title: Prevalence of human papillomavirus in adolescent girls before reported sexual debut.
abstract: BACKGROUND
  Human papillomavirus (HPV) vaccines are recommended for girls prior to sexual debut because they are most effective if administered before girls acquire HPV. Little research has been done on HPV prevalence in girls who report not having passed sexual debut in high HPV-prevalence countries.
  
  
  METHODS
  Using attendance registers of randomly selected primary schools in the Mwanza region of Tanzania, we enrolled girls aged 15-16 years who reported not having passed sexual debut. A face-to-face interview on sexual behavior and intravaginal practices, and a nurse-assisted self-administered vaginal swab were performed. Swabs were tested for 13 high-risk and 24 low-risk HPV genotypes.
  
  
  RESULTS
  HPV was detected in 40/474 (8.4%; 95% confidence interval [CI], 5.9-11.0) girls. Ten different high-risk and 21 different low-risk genotypes were detected. High-risk genotypes were detected in 5.3% (95% CI, 3.5-7.8). In multivariable analysis, only intravaginal cleansing (practiced by 20.9%) was associated with HPV detection (adjusted odds ratio = 2.19, 95% CI, 1.09-4.39).
  
  
  CONCLUSIONS
  This cohort of adolescent Tanzanian girls had a high HPV prevalence prior to self-reported sexual debut, and this was associated with intravaginal cleansing. This most likely reflects underreporting of sexual activity, and it is possible that intravaginal cleansing is a marker for unreported sexual debut or nonpenetrative sexual behaviors.
authors.affiliation: Clinical Research Department, London School of Hygiene and Tropical Medicine, United Kingdom Mwanza Intervention Trials Unit, Tanzania.
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Houlihan
authors.affiliation: Unit of Infections and Cancer, Institut Català d'Oncologica, IDIBELL CIBER, Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: de Sanjosé
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Kathy
authors.initials: K
authors.lastname: Baisley
authors.affiliation: National Institute for Medical Research, Mwanza, Tanzania.
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: David A
authors.initials: DA
authors.lastname: Ross
authors.affiliation: Mwanza Intervention Trials Unit, Tanzania MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Saidi
authors.initials: S
authors.lastname: Kapiga
authors.affiliation: Unit of Infections and Cancer, Institut Català d'Oncologica, IDIBELL.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Godinez
authors.affiliation: Collaborating Centre for HIV Surveillance, School of Medicine, University of Zagreb, Croatia.
authors.forename: Ivana
authors.initials: I
authors.lastname: Bozicevic
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, United Kingdom.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
authors.affiliation: Clinical Research Department, London School of Hygiene and Tropical Medicine, United Kingdom Mwanza Intervention Trials Unit, Tanzania.
authors.forename: Deborah
authors.initials: D
authors.lastname: Watson-Jones
mesh_terms: D000293:Adolescent; D005260:Female; D005838:Genotype; D006801:Humans; D006920:Hygiene; D007407:Interviews as Topic; D027383:Papillomaviridae / Q000235:genetics; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000821:virology; D015995:Prevalence; D012725:Sexual Behavior / Q000706:statistics & numerical data; D013636:Tanzania / Q000453:epidemiology; D014621:Vagina / Q000821:virology
keywords: human papillomavirus; prevalence; sexual debut; sub–Saharan Africa
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