Influence of age and geographical origin in the prevalence of high risk human papillomavirus in migrant female sex workers in Spain

Abstract

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...

Oncogenic Human Papillomavirus (HPV) Type Distribution and HPV Type 16 E6 Variants in Two Spanish Population Groups with Different Levels of HPV Infection Risk

“…This was very marked for Spanish women (29.9% versus 8.3%) and African women (23.1% versus 12.5%) but was not that noticeable for women from other European countries (31.1% versus 36.4%) and for Latin Americans (32.8% versus 23.8%). High prevalence in CSW in Spain had been previously described, both in Spanish (44) and in migrant CSW individuals (9). The rate of oncogenic HPV prevalence in the general population for Spanish women agrees with data previously published in Spain (12,20) and are similar to those of others conducted in European countries, such as Italy, with rates of prevalence of between 6.6 and 7.1% (10,33).…”

Prevalence of Human Papillomavirus (HPV) Genotypes and Multiple Infections in Routine Cervical Cancer Screening in a Spanish Regional Population

“…The ALTS study 2000 [50] found that 58.9% of the subjects with LSIL had between two and six different HPV types. Prevalence of HPV infection depends on the age of the study population [51]. In women aged below 30 years, there was a predominance of multiple infections and ASC-US/LSIL was associated with multiple infection and HSIL with single infections [36].…”

Human Papillomavirus Detection by PCR Assay in a Large Series of High-Grade Squamous Intraepithelial Lesions with Cytohistological Correlation and Follow-Up

“…The latter includes HPV 16, 31, 33, 35, 52, and 58, while the former includes HPV 18, 39, 45, 59, 68, and 70 [5,6,7]. Although the prevalence of specific HR-HPV types in invasive cancers varies by geographical area, HPV 16 and HPV 18 are clearly the predominant types in cancerous lesions, accounting for around 70% of all patients worldwide [23]; they are also the prevailing types in Spain [28,38,39,40]. In a large series of over 10,000 invasive carcinomas, 85% were positive for a single viral type and 6.3% presented more than one viral strain; the most common HPV types detected were types 16, 18, and 45 [28,41].…”