The proportion of women who have already been exposed to human papillomavirus (HPV) infection by the time they first become pregnant, and the influence of pregnancy and delivery on the course of HPV infection are unclear. In Kampala, Uganda, 987 young primiparous pregnant women aged <25 years had gynaecological examination and liquid-based cytology. In the follow-up, women acted as their own controls, i.e., 1st/2nd versus 3rd trimesters (105 women), and during pregnancy versus after delivery (289 women). HPV was assessed using highly sensitive PCR assays. Prevalence of HPV and HIV infections at baseline were 60.0% and 7.3%, respectively. HPV16 and 18 were detected in 8.4% and 5.8%, respectively, i.e., less frequently than HPV51 (8.7%) and 52 (12.1%). At follow-up new HPV infections were detected in 42.9% of women between the 1st/2nd and 3rd trimesters, and 38.1% between pregnancy and delivery, but 50.4% and 71.8% of HPV infections, respectively, cleared, leaving HPV prevalence unchanged in the different periods. Prevalence of cytological abnormalities diminished after delivery (from 21.2% to 12.4%). Presence of genital warts and sexually transmitted infections other than HPV were the strongest risk factors for prevalent or incident HPV infection. Clearance was lower among HIV-positive women. In conclusion, HPV prevalence was high in primiparous women in Uganda, but pregnancy did not seem to be a period of special vulnerability to the infection. ' 2008 Wiley-Liss, Inc.Key words: human papillomavirus; HIV; Uganda; pregnant adolescents; epidemiology Prophylactic vaccines against human papillomavirus (HPV) 16 and 18 are recommended for girls who are not yet sexually active.1 In low-resource countries where the burden of cervical cancer is high, however, a catching up of less young women when they have contacts with medical facilities (e.g., at first delivery) may be worth considering if the number of young women not yet infected by HPV vaccine types is low. Furthermore, although high parity and young age at first birth are risk factors for cervical cancer, even after adjustment for sexual behavior, 2 relatively few studies have provided information on the influence of pregnancy status on the incidence and clearance of HPV infection. Depending upon the study, HPV detection in pregnant women was shown to be higher than, 3,4 or similar to 5-8 HPV infection among nonpregnant women.To further elucidate this issue, we evaluated prevalence, incidence and clearance of HPV infection between the 1st/2nd and 3rd trimesters of pregnancy, and between pregnancy and after delivery, among young primiparous pregnant women in Kampala, Uganda.
Material and methods
Study population and follow-upPrimiparous pregnant women aged below 25 years residing within a 20 km radius for the previous 6 months and presenting themselves for antenatal services at the Naguru Health Centre, located in a suburb of Kampala, Uganda, between May and November 2004, were invited to join the study. Refusals to participate were few (approximately 2%).Trained m...