title: An epidemiological study assessing the prevalence of human papillomavirus types in women in the Kingdom of Bahrain.
abstract: BACKGROUND
  Persistent infection with high-risk (HR) human papillomavirus (HPV) causes cervical cancer, the fourth most frequent cancer in the Kingdom of Bahrain, with an annual incidence of four per 100,000 women. The aim of this study was to assess the prevalence and type distribution of HPV in Bahraini and non-Bahraini women attending routine screening. HPV prevalence was assessed by risk factors and age distribution. Health-related behaviors and HPV awareness were also studied.
  
  
  METHODS
  This observational study was conducted between October 2010 and November 2011 in the Kingdom of Bahrain (NCT01205412). Women aged either ≥20 years attending out-patient health services for routine cervical screening or ≥16 years attending post-natal check-ups were enrolled. Cervical samples were collected and tested for HPV-DNA by polymerase chain reaction and typed using the SPF10 DEIA/LiPA25 system. All women completed two questionnaires on health-related behavior (education level, age at first marriage, number of marital partners, parity and smoking status) and HPV infection awareness.
  
  
  RESULTS
  HPV DNA was detected in 56 of the 571 women included in the final analysis (9.8%); 28 (4.9%), 15 (2.6%) and 13 (2.3%) women were infected with single, multiple and unidentifiable HPV types, respectively. The most prevalent HPV types among the HPV positive women were HR-HPV-52 in eight (1.4%), HR-HPV-16, -31 and -51 in six women each (1.1%); low-risk (LR)-HPV-6 in four (0.7%); and LR-HPV-70, -74 in three women each (0.5%). Co-infection with other HR-HPV types was observed in 50% HPV-16-positive women (with HPV-31, -45 and -56) and in both HPV-18-positive women (with HPV-52). None of the health-related risk factors studied were associated with any HR-HPV infection. More than half of women (68.7%) had never heard about HPV, but most women (91.3%) in our study were interested in HPV-vaccination.
  
  
  CONCLUSIONS
  HPV prevalence in Bahraini women was 9.8%. The most frequently observed HPV types were HR-HPV-52, -16, -31 and -51 and LR-HPV-6, -70 and -74. These are useful baseline data for health authorities to determine the potential impact of preventive measures including the use of prophylactic vaccines to reduce the burden of cervical cancer.
authors.affiliation: Arabian Gulf University/Medical College, Manama, Bahrain. drkhairyamoosa@gmail.com.
authors.forename: Khairya
authors.initials: K
authors.lastname: Moosa
authors.forename: Adel Salman
authors.initials: AS
authors.lastname: Alsayyad
authors.forename: Wim
authors.initials: W
authors.lastname: Quint
authors.forename: Kusuma
authors.initials: K
authors.lastname: Gopala
authors.forename: Rodrigo
authors.initials: R
authors.lastname: DeAntonio
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D052685:Alphapapillomavirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D001445:Bahrain / Q000453:epidemiology; D002584:Cervix Uteri / Q000821:virology; D060085:Coinfection / Q000453:epidemiology / Q000821:virology; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000208:ethnology / Q000821:virology*; D015995:Prevalence; D012307:Risk Factors; D014611:Vaccination; D055815:Young Adult
chemical_list: D004279:DNA, Viral