title: Vaginal high-risk human papillomavirus infection in a cross-sectional study among women of six different ethnicities in Amsterdam, the Netherlands: the HELIUS study.
abstract: OBJECTIVE
  In the Netherlands the incidence of cervical cancer is higher among ethnic minority populations compared with the general Dutch population. We investigated the prevalence of, and risk factors associated with, vaginal high-risk human papillomavirus (hrHPV) infection in women of six different ethnicities living in Amsterdam.
  
  
  METHODS
  For this cross-sectional study we selected women aged 18-34 years old of six ethnicities from the large-scale multiethnic HEalthy LIfe in an Urban Setting study. Self-collected vaginal swabs were tested for HPV DNA and genotyped using a highly sensitive PCR and reverse line blot assay (short PCR fragment (SPF)10-PCR DNA enzyme immunoassay/LiPA25-system version-1, delft diagnostic laboratory (DDL)). Participants completed a questionnaire regarding demographics and sexual behaviour. Logistic regression using generalised estimating equations was used to assess risk factors of hrHPV, and to investigate whether prevalence of hrHPV differed among ethnicities.
  
  
  RESULTS
  The study population consisted of 592 women with a median age of 27 (IQR: 23-31) years. Dutch and African Surinamese women reported the highest sexual risk behaviour. HrHPV prevalence was highest in the Dutch (40%) followed by the African Surinamese (32%), Turkish (29%), Ghanaian (26%), Moroccan (26%) and South-Asian Surinamese (18%). When correcting for sexual risk behaviour, the odds to be hrHPV-positive were similar for all non-Dutch groups when compared with that of the Dutch group.
  
  
  CONCLUSIONS
  We found an overall higher hrHPV prevalence and higher sexual risk behaviour in the native Dutch population. Further research is needed to unravel the complex problem concerning cervical cancer disparities, such as differences in participation in the cervical cancer screening programme, or differences in clearance and persistence of hrHPV.
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.|Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: C J
authors.initials: CJ
authors.lastname: Alberts
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Vos
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.|Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Borgdorff
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Vermeulen
authors.affiliation: SOA Aids Nederland, Amsterdam, The Netherlands.|Department of General Practice, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Bergen
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.|Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Bruisten
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: S E
authors.initials: SE
authors.lastname: Geerlings
authors.affiliation: Department of Public Health, Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: M B
authors.initials: MB
authors.lastname: Snijder
authors.affiliation: Department of Medical Microbiology and Infection Control, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: van Houdt
authors.affiliation: Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Research School V-ICI, VU University Medical Center, Amsterdam, the Netherlands.|Department of Genetics and Cell Biology, Research Institute GROW (School for Oncology & Developmental Biology), Faculty of Health, Medicine & Life Sciences, Institute for Public Health Genomics, University of Maastricht, Maastricht, The Netherlands.
authors.forename: S A
authors.initials: SA
authors.lastname: Morré
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.|Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: H J C
authors.identifier: http://orcid.org/0000-0001-9784-547X
authors.initials: HJ
authors.lastname: de Vries
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.|Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.|Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: J H H M
authors.initials: JH
authors.lastname: van de Wijgert
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.|Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Prins
authors.affiliation: Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands.|Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands.
authors.forename: M F
authors.initials: MF
authors.lastname: Schim van der Loeff
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000379:methods*; D004522:Educational Status; D005006:Ethnicity / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D009426:Netherlands / Q000453:epidemiology; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology*; D015995:Prevalence; D012725:Sexual Behavior; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D014621:Vagina / Q000821:virology*; D055815:Young Adult
keywords: EPIDEMIOLOGY (GENERAL); ETHNICITY; HPV; WOMEN