Open Access Highly Accessed Research article

Cervical human papillomavirus infection among young women engaged in sex work in Phnom Penh, Cambodia: prevalence, genotypes, risk factors and association with HIV infection

Marie-Claude Couture1*, Kimberly Page1, Ellen S Stein1, Neth Sansothy2, Keo Sichan3, John Kaldor4, Jennifer L Evans1, Lisa Maher4 and Joel Palefsky1

Author Affiliations

1 University of California San Francisco, Global Health Sciences, 50 Beale street, Suite 1200, San Francisco, CA, 94105, USA

2 National Institute for HIV, AIDS, Dermatology and STDs, Phnom Penh, Cambodia

3 Cambodian Women’s Development Agency, Phnom Penh, Cambodia

4 The Kirby Institute, University of New South Wales, Sydney, Australia

For all author emails, please log on.

BMC Infectious Diseases 2012, 12:166  doi:10.1186/1471-2334-12-166

Published: 28 July 2012

Abstract

Background

Although cervical cancer is the leading cancer in Cambodia, most women receive no routine screening for cervical cancer and few treatment options exist. Moreover, nothing is known regarding the prevalence of cervical HPV or the genotypes present among women in the country. Young sexually active women, especially those with multiple sex partners are at highest risk of HPV infection. We examine the prevalence and genotypes of cervical HPV, as well as the associated risk factors among young women engaged in sex work in Phnom Penh, Cambodia.

Methods

We conducted a cross-sectional study among 220 young women (15–29 years) engaged in sex work in different venues including brothels or entertainment establishments, and on a freelance basis in streets, parks and private apartments. Cervical specimens were collected using standard cytobrush technique. HPV DNA was tested for by polymerase chain reaction (PCR) and genotyping using type-specific probes for 29 individual HPV types, as well as for a mixture of 10 less common HPV types. All participants were also screened for HIV status using blood samples. Multivariate logistic regression analyses were conducted to assess risk factors for any or multiple HPV infection.

Results

The prevalence of cervical HPV 41.1%. HPV 51 and 70 were the most common (5.0%), followed by 16 (4.6%), 71 (4.1%) and 81 (3.7%). Thirty-six women (16.4%) were infected with multiple genotypes and 23.3% were infected with at least one oncogenic HPV type. In multivariate analyses, having HIV infection and a higher number of sexual partners were associated with cervical HPV infection. Risk factors for infection with multiple genotypes included working as freelance female sex workers (FSW) or in brothels, recent binge use of drugs, high number of sexual partners, and HIV infection.

Conclusions

This is the first Cambodian study on cervical HPV prevalence and genotypes. We found that HPV infection was common among young FSW, especially among women infected with HIV. These results underscore the urgent need for accessible cervical cancer screening and treatment, as well as for a prophylactic vaccine that covers the HPV subtypes present in Cambodia.