Objectives: To estimate the prevalence and risk factors of high risk human papillomavirus (HPV) infection in migrant female sex workers (FSW) according to age and geographical origin. Methods: Cross sectional study of migrant FSW attending a sexually transmitted infection (STI) clinic in Madrid during 2002. Information on sociodemographic characteristics, reproductive and sexual health, smoking, time in commercial sex work, history of STIs, HIV, hepatitis B, hepatitis C, syphilis, and genitourinary infections was collected. High risk HPV Infection was determined through the Digene HPV Test, Hybrid Capture II. Data were analysed through multiple logistic regression. Results: 734 women were studied. Overall HPV prevalence was 39%; 61% in eastern Europeans, 42% in Ecuadorians, 39% in Colombians, 29% in sub-Saharan Africans, and 24% in Caribbeans (p = 0.057). HPV prevalence showed a decreasing trend by age; 49% under 20 years, 35% in 21-25 years,14% over 36 years% (p,0.005). In multivariate analyses, area of origin (p = 0.07), hormonal contraception in women not using condoms (OR 19.45 95% CI: 2.45 to 154.27), smoking, age, and an interaction between these last two variables (p = 0.039) had statistically significant associations with HPV prevalence. STI prevalence was 11% and was not related to age or geographical origin. Conclusions: High risk HPV prevalence in migrant FSW is elevated and related to age, area of origin, and use of oral contraceptives in women not using condoms. These data support the role of acquired immunity in the epidemiology of HPV infection and identifies migrant FSW as a priority group for sexual health promotion.H uman papillomavirus infection (HPV) is the commonest sexually transmitted infection (STI) worldwide. More than 20 types of papillomavirus have been associated with cervical cancer, the second cause of cancer related mortality in women globally.1-3 Most HPV infections are asymptomatic and resolve spontaneously with cervical smear abnormalities only occurring in those women with persistent HPV infection.4 5 The advent of molecular biology tools in HPV diagnosis has allowed us to identify HPV infection, differentiate HPV types, and discriminate groups of the population with different risks of infection.2 HPV prevalence depends largely on age and on sexual practices.6-8 The prevalence of high risk HPV ranges from 11% in healthy women in Belgium, 9 20% in female university students in the United States 10 to 36% in Italian women at risk for human immunodeficiency virus (HIV) infection 11 and 46% in Spanish women in prisons.12 The highest prevalences of HPV have been described in female sex workers (FSWs) as they have multiple risk factors for HPV infection, such as young age and multiple sexual contacts. [13][14][15][16] There is wide heterogeneity in reported HPV prevalences in FSW from studies in different geographical areas; 43% in Mexico, 14 48% in Japan, 15 and 63% in Calcutta, India. 16 Over the last few years, an increasing proportion of the FSWs in European countries are mi...

The aim of this study is to determine oncogenic human papillomavirus (HPV) types and HPV type 16 (HPV16) variant distribution in two Spanish population groups, commercial sex workers and imprisoned women (CSW/IPW) and the general population. A multicenter cross-sectional study of 1,889 women from five clinical settings in two Spanish cities was conducted from May to November 2004. Oncogenic HPV infection was tested by an Hybrid Capture II (HC2) test, and positive samples were genotyped by direct sequencing using three different primer sets in L1 (MY09/11 and GP5؉/GP6؉) and E6/E7. HPV16 variants were identified by sequencing the E6, E2, and L1 regions. Four hundred twenty-five samples were positive for the HC2 test, 31.5% from CSW/IPW and 10.7% from the general population. HPV16 was the most frequent type. Distinct profiles of oncogenic HPV type prevalence were observed across the two populations. In order of decreasing frequency, HPV types 16, 31, 58, 66, 56, and 18 were most frequent in CSW/IPW women, and types 16, 31, 52, 68, 51, and 53 were most frequent in the general population. We analyzed HPV16 intratype variants, and a large majority (78.7%) belonged to the European lineage. AA variants were detected in 16.0% of cases. African variants belonging to classes Af1 (4.0%) and Af2 (1.3%) were detected. Different HPV types and HPV16 intratype variants are involved in oncogenic HPV infections in our population. These results suggest that HPV type distribution differs in CSW/IPW women and in the general population, although further analysis is necessary.Different epidemiological studies reveal that human papillomavirus (HPV) prevalence depends largely on age and sexual practices and that it shows major differences across geographic areas. HPV prevalence has been described to be higher in Latin America and sub-Saharan Africa and lower in Asia and Europe (12,15,17,30,32,35,40,43). More than 100 types of HPV have been identified to date, of which at least 42 are associated with infections of the genital tract (42). Different genotype prevalence profiles have also been observed in different geographic areas (8). Vaccines directed against HPV type 16 (HPV16) and HPV18, present in approximately 70% of cervical cancers worldwide, are currently under evaluation and have shown impressive reductions of 90% in the incidence of HPV infection in the case of types 16 and 18 (16, 18, 22, 27, 45). The preliminary data suggest that bivalent HPV16 and HPV18 vaccine may also protect against HPV16-related types (31, 33, 35, 52, and 58) and HPV18-related types (39, 45, 59, 68, and 85) (G. Dubin, 22nd International Papillomavirus Conference and Clinical Workshop 2005, Oral Communication F-03, 2005). In order to design and evaluate the health impact of HPV infections and the potential benefits of the implementation of future vaccines, it is necessary to know the distribution of oncogenic HPV types in different geographic regions and in different populations (29).In Spain, which has one of the lowest rates of cervical cancer worldwid...

Objectives: To estimate prevalence and determinants of high risk (HR) human papillomavirus (HPV) by country of origin in women attending a family planning centre (FPC) . Conclusions: Prevalence of HR HPV is more than three times higher in Latin Americans than in Spaniards. Latin American women's HPV prevalence resembles more that of their countries of origin. It is essential that health service providers identify these women as a priority group in current cervical screening programmes T here is substantial intercountry variation in human papillomavirus (HPV) prevalence in women from the general population.1-6 Much of this variation may be attributable to different sampling strategies and diagnostic techniques but, even among population based studies, HPV prevalence is higher in women from Latin America 1 5 and sub-Saharan Africa 4 and lower in Asia 2 and Europe. 3 In Spain, one of the countries with the lowest cervical cancer rates worldwide, 7 the only study that has estimated HPV prevalence in women from general population reported a 3% age adjusted prevalence.3 Rates are, as expected, higher in commercial sex workers (CSWs), including migrant CSWs. Over the past decade a large number of migrants have arrived in Spain; 40% come from Latin America and 50% are women.10 Prevalence of HPV in Latin American women is higher than in Spaniards 1 3 5 but no data are available on prevalence and determinants of HPV infection in these women with an a priori higher risk of cervical cancer in our setting. This study estimates differences by country of origin in the prevalence and risk factors for high risk HPV infection in women attending a family planning centre in Alicante, Spain. SUBJECTS AND METHODSThis was a cross sectional study of women attending a family planning centre (FPC) from May 2003 to January 2004. FPC are open and free of charge to all women irrespective of legal status; none of the women invited to participate in this study refused. A structured questionnaire designed ad hoc was administered by a trained investigator to all participants. Data were collected prospectively. High risk HPV (HR HPV) infection was determined through the Digene HPV Test, Hybrid Capture II (HC-II) which identified types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. In all HC-II positive samples, HPV typing was performed by polymerase chain reaction (PCR) and direct sequencing. DNA was recovered from a 150 ml aliquot of the frozen, stored, alkali denatured specimen and was amplified in suitable samples. MY09/MY11 general consensus primers were used to amplify a 450 pb fragment of HPV L1 gene. Positive samples were sequenced using the Big Dye Terminator Cycle Sequencing Kit with inner PCR primers. HPV type assignation was done by phylogenetic analysis using programs contained in the Phylip 3.5 package.Demographic and clinical differences were compared using x 2 tests. Multiple logistic regression was used to study the relations between HR HPV infection and explanatory variables looking for confounding and interaction. ...

The aim of the study was to estimate the prevalence and risk factors associated with infection by high-risk human papillomavirus (HR-HPV) in cervix and squamous intra-epithelial lesions (SIL) in imprisoned women. This was done by a cross-sectional study of imprisoned women attending the gynaecological clinic in Foncalent prison in Alicante, Spain. The study period was from May 2003 to December 2005. HR-HPV infection was determined through Digene HPV Test, Hybrid Capture II (HC-II). HPV typing was determined by multiplex nested PCR assay combining degenerate E6/E7 consensus primers. Multiple logistic regression modelling was used for the analysis of associations between variables where some were considered possible confounders after checking for interactions. A total of 219 women were studied. HR-HPV prevalence was 27.4% and prevalence of SIL was 13.3%. HIV prevalence was 18%, higher in Spaniards than in migrant women (24.6% vs. 14.3%, P<0.05). In multivariate analyses, risk factors for HPV infection were younger age (P for trend=0.001) and tobacco use (OR 2.62, 95% CI 1.01-6.73). HPV infection (OR 4.8, 95% CI 1.7-13.8) and HIV infection were associated with SIL (OR 4.8, 95% CI 1.6-14.1). The commonest HPV types were HPV16 (29.4%), HPV18 (17.6%), HPV39 (17.6%) and HPV68 (17.6%). The prevalence of both HR-HPV infection and SIL in imprisoned women found in this study is high. Determinants for each of the outcomes studied were different. HPV infection is the most important determinant for SIL. A strong effect of HIV co-infection on the prevalence of SIL has been detected. Our findings reinforce the need to support gynaecological clinics in the prison setting.

Multiple endocrine neoplasia type 2A (MEN 2A) is associated with specific germline missense mutations in the RET proto-oncogene. This locus encodes a receptor tyrosine kinase whose activation requires the formation of a multimeric receptor complex including GDNF as a ligand and GFR␣1 as a coreceptor. In order to explore the role of RET, GFR␣1 and GDNF genes in the variation of phenotypes observed in MEN2A families, we analysed germline mutations of these genes in 4 unrelated Spanish MEN2A families (23 cases studied). We found 2 novel variants corresponding to a single change in position ؉ 47 (intron 12) of RET and position ؉22 (intron 7) of GFR␣1. Furthermore, we observed strong cosegregation between 2 polymorphisms of RET [G691S (exon 11) and S904S (TCC-TCG, exon 15) (100%, Fisher's exact test, p< 0.001)]. More interestingly, we found that these polymorphisms occurred at a significantly high frequency in patients with age at onset < 20 years old (Kruskal-Wallis's and Fisher's exact test, p ‫؍‬ 0.007). These findings suggest that the G691S and S904S variants of RET may somehow play a role on the age of onset of MEN 2A.