Prevalence, incidence and risk factors for anogenital warts in Sub Saharan Africa: a systematic review and meta analysis

Infectious Agents and Cancer

Edward K Mbidde⁴  Simon Kasasa⁶  Anthony K Mbonye⁵  Jackson Orem³  Florence M Mirembe¹  Cecily Banura² 

[1] Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda;Department of Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda;Uganda Cancer Institute, P.O. Box 3935, Kampala, Uganda;Uganda Virus Research Institute, P.O. Box 49, Entebbe, Uganda;Department of Community Services, Ministry of Health, P.O. Box 7272, Kampala, Uganda;School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda

关键词: HPV vaccination;    HIV;    Sub Saharan Africa;    Anogenital warts;   

Others  :  802871
DOI  :  10.1186/1750-9378-8-27

 received in 2012-08-18, accepted in 2013-07-01,  发布年份 2013

【 摘 要 】

Introduction

The quadrivalent HPV vaccine is highly effective in primary prevention of anogenital warts (AGWs). However, there is lack of systematic review in the literature of the epidemiology of AGWs in Sub Saharan Africa (SSA).

Objective

To review the prevalence, incidence and risk factors for AGWs in SSA prior to the introduction of HPV vaccination programs.

Methods

PubMed/MEDLINE, Africa Index Medicus and HINARI websites were searched for peer reviewed English language published medical literature on AGWs from January 1, 1984 to June 30, 2012. Relevant additional references cited in published papers were also evaluated for inclusion. For inclusion, the article had to meet the following criteria (1) original studies with estimated prevalence and/or incidence rates among men and/or women (2) detailed description of the study population (3) clinical or self-reported diagnosis of AGWs (4) HPV genotyping of histologically confirmed AGWs. The final analysis included 40 studies. Data across different studies were synthesized using descriptive statistics for various subgroups of females and males by geographical area. A meta - analysis of relative risk was conducted for studies that had data reported by HIV status.

Results

The prevalence rates of clinical AGWs among sex workers and women with sexually transmitted diseases (STDs) or at high risk of sexually transmitted infection (STIs) range from 3.3% - 10.7% in East, 2.4% - 14.0% in Central and South, and 3.5% - 10.5% in West African regions. Among pregnant women, the prevalence rates range from 0.4% - 3.0% in East, 0.2% - 7.3% in Central and South and 2.9% in West African regions. Among men, the prevalence rates range from 3.5% - 4.5% in East, 4.8% - 6.0% in Central and South and 4.1% to 7.0% in West African regions. In all regions, the prevalence rates were significantly higher among HIV+ than HIV- women with an overall summary relative risk of 1.62 (95% CI: 143–1.82).

The incidence rates range from 1.1 – 2.7 per 100 person-years among women and 1.4 per 100 person years among men. Incidence rate was higher among HIV+ (3.0 per 100 person years) and uncircumcised men (1.7 per 100 person-years) than circumcised men (1.3 per 100 person-years).

HIV positivity was a risk factor for AGWs among both men and women. Other risk factors in women include presence of abnormal cervical cytology, co-infection with HPV 52, concurrent bacteria vaginoses and genital ulceration. Among men, other risk factors include cigarette smoking and lack of circumcision.

Conclusions

AGWs are common among selected populations particularly HIV infected men and women. However, there is need for population-based studies that will guide policies on effective prevention, treatment and control of AGWs.

【 授权许可】

   
2013 Banura et al.; licensee BioMed Central Ltd.l

【 图 表 】

Figure 1.

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