The study confirms a low overall HPV prevalence in a largely monogamous population. The protection observed with condom use needs further evaluation.

Transmission routes of Kaposi's sarcoma-associated herpesvirus (KSHV) in the general population are poorly understood. Whereas sexual transmission appears to be common in homosexual men, the evidence for heterosexual transmission is less convincing. In our study, prevalence of KSHV infection was examined among women in the Spanish general population and among sex workers. Subjects consisted of 100 prostitutes and 100 women randomly sampled from the general population and age-matched to the prostitutes. Women had a personal interview and gynecologic examinations in which a blood sample, cervical cells and oral cells were obtained. Peripheral blood mononuclear cells (PBMC), oral and cervical samples were tested for KSHV DNA by quantitative real-time PCR. Sera were tested for antibodies against human immunodeficiency virus (HIV) by ELISA and against KSHV by latent IFA and K8.1 ELISA. Women who were positive in either serologic assay or PCR were considered infected by KSHV. Human papillomavirus (HPV) DNA in cervical scrapes were evaluated using the Hybrid Capture System™. The study population had an average age of 30 years and were HIV-negative. Women from the general population were largely of Spanish nationality, and 61% reported lifetime monogamy. The majority of the prostitutes (76%) were immigrants, primarily from South America. Sex workers were twice as likely to be infected with KSHV than women in the general population (16% vs. 8%, prevalence odds ratio [OR] ‫؍‬ 2.2). KSHV was more prevalent among HPV DNA-positive women (OR ‫؍‬ 2.5) and among women with an early age at first sexual intercourse (OR ‫؍‬ 2.7, p < 0.05). KSHV DNA was detected by PCR in 3% of the oral cavity samples, in 2% of the cervical samples of the prostitutes and in 1% of the cervical samples of women in the general population. All PBMC samples were negative. These results suggest that in low-risk countries for KSHV, oral shedding and heterosexual contacts are potential pathways for KSHV transmission. © 2002 Wiley-Liss, Inc. Key words: KSHV; HHV-8; HPV DNA; epidemiology; prostitutionKaposi's sarcoma-associated herpesvirus (KSHV), also known as human herpesvirus 8 (HHV-8), has been shown to be causally associated with Kaposi's sarcoma and other diseases. 1-3 The natural history of KSHV and its routes of transmission are not well understood. Epidemiologic studies have shown that seroprevalence of KSHV antibodies is more than 25% in African countries, whereas in the United States and Europe is lower than 10%. 4 Data from Latin America are limited but suggest a wide variability within the region. 5,6 Routes of transmission may vary in different geographic areas either reflecting or possibly leading to variations in background prevalence. Nonsexual transmission of KSHV has been reported to be the major route of transmission in countries with high KSHV prevalence rates where infection in children is commonly reported. 6 -9 In countries with lower background prevalence, sexual transmission, at least among homosexual men, may be predominant. Among...