Abstract
BackgroundFemale sex workers (FSWs) are amongst the most susceptible groups to acquire human papillomavirus (HPV) infection and consequently, to develop cervical intraepithelial neoplasia and cervical cancer. This is the first systematic review and meta-analysis to provide estimates of the pooled prevalence of HPV infection and the distribution of HPV types among FSWs across the world.MethodsFive computerized databases were searched for relevant studies published since the inception date of databases to September 2019. The pooled HPV prevalence was calculated by the random effect model described by DerSimonian-Laird. Subgroup analysis was performed to identify the probable sources of heterogeneity. The meta-analysis was performed using the “Metaprop” function in the R package Meta.ResultsSixty-two studies involving 21,402 FSWs from 33 countries were included in this meta-analysis, and the pooled HPV prevalence was 42.6% (95% confidence interval (CI): 38.5–46.7%). HPV-16 (10.1, 95% CI: 8.2–12.5%), HPV-52 (7.9, 95% CI: 5.9–10.7%), and HPV-53 (6.0, 95% CI: 4.4–8.1%) were the most common high-risk HPV types identified among FSWs. The pooled estimated prevalence of HPV infection among FSWs before and after 2010 were slightly different, 43.6% (95% CI: 36.1–51.4%) and 41.9% (95% CI: 37.2–46.8%), respectively.ConclusionDue to the high prevalence of HPV infection, particularly with high-risk types, FSWs have a great susceptibility to the development of cervical and vaginal cancers. Furthermore, they can transmit their infection to their clients, which may result in a high prevalence of HPV and the incidence of HPV-associated malignancies among the general population.
Highlights
Female sex workers (FSWs) are amongst the most susceptible groups to acquire human papillomavirus (HPV) infection and to develop cervical intraepithelial neoplasia and cervical cancer
Studies were considered eligible for inclusion if they reported: (1) original data about the prevalence measure for HPV infection among FSWs published in the English language in peer-reviewed journals; (2) the prevalence of HPV DNA in different genital specimens, including cervical, endocervical, vaginal, and cervico-vaginal samples; (3) Studies detecting HPV DNA and transcripts with polymerase chain reaction (PCR), Hybridization, PCR-Hybridization, and Transcriptionmediated amplification (TMA) methods; (4) letters to the editor, short communications, and English abstracts with sufficient data
Studies meeting any of the following criteria were excluded: (1) studies estimating the incidence of HPV infection among FSWs; (2) studies of the incidence and the prevalence of HPV infection among transgenders, male sex workers, gays, lesbians, and clients of FSWs; (3) Serological studies that measured antibodies to HPV using methods such as enzyme-linked immunosorbent assay (ELISA); (4) review articles, case reports, posters, and conference abstracts; (5) articles in languages other than English with non-English abstracts
Summary
Female sex workers (FSWs) are amongst the most susceptible groups to acquire human papillomavirus (HPV) infection and to develop cervical intraepithelial neoplasia and cervical cancer. This is the first systematic review and meta-analysis to provide estimates of the pooled prevalence of HPV infection and the distribution of HPV types among FSWs across the world. HPV types 6 and 11 are known to be responsible for 90% of genital warts, and types 16 and 18 together cause up to 70% of invasive cervical cancer worldwide. Men who have sex with men (MSM) as a sexually active group have a high prevalence of HPV infection (81 and 47% among HIVpositive and HIV-negative MSM, respectively) [8]. The HPV prevalence among women from the general population seems to be lower so that Sabeena et al have reported the pooled HPV prevalence of 11% among women attending cervical cancer screening clinics [9]
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