Abstract:
BACKGROUND. Women accessing the public health system in Gauteng province, South Africa are largely unscreened for cervical cancer and
have a high background prevalence of human immunodeficiency virus (HIV) infection.
OBJECTIVES. This cross-sectional study describes the age-specific prevalence of human papillomavirus (HPV) infection and cytological
abnormalities among this urban and peri-urban population.
METHOD. Over the period March 2009 - September 2011, 1 524 women attending public sector primary healthcare clinics were invited to
participate in a cervical cancer screening study. All participants were screened with conventional cytology and HPV testing undertaken
using the HPV linear array genotyping kit (Roche Molecular Systems).
RESULTS. Of 1 472 women with valid cytology results, abnormalities were detected in 17.3% (n=255), of which 9.1% (n=134) were high-grade
squamous intraepithelial lesions, and 0.5% (n=8) suggestive of squamous carcinoma. Of the 1 445 women with complete data, the overall
and high-risk HPV DNA prevalences were 74.6% (n=1 078) and 54.3% (n=784), respectively. HPV type 16 and/or 18 were detected in 19.5%
(n=282) of women. Age-specific prevalence of HPV showed a plateau-shaped curve.
CONCLUSIONS. The prevalences of HPV infection and abnormal cytology were much higher than previously reported in general populations
in South Africa and elsewhere. Higher age-specific prevalence and similar plateau-like age-specific epidemiological curves have previously
only been described in studies among HIV-positive women. These findings have implications for planning and development of cervical
screening programmes in developing countries with largely unscreened populations with a high background prevalence of HIV.
