Send to

Choose Destination
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

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



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.


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.


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.


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.


adolescent; africa; epidemiology (general); hpv

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center