Is stress related to the presence and persistence of oncogenic human papillomavirus infection in young women?

Abstract

Background Persistent infection with high-risk human papillomavirus (HR-HPV) is the most important risk factor for the development of cervical cancer, but factors contributing to HR-HPV persistence are incompletely understood. The objective of this study was to test for associations of chronic stress and two aspects of diurnal cortisol secretion (i.e., the cortisol awakening response [CAR] and total cortisol output over the day [AUCgday]) with HR-HPV status at baseline and 12\u2009months later (follow-up). Methods We evaluated 188 women (25\u2009±\u20093\u2009years) at baseline. Follow-up investigation was restricted to HR-HPV infected women at baseline. Of the initial 48 HR-HPV positive participants, 42 completed the follow-up (16 HR-HPV positive and 26 HR-HPV negative). At baseline and follow-up, we determined HR-HPV status in cervical smears, assessed chronic stress, and repeatedly measured salivary cortisol over the day. At baseline, we analyzed salivary cortisol only in a subgroup of 90 participants (45 HR-HPV negative and 45 HR-HPV positive). Results At baseline, higher chronic stress (excessive demands at work: p \u2009=\u2009.022, chronic worrying: p \u2009=\u2009.032), and a higher CAR ( p \u2009=\u2009.014) were related to baseline HR-HPV positivity. At follow-up, there was a statistical trend for a positive association between the CAR and HR-HPV positivity ( p \u2009=\u2009.062). Neither the CAR nor the AUCgday mediated the associations between chronic stress and HR-HPV status. Conclusions Our findings suggest that both chronic stress and diurnal cortisol are related to the presence of HR-HPV infection and may thus play a role in HPV-associated cervical carcinogenesis.