Association Between Herpes Simplex Virus Type II and High-Risk Human Papillomavirus Infections: A Population Study of the National Health and Nutrition Examination Survey, 2009-2016

Abstract Background Human papillomavirus (HPV) is a leading cause of cervical cancer, with 14 subtypes classified as high-risk human papillomavirus (HR-HPV). Despite the availability of vaccines, certain regions still experience limited access. Herpes simplex virus type II (HSV-II), a common sexually transmitted infection, is hypothesized to increase the risk of HR-HPV infections. This study aims to individually analyze whether HSV-II infection increases the risk of each high-risk type of HPV infection in a representative sample of American adults. Methods Data were derived from the National Health and Nutrition Examination Survey (NHANES) from 2009 to 2016, involving 4076 female participants. The study utilized logistic regression to estimate the link between HSV-II infection and HR-HPV infection. And we conducted a further stratified analysis to evaluate the impact of HSV-II on HR-HPV infections in different subgroups. Results After adjustment, the odds of having HR-HPV infection were 1.46 (95%CI, 1.24, 1.71) for those with HSV-II infection. Moreover, women with HSV-II infection had higher odds of HPV18 infection (OR=3.01, 95% CI: 2.05, 4.41) and HPV58 (OR=2.05, 95% CI: 1.52, 3.32) infection even after adjusting for potential confounding factors. The results remain significant in subgroup analysis and in the interaction test. Conclusion The study found a significant association between HSV-II infection and HR-HPV infection, particularly with HPV types 18 and 58, highlighting the importance of preventing HSV infection and advocating for early vaccination with HPV vaccine for those vulnerable to HSV infection. Further prospective studies are needed to validate their causal associations and elucidate the underlying mechanisms.