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Sex Transm Infect. 2019 Aug;95(5):374-379. doi: 10.1136/sextrans-2018-053756. Epub 2019 Jan 13.

Human papillomavirus DNA detected in fingertip, oral and bathroom samples from unvaccinated adolescent girls in Tanzania.

Author information

1
Division of Infection and Immunity, University College London, London, UK Catherine.houlihan@lshtm.ac.uk.
2
Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
3
MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
4
French National Center for Scientific Research (CNRS), Laboratory MIVEGEC (CNRS IRD Uni Montp), Montpellier, France.
5
Infections and Cancer Laboratory, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Barcelona, Spain.
6
CIBER-ONC, Hospitalet de Llobregat, Barcelona, Spain.
7
National Institute for Medical Research, Mwanza, Tanzania.
8
Mwanza Interventional Trials Unit, Mwanza, Tanzania.
9
Sexual and Reproductive Health, PATH, Seattle, Washington, USA.

Abstract

OBJECTIVE:

Human papillomavirus (HPV) DNA has been detected in vaginal samples from adolescent girls who report no previous sex and, in high-income settings, from fingertips, raising the possibility of non-sexual transmission. No such studies originate from East Africa which bears among the highest cervical cancer incidence and HPV prevalence worldwide. HPV-related oral cancer incidence is increasing, but oral HPV prevalence data from East Africa are limited. We aimed to describe the HPV DNA prevalence in genital and non-genital sites and in the bathroom of unvaccinated adolescent girls, and examine genotype concordance between sites.

METHODS:

We nested a cross-sectional study of HPV in genital and extragenital sites within a cohort study of vaginal HPV acquisition. Unvaccinated girls age 16-18 years in Tanzania, who reported ever having had sex, were consented, enrolled and tested for the presence of HPV DNA in vaginal samples collected using self-administered swabs, oral samples collected using an oral rinse, and on fingertips and bathroom surfaces collected using a cytobrush.

RESULTS:

Overall, 65 girls were enrolled and 23 (35%, 95% CI 23% to 47%) had detectable vaginal HPV. Adequate (β-globin positive) samples were collected from 36 girls' fingertips and HPV was detected in 7 (19%, 95% CI 6% to 33%). 63 girls provided adequate oral samples, 4 (6%, 95% CI 0% to 13%) of which had HPV DNA detected. In bathroom samples from 58 girls, 4 (7%, 95% CI 0% to 14%) had detectable HPV DNA. Of the 11 girls with extragenital HPV, six had the same genotype in >1 site.

CONCLUSION:

We found a high prevalence of HPV in non-genital sites in adolescent girls and in their bathrooms, in this region with a high cervical cancer incidence. Concordance of genotypes between sites supports the possibility of autoinoculation.

KEYWORDS:

adolescent; africa; epidemiology (general); hpv

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