title: Burden of human papillomavirus-related cervical disease in the extended middle East and north Africa-a comprehensive literature review.
abstract: OBJECTIVE
  This study aimed to analyze the burden of human papillomavirus (HPV) in the Extended Middle East and North Africa (EMENA) region and to discuss the potential impact on HPV-related diseases derived from changing sexual behaviors and perceptions.
  
  
  METHODS
  A comprehensive retrospective review of the available epidemiological data (publications in the past 30 years until January 2011) on HPV and its related diseases (especially as they relate to the cervix) in the EMENA region was carried out.
  
  
  RESULTS
  Analysis of the burden of HPV in the EMENA region highlights an unexpectedly high prevalence of HPV, with rates of HPV ranging from 0% to 25% in low-risk women with normal cytology and up to 98% in those with genital warts and preinvasive and invasive lesions. In addition, cervical cancer screening practices are, at best, opportunistic in most countries of the region; therefore, the observed change in social and sexual behavior in the EMENA population, particularly in youths, could lead to an increase in HPV and its related diseases especially cervical cancer.
  
  
  CONCLUSIONS
  This article emphasizes the need for the introduction and standardization of screening practices in the region. Moreover, surveillance studies are needed to enable the identification of HPV type distribution and to determine the potential impact of the introduction of HPV vaccines. These socio-epidemiological data are of marked value to health care decision and policymakers in prioritizing available public health interventions.
authors.affiliation: Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon. mike@aub.edu.lb
authors.forename: Muhieddine
authors.initials: M
authors.lastname: Seoud
mesh_terms: D000352:Africa, Northern / Q000453:epidemiology; D001521:Behavior Therapy / Q000379:methods; D003218:Condylomata Acuminata / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008877:Middle East / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology* / Q000635:transmission; D015995:Prevalence; D012189:Retrospective Studies; D012725:Sexual Behavior; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology*