Pre-vaccination Prevalence and Genotype Distribution of Human Papillomavirus Infection among Women from Urban Tunis: a Cross-sectional Study

  • Guettiti, Haifa (Department of Pathology, Faculty of Medicine, Institut Pasteur de Tunis) ;
  • Ennaifer, Emna (Department of Pathology, Faculty of Medicine, Institut Pasteur de Tunis) ;
  • Attia, Leila (Department of Gynecology Charles Nicolle Hospital Tunis) ;
  • Chelly, Dalenda (Department of Gynecology Centre de maternite et de Neonatologie Tunis) ;
  • Alaya, Nissaf Ben (Department of Epidemiology, Observatoire National de Tunis) ;
  • Aissa, Rim Ben (Family Planning Clinic of Ariana Tunis) ;
  • Laassili, Thalja (Department of Pathology, Faculty of Medicine, Institut Pasteur de Tunis) ;
  • Boubaker, Samir (Department of Pathology, Faculty of Medicine, Institut Pasteur de Tunis)
  • Published : 2014.11.28


Background: To estimate the pre-vaccination distribution of human papillomavirus (HPV) types among women from urban Tunis. Materials and Methods: A total of 611 women aged 18-69 years were enrolled in three local gynaecological outpatient departments. All underwent a gynaecological examination with Pap test and dry swab for HPV detection and typing performed by linear array genotyping test (Roche). Cytological examination was conducted on conventional Pap smears. Results: HPV DNA was found in 6.5% of the women; the most frequent HPV types were HPV 16 and HPV 11 at 3.27% and 1.96%, respectively. The second most frequent high risk (HR) HPV type was HPV 58 (0.82%) followed by HPV 18, HPV 31 and HPV 33 found in only 0.33% of women. Single infections with HPV types, targeted by the quadrivalent vaccine (6, 11, 16, and 18), were detected in 3.6 % of the study patients (55% of positive women). HPV infection was found in 3.83% of women with normal cytology and in 47.4% of women with cytological abnormalities. No statistically significant trend in prevalence by age group emerged for any HPV type or for high or low risk types. Conclusions: These data show a relatively low prevalence of HPV infection in women from urban Tunis with a high proportion of HPV16 and HPV58. This should be considered in the upcoming screening programs and vaccination strategy.


  1. Abdel Aziz MT, Abdel Aziz MZ, Atta HM et al (2006). Screening for human papillomavirus (HPV) in Egyptian women by the second-generation hybrid capture (HC II) test. Med Sci Monit, 12, 43-9.
  2. Akcali S, Goker A, Ecemis T, Kandiloglu AR, Sanlidag T (2013). Human papilloma virus frequency and genotype distribution in a Turkish population. Asian Pac J Cancer Prev, 14, 1503-6.
  3. Bruni L, Diaz M, Castellsague X, et al (2010). Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis, 202, 1789-99.
  4. Castle PE, Schiffman M, Herrero R, et al (2005). A prospective study of age trends in cervical human papillomavirus acquisition and persistence in Guanacaste, Costa Rica. J Infect Dis, 191, 1787-9.
  5. Clifford GM, Gallus S, Herrero R, et al (2005). Worldwide distribution of human papillomavirus types in cytologically normal women in the International agency for research on cancer HPV prevalence surveys: a pooled analysis. Lancet, 366, 991-8.
  6. Clifford GM, Rana RK, Franceschi S, et al (2005). Human papillomavirus genotype distribution in low-grade cervical lesions: comparison by geographic region and with cervical cancer. Cancer Epidemiol Biomarkers Prev, 14, 1157-64.
  7. Dai M, Bao YP, Li N, et al (2006). Human papillomavirus infection in shanxi province, people's republic of China: a population-based study. Br J Cancer, 95, 96-101.
  8. De Marco F, Houissa-Kchouk F, Khelifa R, Marcante ML (2006). High-risk HPV types in Tunisia. a pilot study reveals an unexpectedly high prevalence of types 58 and 82 and lack of HPV 18 among female prostitutes. J Med Virol, 78, 950-3.
  9. De Vuyst H, Clifford G, Li N, Franceschi S (2009). HPV infection in Europe. Eur J Cancer, 45, 2632-9.
  10. Evans MF, Adamson CS, Papillo JL, et al (2006). Distribution of human papillomavirus types in ThinPrep Papanicolaou tests classified according to the Bethesda 2001 terminology and correlations with patient age and biopsy outcomes. Cancer, 106, 1054-64.
  11. Hammouda D, Munoz N, Herrero R, et al (2005). Cervical carcinoma in Algiers, Algeria: human papillomavirus and lifestyle risk factors. Int J Cancer, 113, 483-9.
  12. Hammouda D, Clifford GM, Pallardy S, et al (2011). Human papillomavirus infection in a population-based sample of women in Algiers, Algeria. Int J Cancer, 128, 2224-9.
  13. Hassen E, Remadi S, Chouchane L (1999). Detection and molecular typing of human papillomaviruses: prevalence of cervical infection in the Tunisian central region. Tunis Med, 77, 497-502.
  14. Hassen E, Chaieb A, Letaief M, et al (2003). Cervical human papillomavirus infection in Tunisian women. Infection, 31, 143-8.
  15. Laowahutanont P, Karalak A, Wongsena M, et al (2014). Prevalence of high risk human papillomavirus infection with different cervical cytological features among women undergoing health examination at the national cancer institute, Thailand. Asian Pac J Cancer Prev, 15, 5879-82.
  16. Martin-Hirsch P, Lilford R, Jarvis G, Kitchener HC (1999). Efficacy of cervical-smear collection devices: a systematic review and meta-analysis. Lancet, 354,1763-70.
  17. Oliveira-Silva M, Lordello CX, Zardo LM et al (2011). Human Papillomavirus in Brazilian women with and without cervical lesions. Virol J, 5, 4.
  18. Sancho-Garnier H, Khazraji YC, Cherif MH et al (2013). Overview of cervical cancer screening practices in the extended Middle East and North Africa countries. Vaccine, 6, 51-7.
  19. Shah KV, Daniel RW, Tennant MK, et al (2001). Diagnosis of human papillomavirus infection by dry vaginal swabs in military women. Sex Transm Infect, 77, 260-4.
  20. Smith JS, Melendy A, Rana RK, Pimenta JM (2008). Age-specific prevalence of infection with human papillomavirus in females: a global review. J Adolesc Health, 43, 5-25.
  21. Takehara K, Toda T, Nishimura T, et al (2011). Human papillomavirus types 52 and 58 are prevalent in uterine cervical squamous lesions from Japanese women. Patholog Res Int, 246936.
  22. Unger, E. R, J. Dillner, T Zhou (2009). Human papillomavirus laboratory manual, 1st ed. WHO. Geneva, Switzerland.
  23. Xi LF, Toure P, Critchlow CW, et al (2003). Prevalence of specific types of human papillomavirus and cervical squamous intraepithelial lesions in consecutive, previously unscreened, west-African women over 35 years of age. Int J Cancer, 103, 803-9.
  24. Znazen A, Frikha-Gargouri O, Berrajah L, et al (2010). Sexually transmitted infections among female sex workers in Tunisia: high prevalence of Chlamydia trachomatis. Sex Transm Infect, 86, 500-5.

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