National point prevalence survey of human papillomavirus infections in Tunisia, 2012–2014: Genotypes and risk factors

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Background Persistent infection with high-risk Human Papillomavirus (HPV) genotypes may, without treatment, progress to invasive cervical cancer, the second gynecological cancer in Tunisia. This study aims to determine the prevalence of HPV infections, to identify risk factors and main circulating genotypes. Methods National point prevalence survey, between December 2012 and December 2014. Were eligible for inclusion, women aged 18 to 65 years, sexually active, who sought medical attention at their primary health care centre or clinic, the day of the survey, and who gave written consent. Women having an abnormal genital bleeding or a visible lesion in the cervix were not included. A standardized questionnaire on sociodemographic and behavioral factors was orally administered. A liquid-based Pap smear sample was obtained from included women using a cervical brush. If betaglobin positive, samples were analyzed for HPV detection and typing. Multiple logistic regression modeling was done using SPSS 20. Results Out of 1518 women included in the survey with mean age 40.4 ± 0.9 years, 1229 were betaglobin positive. The national prevalence of HPV infection was 7.8% (95% CI [3.4–14.4%]). In multivariate analysis, factors associated to HPV infection were having multiple sexual partners (ORa = 5.2; 95% CI [2.2–11.6]), smoking (ORa = 4.7; 95% CI [2.2–9.8]) and medical history of sexually transmitted infection (ORa = 1.9; 95% CI [1.2–3.1]). Twenty different genotypes of HPV were identified, the most common were HPV6 (25.4%; 95% CI [16.9–36.9%]) and HPV16 (14.1%; 95% CI [16.9–36.9%]). Conclusions T This first national prevalence survey of HPV infection in Tunisia provides important insight into associated factors and main circulating genotypes to improve cervical screening. Next step is a cost-effectiveness analysis of a national HPV immunization programme.