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Prevalence of Human Papillomavirus Infection in Women in Portugal: The CLEOPATRE Portugal Study
  1. Angela Pista, PhD*,
  2. Carlos Freire de Oliveira, PhD,
  3. Maria João Cunha, MD,
  4. Maria Teresa Paixao, PhD*,
  5. Odete Real, MD§,
  6. on behalf of the CLEOPATRE Portugal Study Group
  1. *National Institute of Health, Lisbon;
  2. University Hospital, Coimbra;
  3. Sanofi Pasteur MSD, Amadora; and
  4. §Cytopathology Laboratory, Coimbra, Portugal.
  1. Address correspondence and reprint requests to Angela Pista, PhD, Instituto Nacional de Saúde Avenida Padre Cruz, 1649-016 Lisboa, Portugal. E-mail: angela.pista{at}


Objective: Human papillomavirus (HPV) is responsible for a range of diseases, including cervical cancer. The primary objectives of the CLEOPATRE Portugal study were to estimate the overall and age-stratified prevalence of cervical HPV infection and to assess HPV prevalence and type-specific distribution by cytological results among women aged 18 to 64 years, who reside in mainland Portugal.

Materials and Methods: This cross-sectional population-based study recruited women aged 18 to 64 years, according to an age-stratified sampling strategy, who attended gynecology/obstetrics or sexually transmitted disease clinics across the 5 regional health administrations in mainland Portugal between 2008 and 2009. Liquid-based cytology samples were collected and analyzed centrally for HPV genotyping (clinical array HPV 2 assay) and cytology. Prevalence estimates were adjusted for age using 2007 Portuguese census data.

Results: A total of 2326 women were included in the study. The overall prevalence of HPV infection in the study was 19.4% (95% confidence interval, 17.8%-21.0%), with the highest prevalence in women aged 18 to 24 years. High-risk HPV types were detected in 76.5% of infections, of which 36.6% involved multiple types. The commonest high-risk type was HPV-16. At least 1 of the HPV types 6/11/16/18 was detected in 32.6% of infections. The HPV prevalence in normal cytology samples was 16.5%. There was a statistically significant association between high-risk infection and cytological abnormalities (P < 0.001).

Conclusions: This is the first population-based study to quantify and describe cervical HPV infection in mainland Portugal. This study provides baseline data for future assessment of the impact of HPV vaccination programs.

  • Human papillomavirus
  • Portugal
  • HPV prevalence
  • HPV genotyping
  • Cytology

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  • This study was sponsored by Sanofi Pasteur MSD.