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PubMed1998

HIV infection and high risk behavior among patients attending an STD referral clinic in Prague, Czech Republic.

OBJECTIVE: This survey was conducted to determine the prevalence of HIV infection and associated risk behaviour in a high risk population of clients attending an STD clinic in Prague, Czech Republic. METHODS: Between September 1994 and January 1995, clients entering the Apolinar STD clinic in Prague, Czech Republic, were enrolled in a blinded, unlinked HIV antibody seroprevalence study. Non-identifying demographic characteristics, STD diagnoses, HIV risk exposures, and voluntary HIV testing experience were extracted from medical charts. RESULTS: Of 1394 patients for whom serum was available for testing, one was positive for HIV (HIV prevalence 0.07%, 95% confidence interval (CI) 0.01, 0.41%). This person was one of 28 men having sex with men (MSWM) (HIV prevalence among MSWM 3.6%, 95% CI 0.6, 17.7%). Among the 775 male clients, 75.5% had heterosexual unprotected sex, 11.1% had sex with high risk partners or prostitutes, 3.6% were MSWM, 1.0% were injecting drug users (IDUs), 0.7% were both MSWM and IDUs, and 6.8% and 1.8% had other or no recognized risk for HIV/STDs, respectively. Among the 619 female clients, 74.5% had heterosexual unprotected sex, 11.6% were prostitutes, 7.8% had sex with high risk partners, 1.1% were IDUs, and 3.9% and 2.3% had other or no recognised risk, respectively. The 304 adolescent patients (age 11-19 years) differed significantly (p < 0.05) in risk behaviour and STD diagnoses from the 1090 patients who were 20 years and older. Adolescents were significantly more likely to be female (58.6% v 40.5%, OR = 2.1), IDUs (3.6% v 0.4%, OR = 10.2), prostitutes (8.9% v 4.7%, OR = 2.0), and have sex partners with STDs (7.6% v 4.4%, OR = 1.8). The adolescent patients were also significantly more likely to be diagnosed with gonorrhoea (21.1% v 12.3%, OR = 1.9) and non-gonococcal urethritis (27.6% v 17.2%, OR = 1.8), and significantly less likely to have been tested previously for HIV (19.1% v 31.9%, OR = 0.5). CONCLUSIONS: HIV infection is currently uncommon in this population. However, the high rates of unprotected sex, prostitution, injecting drug use, and STDs, especially among adolescents, provide the basis for an epidemic in this population. Aggressive prevention education should be started before adolescence.

Adolescent↗
PubMed1999

Risky business: health and safety in the sex industry over a 9 year period.

OBJECTIVES: To assess whether a previously established low sexually transmitted infection/HIV risk in prostitutes in London has been sustained, and to measure other occupational risks, including mortality. DESIGN: 9 year prospective study in west London. SUBJECTS: 402 prostitutes recruited from 1985 to 1991, 320 were followed up for 675 person years to 1994. MAIN OUTCOME MEASURES: Condom use in commercial and non-commercial sex; viral and bacterial sexually transmitted infection at initial and follow up visits; death. RESULTS: Condom use increased significantly from 1986 to 1993 and protected the majority of commercial sexual contacts. Baseline prevalence: HIV 1.3%, hepatitis C 6.7%, hepatitis B 6.6%, syphilis 2.3%, HTLV-I/II 0.4%, gonorrhoea 3.0%, chlamydia 8.2%, genital herpes 16.8%. Incidence (per 100 person years): HIV 0.2, hepatitis C 0.3, gonorrhoea 5.6, chlamydia 12.6, genital herpes 6.5. Viral infections were associated with injecting drug use and non-British nationality; bacterial infections were associated with numbers of non-commercial partners but not with sexual contacts at work. Four women died during the course of the study; two had AIDS, two were murdered. This mortality of 5.93 per 1000 person years was 12 times the expected rate for women of a similar age. CONCLUSIONS: This study shows that it is possible to have a larger number of sexual partners and remain free from sexually transmitted infections provided that condoms are used consistently: there has been a sustained increase in condom use in the sex industry. None the less, prostitutes are at increased risk of sexually transmitted infections, primarily through non-commercial sexual partnerships. Infectious diseases are only one of the risks facing prostitutes, as illustrated by the mortality from violence as well as from HIV infection.

Adolescent↗
PubMed2004

Stromal cell-derived factor (SDF) 1-3'A polymorphism may play a role in resistance to HIV-1 infection in seronegative high-risk Thais.

OBJECTIVE: It is known that a 32-bp-deleted CCR5 mutant (CCR5-Delta32) plays a critical role in resistance to human immunodeficiency virus type 1 (HIV-1) infection. We became aware of a number of seronegative patients at high risk of HIV-1 infections. Since CCR-Delta32 is not found in Thais, we examined the role of stromal cell-derived factor (SDF) 1-3'A polymorphism in resistance to HIV-1 in seronegative Thai prostitutes at high risk. METHODS: We determined CCR5-Delta32 by PCR, SDF1-3'A by RFLP, and plasma SDF-1 level by sandwich ELISA. RESULTS: We did not find any CCR-Delta32 mutant in 432 subjects. In our SDF1-3'A genotyping, we found allelic frequencies of 0.406, 0.199, and 0.289 in HIV-1-seronegative prostitutes at high risk, HIV-1-seropositive patients, and normal blood donors, respectively. There was a significant difference in the allelic frequencies of SDF1-3'A between HIV-1-seronegative prostitutes at high risk and HIV-1-seropositive patients (p < 0.005). Striking differences were seen in homozygotes (SDF1-3A/3A); 20.3% in HIV-1-seronegative patients at high risk compared with 2.5% in HIV-1-seropositive patients. In addition, we showed that the plasma SDF1 level in the HIV-1-seronegative prostitutes at high risk was twice that found in normal blood donors (p = 0.005), and even higher than that of HIV-1-seropositive patients (p = 0.002). CONCLUSIONS: The finding is relevant as regards the fact that SDF1-3'A polymorphism induces an increase of SDF1 chemokine production, in which it competes with HIV-1 in binding to CXCR4 receptor, and in turn inhibits HIV-1 infection. The SDF1-3'A-mediated resistant mechanism in Thais differs from that of CCR5-Delta32-mediated resistance in Caucasians. This study provides the first evidence for SDF-3'A polymorphism in resistance to HIV-1 infection in Thais, and may represent the resistant mechanism in the extremely rare CCR5-Delta32 mutant of other ethnic groups such as Africans and Japanese.

Adult↗
PubMed1979

The relationship between female criminality and drug use.

A 2-year study of four groups of women (N = 268)--addicts, prostitute-addicts, prostitutes, and female offenders--reveals that the link between female criminal activity and female drug involvement is significant. All four groups report "drug costs" as a major percentage of their monthly expenses. Prostitutes and female offenders report purchasing drugs mainly for resale. Female offenders report most of their income as coming from drugs sales, shoplifting, and larceny. For all of the women addicted to heroin, reselling drugs and prostitution were the usual means of support. There is insufficient evidence at this point in the research to link the use of a specific category of drugs to specific types of offenses. The main determinants in choice of crime for these subjects were skill and opportunity.

Adolescent↗
PubMed2000

[Incidence of genitourinary infection caused by Chlamydia trachomatis in a STD center calculated by direct antigen detection].

OBJECTIVE: Chlamydia trachomatis is one of the most common sexually transmitted agents which causes a wide spectrum of diseases including urethritis in men and endocervicitis in women. We analyzed patients with genitourinary C. trachomatis infections evaluating risk factors and the association with other sexually transmitted infections. MATERIAL AND METHODS: We processed 1,180 specimens from 913 patients (772 women and 141 men), attended at a Sexually Transmitted Diseases (STD) Center. The diagnostic of C. trachomatis infection was made by an enzyme-linked fluorescent immunoassay, Vidas Chlamydia test (bioMérieux). RESULTS: The incidence of C. trachomatis infection was 4.8% (57 cases) and was higher in women (70.1%) than in men (29.8%). The risk groups observed were: 26 prostitute, 7 contact with prostitute or risk partner, 5 homosexual, 5 promiscuous heterosexual and 14 without risk groups. Associated with this infection we observed other: 10 bacterial vaginosis, 8 Papillomavirus infection, 3 Trichomonas vaginalis infections, 2 Neisseria gonorrhoeae infections and 2 Candidiasis. The 53.4% of these patients didn't have any symptomatology at the consult moment. CONCLUSIONS: The control of patients with risk factors is important for the diagnostic of C. trachomatis and other sexually transmitted infections, because most of them were prostitutes and asymptomatic. Within men, homosexuality, contact with prostitute or risk partner were the practices with higher risk.

Antigens, Bacterial↗
PubMed1990

Behavioral risk factors of human immunodeficiency virus infection among intravenous drug users and implications for preventive interventions.

Risk behaviors for HIV infection in relation to drug and sexual activities among 262 intravenous drug users (IVDUs) from methadone clinics in New York City were investigated using a structured questionnaire in 1986. The overall seroprevalence rate was 60.1 per cent. Intravenous heroin and cocaine users were found to be significantly more likely to be HIV positive than those who used heroin and cocaine intranasally. Among female IVDUs, excluding prostitutes (defined by self-report of sex for money or drugs), the HIV positive participants reported higher numbers of sex partners than those participants who were HIV negative. The female IVDUs who reported prostitution during the last 12 months were less likely to be HIV positive than those who did not. All males who reported passive anal and oral sex without using condoms during the last 12 months were found to be HIV positive. All female prostitutes who reported use of condoms during the last 12 months were found to be HIV negative. Interventions in methadone maintenance programs should focus on the IVDUs who are still using heroin, cocaine, and marijuana; sexually active females; and those IVDUs not using condoms (particularly among prostitutes).

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Clinical studies of Chlamydia trachomatis in male urethritis].

From January through December 1986, the urethral smear specimens from 132 male urethritis patients were examined by using Chlamydia trachomatis direct specimen test (Micro Trak). C. trachomatis was detected in 59 (44.7%) out of 132 male urethritis patients, 8 (30.8%) out of 26 patients with gonococcal urethritis (GU), and 51 (48.1%) out of 106 patients with non-gonococcal urethritis (NGU). In 5 (31.3%) out of 16 cases, already treated in other hospitals, infection of C. trachomatis was revealed. The age distribution of the patients with chlamydial urethritis (NGU-C) was between 19 and 52 years old, and the average was 30.9 years old. The peak incubation periods of GU and NGU-C were seen within 7 days and between 8 and 14 days, respectively. In NGU-C patients, 70.6% of them showed WBC less than or equal to 9/hpf in first voided urine sediment. The source of infection was a non-prostitute in 22.2% and a prostitute in 72.2% of GU, while in NGU-C 23.5% was infected from a non-prostitute, and 62.7% from a prostitute. Ofloxacin (OFLX) was administered in a daily dosage of 600 mg (in 3 divided oral doses) for 5 to 14 days in 38 NGU-C patients, and C. trachomatis was eliminated in all cases after the treatment.

Adult↗
PubMed1995

[Secondary prevention of sexually transmissible diseases in public health service--analysis of initial experiences in a Bremen counselling office of the chief public health office].

Medical activities of the Public Health STD programme in Bremen were analysed during a period of one year. This experimental project comprises various activities on primary prevention, counselling services, including streetwork, on social and health issues related to sexual health and confidential, anonymous diagnosis and treatment of STD. 621 examination in 248 patients were evaluated. The need for STD screening and treatment has not yet been assessed in Bremen. Nevertheless, a considerable number of individuals considered themselves in need for STD screening or treatment in a public health setting. In comparison with 1975-1985, when bimonthly mandatory screening on female prostitutes was common in Bremen, the number of examinations declined by a factor of ten, whereas the actual number of treated persons remained stable. Of all examinations, 511 (82.3%) were carried out on females, 110 (17.7%) on males, 351 (56.5%) on German citizens and 270 (43.5%) on clients with foreign citizenship. 461 (74.2%) of all examinations involved female prostitutes. Sexually transmitted diseases were shown to be present in 39.3% (244/621) of the examinations. In addition, "vaginitis" was found in 47.7% of gynaecological checks. The STD prevalence was extraordinary high in female drug-addicted (75%) and foreign prostitutes (40.6%). Only in foreign prostitutes a significant association between incidence of STD and age was found. Costs in relation to the detection of one STD were found to be rather low compared to the benefit to the individuals and the society. Therefore, the STD/HIV prevention programme should be maintained.

Adolescent↗
PubMedDate not supplied

[Sexually transmitted diseases in a high risk subpopulation from the province of Soria].

BACKGROUND: Women who practise prostitution constitute a high risk group for acquiring sexually transmitted diseases (STD). The aim of this study was to know the frequency of these processes among prostitutes in the province of Soria. METHODS: A descriptive transversal study including 86 women who voluntarily went to a Family Planning Center (FPC) in Soria was carried out in the period between October 1986 to December 1991. Patients were submitted to: investigation of T. vaginalis, N. gonorrhoeae, G. vaginalis, C. trachomatis, S. agalactiae and yeast infections. Complete clinical history was obtained from all including sociodemographic variables and those of risk of infection. RESULTS: Of the 86 women studied 12 (14%) had positive syphilis tests (treponemic and reaginic). In 12 (14%) N. gonorrhoeae was isolated. The search for C. trachomatis was positive in 16 (18.60%). In 19 (22.10%) T. vaginalis was directly observed. Twenty-three (26.74%) presented some type of positive serology to B virus. Five (5.81%) were HIV-1 seropositive. Candida spp. was isolated in 27 (31.39%) as was G. vaginalis and S. agalactiae in 21 (24.41%). Clinical examination did not show any macroscopic lesion suggesting venereal disease. CONCLUSIONS: Infection by Candida spp. and G. vaginalis were found to be the most frequent. The seroprevalence of HIV-1 in this series was the lowest in the country having a clear relation with the use of intravenous drugs (IVDA). Sexually transmitted diseases maintain a high prevalence in high risk groups such as prostitutes thus requiring energic prevention plans, overall in the group of young IVDA prostitutes.

Adolescent↗
PubMed1995

[Interferon-alpha controls HPV infection in cervix epithelium].

UNLABELLED: Decreased immune response is necessary for a prolonged HPV-infection and allows HPV to be virulent as an oncogene. This study shows that HPV-infection in cervical epithelium is determined by the immune system and IFN-alpha can be shown to be a prognostic parameter for the HPV-infection. The cytokines (IFN-alpha, IFN-gamma, and TNF-alpha) from stimulated peripheral blood mononuclear cells (PBMC) were measured using monoclonal IFN-antibodies and ELISA test. To detect HPV-16, PCR (e6 and e7 areas) was used, followed by southern-blot of the PCR-products. In all of our patients (n = 139) no cytological change was observed in the cervical epithelium over a period of 3 years. Comparison was made between 3 groups: 1: controls (n = 89, HPV-pos. n = 6) 2: registered prostitutes without drug abuse (n = 30, HPV-pos. n = 6) and 3: HIV-infected, previous drug users (CDC II, n = 20, HPV-pos. n = 2). RESULTS: The stimulated IFN-alpha values are highest in the control collective (169 +/- 35 U/ml) and are significantly lower in the prostitutes (98 +/- 26 U/ml, p < 0.05) and in the HIV-infected group (49 +/- 15 U/ml, p < 0.01). The difference between the latter groups being significant as well (p < 0.05). Dividing the controls into HPV-16 positive and HPV-16 negative subgroups, the IFN-alpha values are significantly higher in HPV-16 negative group (193 +/- 48 U/ml) compared to HPV-16 positive group (38 +/- 3 U/ml, p < 0.05). Also in the collective of prostitutes and HIV infected patients there is a similar significant difference between the HPV-16 positive and HPV-16 negative patients (Prostitutes: HPV-16 negative = 94 +/- 21 U/ml, HPV-16 positive = 36 +/- 7 U/ml, p < 0.05; HIV-infected: HPV-16 negative = 35 +/- 13 U/ml, HPV-16 positive = 13 +/- 3 U/ml).

AIDS-Related Opportunistic Infections↗
PubMed1989

Female to male transmission of human immunodeficiency virus type 1: risk factors for seroconversion in men.

To determine the frequency and risk factors for female to male sexual transmission of human immunodeficiency virus type 1 (HIV-1), a prospective study was carried out in 422 men who had acquired a sexually transmitted disease (STD) from a group of prostitutes with a prevalence of HIV-1 infection of 85%. The initial seroprevalence of HIV among the men was 12%. 24 of 293 (8.2%) initially seronegative men seroconverted to HIV-1. Newly acquired infection was independently associated with frequent prostitute contact (risk ratio 3.2, 95% confidence interval 1.2-8.1), with the acquisition of genital ulcer disease (risk ratio 4.7, 95% confidence interval 1.3-17.0), and with being uncircumcised (risk ratio 8.2, 95% confidence interval 3.0-23.0). 96% of documented seroconversions occurred in men with one or both of the latter two risk factors. In a subgroup of 73 seronegative men who reported a single prostitute sexual contact, the frequency of HIV-1 infection was 8.2% during 12 weeks of observation. No man without a genital ulcer seroconverted. A cumulative 43% of uncircumcised men who acquired an ulcer seroconverted to HIV-1 after a single sexual exposure. These data indicate an extremely high rate of female to male transmission of HIV-1 in the presence of STD and confirm a causal relation between lack of male circumcision, genital ulcer disease, and susceptibility to HIV-1 infection.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers.

This study reports findings from a survey of condom-related beliefs, behaviors, and perceived social norms in Mexican migrant laborers that live and work in the United States for extended periods of time. Snowball sampling was used to recruit 501 Mexican migrants from five "sending towns" in Jalisco, Mexico, with historically high rates of out-migration to the United States. Results showed that subjects reported few negative beliefs about condom use and high efficacy to use condoms in challenging sexual situations but social norms sanctioning condoms were limited. Results also revealed mixed knowledge of HIV transmission, poor knowledge of condom use, and higher condom use with occasional versus regular sex partners. Forty-four percent of male migrants reported sex with prostitutes while in the U.S., with married men reporting less condoms use with prostitutes than single men. It was concluded that condom promotion efforts with Mexican migrants should concentrate on men to encourage consistent use with occasional sex partners, including prostitutes. AIDS prevention education should be provided with sensitivity to the language needs, limited education, and extreme social and geographic marginality of this highly underresearched Latino population.

Adult↗
PubMed1993

HIV-1 infection in young men in northern Thailand.

OBJECTIVES: To determine risk factors for HIV-1 infection in young men in northern Thailand. METHODS: At enrollment into a prospective study, data were collected from a self-administered questionnaire and serologic testing on a cohort of 1115 young men selected by lottery for conscription. RESULTS: The overall HIV-1 infection rate was 6.9%; however, the rate was 15.3% among the 387 (34.7%) men who had been living in the upper north subregion of Thailand compared with 2.5% for the remaining 728 men (P < 0.001). A history of sex with female prostitutes was reported by 74.7% of men and increased frequency of this type of sex was highly associated with HIV-1 infection and a history of sexually transmitted disease (STD) symptoms (chi 2 for trend, P < 0.001). In stratified and multivariate analyses, however, history of STD symptoms, reported by 42.5% of the cohort, was most strongly associated with HIV-1 infection. Only 42.8% of men who reported sex with prostitutes had used condoms more than half the time. CONCLUSIONS: Young men in the general population in northern Thailand are at high risk for HIV-1 infection via sex with female prostitutes; STD are highly associated with HIV-1 infection. Increasing condom use and controlling STD should be immediate goals of HIV control programs.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Controlling HIV in Africa: effectiveness and cost of an intervention in a high-frequency STD transmitter core group.

Since 1985, a population of over 1,000 predominantly HIV-positive female prostitutes residing in a low-income area of Nairobi, has been enrolled in a sexually transmitted disease (STD)/HIV control programme. The major elements of the programme include the diagnosis and treatment of conventional STD, and the promotion of condom use to prevent the transmission of HIV and other sexually transmitted infections. Using estimates of numbers of HIV-seropositive prostitutes, numbers of sexual contacts, susceptibility of clients to HIV, HIV transmission efficiency, rates of condom use and the basic reproductive rate of HIV infection in Kenya, we estimate that the programme is responsible for preventing between 6,000 and 10,000 new cases of HIV infection per year among clients and contacts of clients. The total annual operating cost of the programme is approximately US$77,000 or between US$8.00 and US$12.00 for each case of HIV infection prevented. Programmes to reduce the transmission of HIV and other sexually transmitted infections which are targeted at high-frequency STD transmitters, such as prostitutes, can be effective and relatively inexpensive to undertake. More such programmes should be developed and evaluated in different settings.

Acquired Immunodeficiency Syndrome↗
PubMed1990

HIV infection surveillance in Mogadishu, Somalia.

A group of 89 prostitutes and 45 patients attending sexually transmitted disease clinics in Mogadishu, Somalia were examined for evidence of HIV infection. Both groups reported more than 1 sexual partner routinely and had sexual contacts with prostitutes. There was a significant amount of sexually transmitted diseases (STDs) in these two groups, with 11.2% and 6.7% respectively being culture positive for N. gonorrhoea. Among the prostitutes, 28.1% were positive for antibodies to T. pallidum while only 4.4% of the STD patients were positive. One isolate of N. gonorrhoea was resistant to penicillin. All study participants were negative for antibodies to HIV suggesting an extremely low prevalence of HIV in high risk behaviour groups in the capital city of Somalia.

Adult↗
PubMed1998

Sexual transmission of GB virus C/hepatitis G virus.

Although it is established that infection with GB virus C (GBV-C) or hepatitis G virus (HGV) can be transmitted parenterally, the prevalence of GBV-C/HGV viremia in the general population (2-5%) is relatively high compared with other parenterally borne viruses such as hepatitis C virus. To investigate the possibility of sexual transmission of GBV-C/HGV, we determined the frequency of viremia by the polymerase chain reaction and serological reactivity to the E2 protein by ELISA in samples collected from individuals at risk for sexually transmitted diseases attending a city genitourinary medicine clinic. GBV-C/HGV viremia was detected in 27 of 87 male homosexuals (31%) and 9 of 50 prostitutes (18%), frequencies significantly greater than those in matched controls (2/63) and local blood donors (2.3%). Among nonviremic individuals, a high frequency of serological reactivity to the E2 protein of GBV-C/HGV was also observed in the risk groups (male homosexuals: 14/60; prostitutes: 11/41), although these figures are likely to be underestimates of the frequency of past infection as detectable anti-E2 reactivity may attenuate rapidly over time following resolution of infection. Infection with GBV-C/HGV was more frequent among those coinfected with human immunodeficiency virus type 1. Among male homosexuals from whom retrospective samples were available, evidence for de novo infection was found in 9 of 22 individuals over a mean sampling time of 2.9 years, predicting an annualized incidence of GBV-C/HGV infection of approximately 11% in this group. The high prevalence and incidence of GBV-C/HGV infection in these individuals and prostitutes provides strong evidence for its spread by sexual contact. Further studies are required to investigate the mechanism of its transmission and the clinical significance of acute and persistent infection in these risk groups.

Adolescent↗
PubMed1999

Gender differences in HIV risk behaviors in an adult emergency department in New York City.

BACKGROUND: The human immunodeficiency virus (HIV) epidemic in the US increasingly involves urban heterosexual adults, particularly women, belonging to ethnic minority groups. An understanding of gender-based differences in HIV risk behaviors within these groups would be of value in the ongoing struggle to limit HIV transmission in metropolitan centers. METHODS: This was a prospective study of demographic and historical characteristics and HIV risk behaviors. The study utilized a structured interview format, which was administered to all patients treated by participating emergency department physicians. RESULTS: On univariate analysis of data obtained from 1,460 patients who had neither a known HIV infection nor a chief complaint or final emergency department diagnosis associated with HIV risk behaviors, men were more likely to be older, homeless, to have ever injected drugs, used crack, engaged in same-gender sex, paid for sex, been incarcerated, or had syphilis or gonorrhea. Women were more likely to report prior chlamydia infection or to report that their sole sex partners had other partners within the past year. On multivariate analysis, variables independently associated with male gender included homelessness, injection drug use, crack use, any prior sexually transmitted disease (in subjects 35 years of age or older), and sex with prostitutes. In a separate analysis of patients admitting to drug use, the male predominance of other risk behaviors was not observed; the only significant differences between genders were a higher rate of prostitution among women and a higher rate of sexual contact with a prostitute among men. CONCLUSIONS: In patients visiting an inner-city emergency department in the Bronx, HIV risk behaviors are generally more common in men, but rates of risk behaviors among male and female drug users are comparable.

Adult↗
PubMed2003

Cervical human papillomavirus infection in Tunisian women.

BACKGROUND: It is well established that certain types of human papillomavirus (HPV) are the sexually transmitted agents etiologically linked to cervical cancer. Sexual habits have been shown to be a major determining factor for HPV infection. A large study was carried out to investigate the prevalence and risk factors associated with cervical infection with HPV in Tunisian women. MATERIALS AND METHODS: PCR and restriction enzyme digestion were used to characterize HPV cervical infection in 106 Tunisian married women and 51 legal prostitutes. Epidemiological data were collected and correlated with HPV molecular genotyping. RESULTS: There was a higher relative frequency of HPV-DNA in prostitutes (39%) than in married women (14%) (p = 0.001). Molecular analyses of HPV types showed the most prevalent type in prostitutes to be HPV-16, a high-risk oncogenic type. In married women, the most prevalent type was HPV-6 which is associated with a low risk for cervical cancer. HPV-DNA detection was markedly increased in young adult women and in those having recent sexual experience. CONCLUSION: Cervical HPV infection in Tunisia is less frequent than in other African countries, but far from uncommon. The decrease of HPV prevalence in older women, regardless of their sexual behavior, may result from an efficient immune response acquired with age.

Adolescent↗