title: Human papillomavirus prevalence and type distribution among women attending routine gynecological examinations in Saudi Arabia.
abstract: BACKGROUND
  Cervical cancer (CC) is caused by persistent infection with high-risk (HR) human papillomavirus (HPV) types. In Saudi Arabia which has a population of 6.5 million women over the age of 15 years, approximately 152 new cases of CC are diagnosed and 55 women die from the disease annually. Nevertheless current epidemiological data for HPV in this population are limited. This study evaluated the prevalence and type distribution of HPV and documented the awareness of HPV infection and health-related behavior among Saudi and non-Saudi women attending routine examination.
  
  
  METHODS
  This was an observational, epidemiological cross-sectional study conducted between April 2010 and December 2011 at three hospitals in Saudi Arabia. Cervical samples from women aged ≥15 years, who were attending routine gynecological examinations were collected and tested for HPV-DNA by polymerase chain reaction and typed using the SPF10 DEIA/LiPA25 system. Two questionnaires on health-related behavior and awareness of HPV infection were completed.
  
  
  RESULTS
  A total of 417 women, mean age (standard deviation) 41.9 (±10.4) years, were included in the final analysis, of whom 77% (321/417) were Saudi nationals. HPV-DNA was detected in 9.8% women (41/417, 95% confidence interval [CI]: 7.1-13.1). The prevalence of any HR-HPV by age was: 25-34 years: 3.0%; 35-44 years: 4.5%; 45-54 years: 3.2%; >55 years: 10.9%. The most prevalent HR-HPV-types were: HPV-68/73 (5 cases); HPV-18 (4 cases); HPV-16 (3 cases). The most prevalent low risk (LR) types were HPV-6 (4 cases); HPV-42, HPV-53 and HPV-54 (2 cases each). The prevalence of HPV was higher among non-Saudi nationals vs. Saudi nationals (16.7% vs. 7.8%, P = 0.0234). No statistically significant risk factors were identified: 32.2% (101/314) women were aware of HPV and 89.9% (285/317) showed an interest in HPV vaccination.
  
  
  CONCLUSIONS
  The overall prevalence of HPV was 9.8% in Saudi Arabia, but was higher in women over 55 years, as well as in non-Saudi nationals. These data provide a reference for public health authorities and may also help in determining future policies for the prevention of CC.
  
  
  BACKGROUND
  NCT01213459.
authors.affiliation: King Fahd Medical City, P.O. Box 59046, Riyadh, 11525, Saudi Arabia. abalobaid@kfmc.med.sa.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: AlObaid
authors.affiliation: King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, Riyadh, 11211, MBC-52, Saudi Arabia. i_albadawi@yahoo.com.
authors.forename: Ismail A
authors.initials: IA
authors.lastname: Al-Badawi
authors.affiliation: Department of Obstetrics and Gynecology, King Abdulaziz Medical City, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, P.O Box 22490, Riyadh, 11426, Saudi Arabia. halkadri@gmail.com.
authors.forename: Hanan
authors.initials: H
authors.lastname: Al-Kadri
authors.affiliation: GlaxoSmithKline Pharmaceuticals Ltd, Bangalore, India. kusuma.b.gopala@gsk.com.
authors.forename: Kusuma
authors.initials: K
authors.lastname: Gopala
authors.affiliation: GlaxoSmithKline Vaccines, Wavre, Belgium. Walid.x.kandeil@gsk.com.
authors.forename: Walid
authors.initials: W
authors.lastname: Kandeil
authors.affiliation: DDL Diagnostic Laboratory, Rijswijk, the Netherlands. w.g.v.quint@ddl.nl.
authors.forename: Wim
authors.initials: W
authors.lastname: Quint
authors.affiliation: King Faisal Specialist Hospital & Research Centre, P.O. Box 3354, Riyadh, 11211, MBC-52, Saudi Arabia. murad2076@yahoo.com.|Sydney Gynecologic Oncology Group, Royal Prince Alfred Hospital, Sydney, Australia. murad2076@yahoo.com.
authors.forename: Murad
authors.initials: M
authors.lastname: Al-Aker
authors.affiliation: GlaxoSmithKline Vaccines, Wavre, Belgium. rodrigo.d.deantonio@gsk.com.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: DeAntonio
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D003430:Cross-Sectional Studies; D005260:Female; D058869:Gynecological Examination; D006801:Humans; D008875:Middle Aged; D027383:Papillomaviridae / Q000235:genetics / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D014611:Vaccination; D014626:Vaginal Smears / Q000706:statistics & numerical data; D014932:Women's Health Services; D055815:Young Adult