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Human Papillomavirus and Cervical Neoplasia Among Female Sex Workers in Madagascar
  1. Jennifer S. Smith, PhD*,
  2. Kathleen Van Damme, MD,
  3. Nantenaina Randrianjafisamindrakotroka, MD,
  4. Jie Ting, MSPH*,
  5. Tiana Rabozakandraina, MD§,
  6. Bodo S. Randrianasolo, MD§,
  7. Mbolatiana Raharinivo, MD,
  8. Sandrine Zanasaotra, MD,
  9. Marcia Hobbs, PhD,
  10. Allen Rinas, MS,
  11. Myron Cohen, MD,
  12. Patti Gravitt, PhD** and
  13. Frieda Behets, PhD*
  1. * Gillings School of Global Public Health,
  2. University of Carolina School of Medicine, University of Carolina, Chapel Hill, NC;
  3. Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona;
  4. § National Institute of Community and Public Health;
  5. University of Carolina-Madagascar;
  6. Cytology and Pathology Laboratories, Centre Hospitalier Universitaire Joseph Ravoahangy Andrianavalona, Antananarivo, Madagascar; and
  7. ** Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  1. Address correspondence and reprint requests to Jennifer S. Smith, PhD, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC. E-mail: jenniferS{at}


Introduction: Human papillomavirus (HPV) prevalence and type distribution were estimated among 90 female sex workers (FSWs) aged 18 to 58 years in Antananarivo, Madagascar.

Methods: A total of 90 FSWs aged 18 to 58 years in Antananarivo, Madagascar, were included in this study. Information on sexual and behavioral characteristics was obtained via a questionnaire. Exfoliated cervical cell specimens were collected for conventional cytologic examination and HPV DNA testing by polymerase chain reaction. The prevalence rates of HPV DNA and their corresponding 95% confidence intervals were stratified into the following 3 age groups: younger than 25, 25 to 34, and 35 years or older. To assess the association between HPV DNA positivity and sociodemographic and sexual behavioral factors, age-adjusted odds ratios and 95% confidence intervals were calculated using unconditional logistic regression.

Results: The HPV prevalence in exfoliated cervical cell specimens was 36.7%. The most common HPV types found were HPV-52 (11.1%), HPV-31 and -39 (each at 5.6%), and HPV-16 and -83 (each at 3.3%). The prevalence of low-grade squamous intraepithelial lesions was 3.3%, and that of atypical squamous cells of undetermined significance was 18.9%. No high-grade lesion was found. Although associations were imprecise, the HPV prevalence was higher among women who reported younger age at the first intercourse, contraceptive use, a history of cervical lesions, and no history of condom use.

Discussion: The prevalence rates of HPV and cervical lesions among FSWs in Madagascar appear higher than among FSW populations from other African countries with a relatively higher population-based prevalence of human immunodeficiency virus infection.

  • HPV
  • Cervical precancer
  • Female sex workers
  • Madagascar

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