Objectives

Sub-Saharan Africa is a region with high incidence of both human immunodeficiency virus (HIV) and cervical cancer. We conducted the first national study in Togo to assess prevalence of human papillomavirus (HPV), HIV and other sexually transmitted infections (STIs) among female sex workers (FSW).

Methods

A multicentric cross-sectional study was conducted among FSW recruited in hot spots (clubs, streets) in four Togolese cities. HPV and STIs were tested from cervical and anal swabs. HIV and syphilis were screened with rapid tests.

Results

In all, 310 FSW were recruited; HIV and cervical high-risk HPV (hrHPV) prevalence were 10.6% (33/310) and 32.9% (102/310), respectively. The most frequent hrHPV types were HPV58 (13.6%, 19/140), HPV35 (12.9%, 18/140), HPV31 (12.1%, 17/140) and HPV16 (10.7%, 15/140). Prevalence of hrHPV and multiple hrHPV infections showed higher rates in HIV-positive than in HIV-negative FSW (48.5% versus 31.0%, p 0.04 and 21.2% versus 9.0%, p 0.03; respectively). Prevalence of hrHPV was higher in cervical than anal swabs (34.1% versus 20.7%, p 0.0004). High-risk HPV anal infections were more frequent among HIV-positive than HIV-negative FSW (51.9% versus 17.3%, p 2 × 10⁻⁵). Concomitant anal and cervical hrHPV infections were present in 43.2% (41/95) of hrHPV-positive FSW. Overall prevalence in the cervix of Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Trichomonas vaginalis were 4.2%, 6.1%, 5.5% and 6.5%, respectively.

Conclusions

This first African study on paired cervical and anal samples showed a high prevalence of genital HPV infections with a rather high rate of concomitant HPV infections but low type concordance. We report an unusual distribution of hrHPV types. These findings highlight the critical need for implementation of a national HPV vaccination strategy.

中文翻译：

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多哥的女性性工作者中的人乳头瘤病毒，人免疫缺陷病毒和其他性传播感染的流行：一项全国横断面调查

目标

撒哈拉以南非洲地区是人类免疫缺陷病毒（HIV）和宫颈癌高发地区。我们在多哥进行了首次国家研究，以评估女性性工作者（FSW）中人类乳头瘤病毒（HPV），HIV和其他性传播感染（STIs）的患病率。

方法

在四个多哥城市的热点地区（俱乐部，街道）招募的FSW进行了多中心横截面研究。从宫颈和肛门拭子检测HPV和性传播感染。通过快速测试筛查了艾滋病毒和梅毒。

结果

总共招募了310名FSW；HIV和宫颈高危HPV（hrHPV）患病率分别为10.6％（33/310）和32.9％（102/310）。hrHPV最常见的类型是HPV58（13.6％，19/140），HPV35（12.9％，18/140），HPV31（12.1％，17/140）和HPV16（10.7％，15/140）。hrHPV和多种hrHPV感染的患病率表明，HIV阳性的比率高于HIV阴性的FSW（分别为48.5％对31.0％，p 0.04和21.2％对9.0％，p 0.03；）。宫颈拭子中hrHPV的患病率高于肛门拭子（34.1％对20.7％，p 0.0004）。HIV阳性的高危HPV肛门感染比HIV阴性的FSW更为频繁（51.9％对17.3％，p 2×10 ^-5）。hrHPV阳性FSW的同时发生肛门和宫颈hrHPV感染，占43.2％（41/95）。子宫颈的总体患病率淋病奈瑟菌，沙眼衣原体，生殖支原体和阴道毛滴虫分别为4.2％，6.1％，5.5％和6.5％。

结论

这项有关配对的宫颈和肛门样本的非洲研究首次显示，生殖器HPV感染的患病率较高，伴随的HPV感染率较高，但类型一致性较低。我们报告了hrHPV类型的异常分布。这些发现凸显了实施国家HPV疫苗接种战略的迫切需要。