Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Sexual behavior and factors associated with young age at first intercourse and HPV vaccine uptake among young women in Germany: implications for HPV vaccination policies

Authors: Cornelius Remschmidt, Michaela Fesenfeld, Andreas M Kaufmann, Yvonne Deleré

Published in: BMC Public Health | Issue 1/2014

Login to get access

Abstract

Background

In Germany, immunization against human papillomaviruses (HPV) is free of charge for all females aged 12 to 17 years. Since HPV infection rates rise soon after first intercourse, immunization against HPV should be completed before sexual debut. Knowledge of country-specific data on age at first intercourse and related risk factors is important to optimize prevention of HPV and other sexually transmitted infections. Therefore, the primary aim of this study was to describe sexual behavior in young women in Germany. Secondary aims were to identify factors that are (i) associated with younger age at first intercourse and (ii) with HPV vaccine uptake.

Methods

Between 2010 and 2012, we conducted a cross-sectional study among randomly selected women aged 20 to 25 years in Germany. We used a structured, self-administered questionnaire to collect sociodemographic data, information on sexual habits such as age at first intercourse, and information on HPV vaccine uptake. We used univariate and multivariate logistic regression analyses to identify factors associated with younger age at first intercourse and with HPV vaccine uptake.

Results

A total of 823 women (response rate: 14.2%) participated, 785 (95.4%) of which reported having had intercourse already. 70% of these women experienced first intercourse before the age of 18 years. However, less than 5% were younger than 14 years at sexual debut. Younger age at first intercourse was independently associated with a higher number of sexual partners, smoking, and past pregnancies. HPV vaccine uptake was associated with higher education, whereas smoking and a migrant background reduced the chance of being vaccinated.

Conclusion

In Germany, only a small proportion of women experienced first intercourse before the age of 14 years. Younger age at first intercourse was associated with behavior that might increase the risk of HPV infections or other sexually transmitted infections. Therefore, to optimize the HPV vaccination strategy, HPV vaccination series should be completed before the age of 14 years in Germany.
Appendix
Available only for authorised users
Literature
1.
Veldhuijzen NJ, Snijders PJ, Reiss P, Meijer CJ, van de Wijgert JH: Factors affecting transmission of mucosal human papillomavirus. Lancet Infect Dis. 2010, 10: 862-874. 10.1016/S1473-3099(10)70190-0.CrossRefPubMed
2.
Syrjanen K, Hakama M, Saarikoski S, Vayrynen M, Yliskoski M, Syrjanen S, Kataja V, Castren O: Prevalence, incidence, and estimated life-time risk of cervical human papillomavirus infections in a nonselected Finnish female population. Sex Transm Dis. 1990, 17: 15-19. 10.1097/00007435-199017010-00004.CrossRefPubMed
3.
Winer RL, Lee SK, Hughes JP, Adam DE, Kiviat NB, Koutsky LA: Genital human papillomavirus infection: incidence and risk factors in a cohort of female university students. Am J Epidemiol. 2003, 157: 218-226. 10.1093/aje/kwf180.CrossRefPubMed
4.
Collins S, Mazloomzadeh S, Winter H, Blomfield P, Bailey A, Young LS, Woodman CB: High incidence of cervical human papillomavirus infection in women during their first sexual relationship. BJOG. 2002, 109: 96-98. 10.1111/j.1471-0528.2002.01053.x.CrossRefPubMed
5.
Group FIS: Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection. J Infect Dis. 2007, 196: 1438-1446.CrossRef
6.
7.
Roset Bahmanyar E, Paavonen J, Naud P, Salmeron J, Chow SN, Apter D, Kitchener H, Castellsague X, Teixeira JC, Skinner SR, Jaisamrarn U, Limson GA, Garland SM, Szarewski A, Romanowski B, Aoki F, Schwarz TF, Poppe WA, De Carvalho NS, Harper DM, Bosch FX, Raillard A, Descamps D, Struyf F, Lehtinen M, Dubin G, HPV PATRICIA Study Group: Prevalence and risk factors for cervical HPV infection and abnormalities in young adult women at enrolment in the multinational PATRICIA trial. Gynecol Oncol. 2012, 127: 440-450. 10.1016/j.ygyno.2012.08.033.CrossRefPubMed
8.
Dunne EF, Sternberg M, Markowitz LE, McQuillan G, Swan D, Patel S, Unger ER: Human papillomavirus (HPV) 6, 11, 16, and 18 prevalence among females in the United States–National Health And Nutrition Examination Survey, 2003–2006: opportunity to measure HPV vaccine impact?. J Infect Dis. 2011, 204: 562-565. 10.1093/infdis/jir342.CrossRefPubMed
9.
Oakeshott P, Aghaizu A, Reid F, Howell-Jones R, Hay PE, Sadiq ST, Lacey CJ, Beddows S, Soldan K: Frequency and risk factors for prevalent, incident, and persistent genital carcinogenic human papillomavirus infection in sexually active women: community based cohort study. BMJ. 2012, 344: e4168-10.1136/bmj.e4168.CrossRefPubMedPubMedCentral
10.
Nielsen A, Kjaer SK, Munk C, Iftner T: Type-specific HPV infection and multiple HPV types: prevalence and risk factor profile in nearly 12,000 younger and older Danish women. Sex Transm Dis. 2008, 35: 276-282. 10.1097/OLQ.0b013e31815ac5c7.CrossRefPubMed
11.
Delere Y, Remschmidt C, Leuschner J, Schuster M, Fesenfeld M, Schneider A, Wichmann O, Kaufmann AM: Human Papillomavirus prevalence and probable first effects of vaccination in 20 to 25 year-old women in Germany: a population-based cross-sectional study via home-based self-sampling. BMC Infect Dis. 2014, 14: 87-10.1186/1471-2334-14-87.CrossRefPubMedPubMedCentral
12.
Scheidt-Nave C, Kamtsiuris P, Gosswald A, Holling H, Lange M, Busch MA, Dahm S, Dolle R, Ellert U, Fuchs J, Hapke U, Heidemann C, Knopf H, Laussmann D, Mensink GB, Neuhauser H, Richter A, Sass AC, Rosario AS, Stolzenberg H, Thamm M, Kurth BM: German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave. BMC Public Health. 2012, 12: 730-10.1186/1471-2458-12-730.CrossRefPubMedPubMedCentral
13.
Delere Y, Schuster M, Vartazarowa E, Hansel T, Hagemann I, Borchardt S, Perlitz H, Schneider A, Reiter S, Kaufmann AM: Cervicovaginal self-sampling is a reliable method for determination of prevalence of human papillomavirus genotypes in women aged 20 to 30 years. J Clin Microbiol. 2011, 49: 3519-3522. 10.1128/JCM.01026-11.CrossRefPubMedPubMedCentral
14.
Remschmidt C, Kaufmann AM, Hagemann I, Vartazarova E, Wichmann O, Delere Y: Risk factors for cervical human papillomavirus infection and high-grade intraepithelial lesion in women aged 20 to 31 years in Germany. Int J Gynecol Cancer. 2013, 23: 519-526. 10.1097/IGC.0b013e318285a4b2.CrossRefPubMed
15.
16.
Crochard A, Luyts D, di Nicola S, Goncalves MA: Self-reported sexual debut and behavior in young adults aged 18–24 years in seven European countries: implications for HPV vaccination programs. Gynecol Oncol. 2009, 115: S7-S14. 10.1016/j.ygyno.2009.06.003.CrossRefPubMed
17.
Jensen KE, Munk C, Sparen P, Tryggvadottir L, Liaw KL, Dasbach E, Nygard M, Kjaer SK: Women’s sexual behavior. Population-based study among 65,000 women from four Nordic countries before introduction of human papillomavirus vaccination. Acta Obstet Gynecol Scand. 2011, 90: 459-467. 10.1111/j.1600-0412.2010.01066.x.CrossRefPubMed
18.
19.
20.
Franceschi S, Castellsague X, Dal Maso L, Smith JS, Plummer M, Ngelangel C, Chichareon S, Eluf-Neto J, Shah KV, Snijders PJ, Meijer CJ, Bosch FX, Muñoz N: Prevalence and determinants of human papillomavirus genital infection in men. Br J Cancer. 2002, 86: 705-711. 10.1038/sj.bjc.6600194.CrossRefPubMedPubMedCentral
21.
Kjaer SK, Munk C, Winther JF, Jorgensen HO, Meijer CJ, van den Brule AJ: Acquisition and persistence of human papillomavirus infection in younger men: a prospective follow-up study among Danish soldiers. Cancer Epidemiol Biomarkers Prev. 2005, 14: 1528-1533. 10.1158/1055-9965.EPI-04-0754.CrossRefPubMed
22.
Langille DB, Asbridge M, Flowerdew G, Allen M: Associations of sexual risk-taking with having intercourse before 15 years in adolescent females in Cape Breton, Nova Scotia, Canada. Sex Health. 2010, 7: 199-204. 10.1071/SH09087.CrossRefPubMed
23.
Greenberg J, Magder L, Aral S: Age at first coitus. A marker for risky sexual behavior in women. Sex Transm Dis. 1992, 19: 331-334. 10.1097/00007435-199211000-00006.CrossRefPubMed
24.
Olesen TB, Jensen KE, Nygard M, Tryggvadottir L, Sparen P, Hansen BT, Liaw KL, Kjaer SK: Young age at first intercourse and risk-taking behaviours–a study of nearly 65 000 women in four Nordic countries. Eur J Public Health. 2012, 22: 220-224. 10.1093/eurpub/ckr055.CrossRefPubMed
25.
Buston K, Williamson L, Hart G: Young women under 16 years with experience of sexual intercourse: who becomes pregnant?. J Epidemiol Community Health. 2007, 61: 221-225. 10.1136/jech.2005.044107.CrossRefPubMedPubMedCentral
26.
Giambi C, Donati S, Carozzi F, Salmaso S, Declich S, Atti ML, Ronco G, Alibrandi MP, Brezzi S, Collina N, Franchi D, Lattanzi A, Minna MC, Nannini R, Barretta E, Burroni E, Gillio-Tos A, Macallini V, Pierotti P, Bella A: A cross-sectional study to estimate high-risk human papillomavirus prevalence and type distribution in Italian women aged 18–26 years. BMC Infect Dis. 2013, 13: 74-10.1186/1471-2334-13-74.CrossRefPubMedPubMedCentral
27.
Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S: Human papillomavirus and cervical cancer. Lancet. 2007, 370: 890-907. 10.1016/S0140-6736(07)61416-0.CrossRefPubMed
28.
Giambi C, Donati S, Declich S, Salmaso S, Degli Atti ML, Alibrandi MP, Brezzi S, Carozzi F, Collina N, Franchi D, Lattanzi A, Meda M, Minna MC, Nannini R, Scherillo I, Bella A, PreGio Working Group: Estimated acceptance of HPV vaccination among Italian women aged 18–26 years. Vaccine. 2011, 29: 8373-8380. 10.1016/j.vaccine.2011.08.079.CrossRefPubMed
29.
Donadiki EM, Jimenez-Garcia R, Hernandez-Barrera V, Carrasco-Garrido P, Lopez de Andres A, Velonakis EG: Human papillomavirus vaccination coverage among Greek higher education female students and predictors of vaccine uptake. Vaccine. 2012, 30: 6967-6970. 10.1016/j.vaccine.2012.09.028.CrossRefPubMed
30.
Blodt S, Holmberg C, Muller-Nordhorn J, Rieckmann N: Human Papillomavirus awareness, knowledge and vaccine acceptance: a survey among 18–25 year old male and female vocational school students in Berlin, Germany. Eur J Public Health. 2012, 22: 808-813. 10.1093/eurpub/ckr188.CrossRefPubMed
31.
Delere Y, Bohmer MM, Walter D, Wichmann O: HPV vaccination coverage among women aged 18–20 years in Germany three years after recommendation of HPV vaccination for adolescent girls: results from a cross-sectional survey. Hum Vaccin Immunother. 2013, 9: 1706-1711. 10.4161/hv.24904.CrossRefPubMedPubMedCentral
32.
Sadry SA, De Souza LR, Yudin MH: The impact of ethnicity on awareness and knowledge of and attitudes towards the human papillomavirus and vaccine among adult women. J Obstet Gynaecol Can. 2013, 35: 995-1003.CrossRefPubMed
33.
34.
Szarewski A, Cadman L, Mesher D, Austin J, Ashdown-Barr L, Edwards R, Lyons D, Walker J, Christison J, Frater A, Waller J: HPV self-sampling as an alternative strategy in non-attenders for cervical screening - a randomised controlled trial. Br J Cancer. 2011, 104: 915-920. 10.1038/bjc.2011.48.CrossRefPubMedPubMedCentral
Metadata
Title
Sexual behavior and factors associated with young age at first intercourse and HPV vaccine uptake among young women in Germany: implications for HPV vaccination policies
Authors
Cornelius Remschmidt
Michaela Fesenfeld
Andreas M Kaufmann
Yvonne Deleré
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-1248

Other articles of this Issue 1/2014

BMC Public Health 1/2014 Go to the issue

Research article

A Markov chain model for studying suicide dynamics: an illustration of the Rose theorem

Research article

Incidence of paediatric fatal and non-fatal low speed vehicle run over events in Queensland, Australia: eleven year analysis

Research article

Changes in exposure to ‘life stressors’ in the Aboriginal and Torres Strait Islander population, 2002 to 2008

Research article

Fair relationships and policies to support family day care educators’ mental health: a qualitative study

Research article

Light smoking at base-line predicts a higher mortality risk to women than to men; evidence from a cohort with long follow-up

Research article

HIV prevalence in the Israeli tuberculosis cohort, 1999–2011