was 5 and the median age at first intercourse was 16 years.
A little more than 1 in 5 women reported ever having had an STD other than genital warts data not shown. A total of women The prevalence of ever having had genital warts ranged from The same pattern was reflected in the mean lifetime number of sex partners, for which Icelandic women and Norwegian women had, respectively, the highest 8. Icelandic women also had the lowest mean age at first diagnosis of genital warts Selected characteristics with regard to sexual habits and genital warts in the 4 Nordic countries.
We examined the proportion of women reporting having had genital warts during the past 12 months in relation to age of the women at enrollment in the study, and the same picture emerged in all 4 countries—namely, a decreasing proportion of women with genital warts during the past 12 months with increasing age figure 1. The proportions for all 4 countries were similar from ages 26 to 45 years, whereas younger Icelandic women were much more likely to report genital warts during the past 12 months 4.
Proportion of self-reported clinically diagnosed genital warts during the past 12 months, by age and country. In figure 2A , the cross-sectional proportion of women reporting ever having had clinically diagnosed genital warts according to birth cohort is presented for each country.
For Iceland, Norway, and Sweden, the prevalence initially increased with increasing birth cohort. However, for older birth cohorts, a lower prevalence of having had genital warts was observed.
In contrast, a continuously increasing prevalence with increasingly older birth cohorts was found among Danish women. Icelandic women born after reported a much higher prevalence of genital warts than in any other country figure 2A. Sexual activity in terms of mean lifetime number of sex partners by birth cohort in the different Nordic countries figure 2B mirrored the picture observed for the age-specific prevalence of genital warts. We observed a tendency, most pronounced for Iceland, for younger birth cohorts to report more partners than older cohorts, with the exception of women in the youngest birth cohort, who had not yet accumulated that many partners.
The pattern differed in Denmark, where the number of partners remained constant for the birth cohorts born in or before. Prevalence of self-reported clinically diagnosed genital warts A and mean lifetime no. Other important correlates included older age and a history of other STIs. In contrast, a history of genital warts was not strongly correlated with marital status data not shown , age at first sexual intercourse, number of births, and alcohol intake after adjusting for other risk factors.
The analysis of correlates associated with the risk of genital warts was also performed separately for each country, but only the analysis for all 4 countries combined is shown, because the results were similar for all countries. In addition, the overall results did not vary according to the way the women responded data not shown. Correlates of ever receiving a clinical diagnosis of genital warts among 69, women from the 4 Nordic countries. Finally, we estimated age-specific incidences of self-reported clinically diagnosed genital warts by age at first diagnosis and birth cohort.
The age-specific incidences were generally higher in Iceland, Denmark, and Sweden than in Norway.gicucasinca.tk/4602.php
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In Iceland and Norway especially, the age-specific incidence increased strongly with each subsequent younger birth cohort figure 3 , whereas in Denmark the age-specific incidence did not differ much among the birth cohorts. The biggest difference between birth cohorts was observed in Iceland, for which the age-specific incidence for the birth cohorts — and — exceeded that for all of the other countries.
Estimated cumulative incidence of self-reported clinically diagnosed genital warts, by country and birth cohort. The cumulative incidence of having had genital warts up to a certain age was estimated on the basis of information on age at first diagnosis of genital warts. In this population-based study of nearly 70, women 18—45 years of age, we found that, overall, Thus, 1 in 10 Nordic women experience the medical and psychosocial burden of genital warts, and society bears the economic burden of treatment.
The prevalence of genital warts did not differ much across the 4 Nordic countries, but these prevalences are somewhat higher than those reported in previous prevalence studies that were based on representative random population samples e.
Apart from the difference in the ages of participants between the Danish study and the present study, which can explain some of the variation, the Danish study included only women from the greater Copenhagen area, where the lifetime number of sex partners is generally higher than that for the entire country [ 17 ].
Our results for genital warts are in line with those regarding another STI, genital herpes simplex virus HSV infection, for which a recent review concluded that HSV-2 prevalence is higher in Scandinavia than in other areas of Europe [ 18 ]. The results of our study showing that Iceland had the highest prevalence of genital warts, that Sweden and Denmark had the next highest prevalence, and that Norway had the lowest prevalence is consistent with observations for genital chlamydial infection, which displays a similar pattern [ 18 ].
In 3 of the countries Iceland, Norway, and Sweden included in the present study, we found that the prevalence of genital warts was higher among the recent birth cohorts, with the pattern being most pronounced in Iceland. This could be due to a truly increased exposure to HPV among younger birth cohorts, or it could reflect differences in health-seeking behavior, implying that a higher proportion of women from younger birth cohorts have their genital warts clinically diagnosed. A similar pattern could also arise if older women were consequently more likely to forget and thus underreport episodes of genital warts.
However, in Denmark, an increasing prevalence of genital warts with increasingly older birth cohorts was observed.
Interestingly, the pattern of the mean lifetime number of sex partners according to birth cohort in the 4 countries also mirrored the pattern observed for the prevalence of genital warts in a given birth cohort, supporting the view that genital warts is an increasing problem that is due to increasing exposure. There is no reason to believe that significant differences exist in recalling a previous episode of genital warts or lifetime number of sex partners between the 4 Nordic countries. Therefore, these patterns may reflect a paradigm shift in sexual practice in the younger birth cohorts, especially in Iceland but also in Norway and Sweden, with a higher lifetime number of sex partners.
In contrast, such a shift may have happened earlier in Denmark i.
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Support for this comes from a study that found that age at first intercourse remained unchanged among Danish adolescents from to [ 19 ] as well as from another recent study that reported no significant changes in the number of partners or in the proportion of sexually experienced persons among adolescent women from to [ 20 ].
Iceland is usually considered to be very similar to the other Nordic countries, but, in the present study, it differed by having on average the highest lifetime number of sex partners and the youngest age at first intercourse. These findings are in line with a recent study reporting a significantly higher teenage pregnancy rate in Iceland than in the rest of the Nordic countries [ 21 ].
Our results from the analysis of the age-specific incidences of genital warts by birth cohort give additional support to the view of a shift in sexual practices among younger birth cohorts. Because the incidence of a first diagnosis of genital warts at a certain age increased with each subsequent younger birth cohort, the effect could not be explained solely by the younger birth cohorts contracting genital warts earlier.
The results of our study indicating an increasing incidence of genital warts in the younger female population are in line with those from other studies of incident episodes of genital warts [ 7 ], with those from studies of rates of new genital wart claims [ 12 ], and with some HPV seroprevalences over calendar time [ 23 ], but not all [ 24 ]. We also found that reporting previous genital warts correlated with other health-related behaviors and demographic variables, such as the use of hormonal contraceptives, smoking habits, and education, a finding that has also been reported by others [ 13 , 14 , 25 , 26 ].
Some potential limitations of the study should be considered. Being tested can add a new set of confidence when becoming sexually active with a new partner.
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