Open Access Open Badges Research article

Genotype distribution of human papillomavirus (HPV) and co-infections in cervical cytologic specimens from two outpatient gynecological clinics in a region of southeast Spain

Pablo Conesa-Zamora1*, Sebastián Ortiz-Reina2, Joaquín Moya-Biosca2, Asunción Doménech-Peris3, Francisco Javier Orantes-Casado3, Miguel Pérez-Guillermo3 and Marcos Egea-Cortines4*

Author Affiliations

1 Grupo de Patología Molecular y Farmacogenética FFIS011, Hospital Universitario Santa María del Rosell, Cartagena, Spain

2 Servicio de Anatomía Patológica, Hospital Universitario Santa María del Rosell, Spain

3 Servicio de Análisis Clínicos, Hospital Universitario Santa María del Rosell, Spain

4 Área de Genética, Instituto de Biotecnología Vegetal, Escuela Técnica Superior de Ingeniería Agronómica, Universidad Politécnica de Cartagena, Spain

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BMC Infectious Diseases 2009, 9:124  doi:10.1186/1471-2334-9-124

Published: 10 August 2009



Human Papillomavirus (HPV) genotype distribution and co-infection occurrence was studied in cervical cytologic specimens from Murcia Region, (southeast Spain), to obtain information regarding the possible effect of the ongoing vaccination campaign against HPV16 and HPV18.


A total of 458 cytologic specimens were obtained from two outpatient gynecological clinics. These included 288 normal benign (N/B) specimens, 56 atypical squamous cell of undetermined significance (ASC-US), 75 low-grade squamous intraepithelial lesions (LSIL) and 39 high-grade squamous intraepithelial lesions (HSIL). HPV genotyping was performed using PCR and tube array hybridization.


The most frequent genotype found was HPV16 (14.9% in N/B; 17.9% in ASC-US; 29.3% in LSIL and 33.3% HSIL). Distribution of other genotypes was heavily dependent on the cytologic diagnoses. Co-infections were found in 15.3% of N/B, 10.7% of ASC-US, 48% of LSIL and 25.6% of HSIL cases (significantly different at p < 0.001). Strikingly, in N/B diagnoses, genotypes from A5 species were found as coinfecting in all cases. Genotypes from A7 or A9 species appeared in co-infections in 56.5% and 54% respectively whereas genotypes from A6 species appeared in 25.1% of cases.


HPV vaccination might prevent 34.6% and 35.8% of LSIL and HSIL, respectively. Co-infection rate is dependent on both cytologic diagnosis and HPV genotype. Moreover, genotypes belonging to A5, A7 and A9 species are more often found as co-infections than genotype pertaining to A6 species. This suggests that phylogenetically related genotypes might have in common similar grades of dependency for cervical epithelium colonization.