Modeling the sexual transmissibility of human papillomavirus infection using stochastic computer simulation and empirical data from a cohort study of young women in Montreal, Canada

The authors estimated plausible ranges of the probability of human papillomavirus (HPV) transmission per coital act among newly forming couples by using stochastic computer simulation. Comparative empirical data were obtained in 1996-2001 from a cohort study of female university students in Montreal, Canada. Female prevalence and frequency of sexual intercourse and condom use were set equal to those in the cohort. Simulations included 240 combinations of male prevalence, the relative risk for protected versus unprotected sex, and per-act transmission probabilities. Those that produced expected HPV incidence within the 95% confidence interval observed in the cohort were selected. The observed 6-month cumulative incidence following acquisition of a new partner was 17.0% (95% confidence interval: 11.4, 23.0). Expected incidences consistent with those from cohort findings occurred in 54/240 simulations. The range of per-act transmission probabilities was 5-100% (median, 40%). Male HPV prevalence was the same as or greater than that for women in all consistent simulations. Varying condom effectiveness did not produce better-fitting data. This simulation suggests that HPV transmissibility is several-fold higher than that for other viral sexually transmitted infections such as human immunodeficiency virus or herpes simplex virus 2. With high transmissibility, any potential protective effect of condoms would disappear over multiple intercourse acts, underlining the need for an effective HPV vaccine.