ORIGINAL ARTICLE Cross-sectional study of genital carcinogenic HPV infections in Paramaribo, Suriname: prevalence and determinants in an ethnically diverse population of women in a pre-vaccination era Daan T Geraets, 1 Antoon W Grünberg, 2 Jannie J van der Helm, 3,4 Maarten F Schim van der Loeff, 4,5 Koen D Quint, 1,6 Leslie O A Sabajo, 7 Henry J C de Vries 3,5,8 ▸ Additional material is published online only. To view please visit the journal online (10.1136/sextrans-2013- 051384) For numbered affiliations see end of article. Correspondence to Daan T Geraets, DDL Diagnostic Laboratory, Visseringlaan 25, Rijswijk 2288 ER, The Netherlands; daan.geraets@ddl.nl DTG and AWG contributed equally. Received 30 September 2013 Revised 9 April 2014 Accepted 26 May 2014 To cite: Geraets DT, Grünberg AW, van der Helm JJ, et al. Sex Transm Infect Published Online First: [ please include Day Month Year] doi:10.1136/sextrans- 2013-051384 ABSTRACT Objective Cervical cancer is caused by carcinogenic human papillomavirus (HPV) infections. Prior to the introduction of HPV vaccination in Suriname, we performed a cross-sectional study to estimate the prevalence of and determinants for genital carcinogenic HPV infections. Methods Women were recruited at a family planning (FP) clinic and a sexually transmitted infections (STI) clinic. Vaginal swabs were used for HPV genotyping by the SPF 10 PCR- DEIA-LiPA 25 system. Logistic regression was used to identify determinants for carcinogenic HPV infection. Results The prevalence of any HPV was 54.2% and of carcinogenic HPV was 27.9% among 813 women attending the FP clinic. Among the 188 women attending the STI clinic, the prevalence of any HPV (76.1%) and of carcinogenic HPV (40.4%) was significantly higher. HPV52 was the most prevalent genotype in both clinics. The prevalence of HPV16 and/or 18 was 6.4% in the FP clinic and 12.2% in the STI clinic. The following determinants were independently associated with carcinogenic HPV infection among women visiting the FP clinic: ≥2 recent partners (OR 1.53; 95% CI 1.13 to 2.06), Chlamydia trachomatis co-infection (OR 1.89; 95% CI 1.32 to 2.70), disassortative ethnic sexual mixing (OR 1.50; 95% CI 1.13 to 1.99) and ethnic group (OR 1.90; 95% CI 1.27 to 2.85 for Creole and OR 1.67; 95% CI 1.06 to 2.62 for mixed ethnicity, both compared with Hindustani). No independent determinants were found among women visiting the STI clinic. Conclusions Carcinogenic HPV is highly prevalent among women in Suriname, and not equally distributed among ethnic groups. These data provide a baseline to assess possible shifts in the prevalence of HPV genotypes following vaccination. INTRODUCTION A persistent infection with the human papilloma- virus (HPV) is considered a necessary cause of cer- vical cancer. 1 The International Agency for Research on Cancer (IARC) has classified mucosal genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, and 59 as carcinogenic (Class 1), type 68 as probably carcinogenic (Class 2A) and types 26, 30, 34, 53, 66, 67, 69, 70, 73, 82, 85 and 97 as pos- sibly carcinogenic (Class 2B). 2 Other types were not classifiable as to their carcinogenicity (eg, HPV6 and 11) or were considered non- carcinogenic (Class 3). HPV-based strategies for prevention of cervical (pre)cancer are vaccination by a bivalent HPV16/18 vaccine or a quadrivalent HPV6/11/16/18 vaccine 3 and HPV testing in screening and triage. 4 In Suriname, a Caribbean country on the South American continent, age-standardised incidence and mortality rates for cervical cancer were 27.2 and 11.1 per 100 000 women, respectively, in 2008. 5 Suriname has not yet implemented a cer- vical cancer screening programme. Vaccination of girls aged 9–13 with the quadrivalent vaccine was started in November 2013. Suriname has a post-colonial population with a variety of ethnicities. The five major ethnic groups are Creole and Maroon (17.7% and 14.7%, respect- ively; both descendants of African diaspora due to the slave trade, the latter descendants from fugitive slaves settled in the interior forest), Hindustani and Javanese (27.4% and 14.6%, respectively; both des- cendants of labour immigrants from the former British Indies and Dutch Indies, respectively), and mixed ethnicity (12.5%). Other ethnicities are Chinese, indigenous Amerindians and Caucasians. 6 The prevalence of carcinogenic HPV infection among Surinamese women with normal cytological findings was estimated at 80% in one small study (n=100). 7 HPV positivity was 35.4% in the Caribbean, 15.3% in South America and 11.7% globally in a recent meta-analysis among 1 million women with normal cytological findings. 8 Variations in HPV prevalence are mainly due to dif- ferences in study population characteristics (eg, sexual behaviour, age), geographical region and (type-specific) sensitivity of the HPV test used. In addition, ethno-demographic and sexual behaviour risk factors for carcinogenic HPV infec- tions in Suriname have not yet been defined. A recent study showed that the prevalence of Chlamydia trachomatis differed between ethnic groups in Suriname. 9 The same might be true for the prevalence of carcinogenic HPV infection, as ethnic disparities in the prevalence of premalignant cervical lesions have been described. 10 In addition, the prevalence of squamous atypia and mild dyspla- sia is higher among Maroon women than in Javanese, Amerindian and Hindustani women. 11 Geraets DT, et al. Sex Transm Infect 2014;0:1–7. doi:10.1136/sextrans-2013-051384 1 Epidemiology STI Online First, published on June 11, 2014 as 10.1136/sextrans-2013-051384 Copyright Article author (or their employer) 2014. Produced by BMJ Publishing Group Ltd under licence. group.bmj.com on June 11, 2014 - Published by sti.bmj.com Downloaded from