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Vaginal high-risk human papillomavirus infection in a cross-sectional study among women of six different ethnicities in Amsterdam, the Netherlands: the HELIUS study
  1. C J Alberts1,2,
  2. R A Vos1,
  3. H Borgdorff2,3,
  4. W Vermeulen1,
  5. J van Bergen4,5,
  6. S M Bruisten1,2,
  7. S E Geerlings2,
  8. M B Snijder6,
  9. R van Houdt7,
  10. S A Morré8,9,
  11. H J C de Vries2,10,
  12. J H H M van de Wijgert2,3,11,
  13. M Prins1,2,
  14. M F Schim van der Loeff1,2
  1. 1Department of Infectious Diseases, Public Health Service of Amsterdam (GGD), Amsterdam, The Netherlands
  2. 2Division of Infectious Diseases, Department of Internal Medicine, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center (AMC), Amsterdam, The Netherlands
  3. 3Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands
  4. 4SOA Aids Nederland, Amsterdam, The Netherlands
  5. 5Department of General Practice, Academic Medical Center (AMC), Amsterdam, The Netherlands
  6. 6Department of Public Health, Academic Medical Center (AMC), Amsterdam, The Netherlands
  7. 7Department of Medical Microbiology and Infection Control, VU Medical Center, Amsterdam, The Netherlands
  8. 8Laboratory of Immunogenetics, Department of Medical Microbiology and Infection Control, Research School V-ICI, VU University Medical Center, Amsterdam, the Netherlands
  9. 9Department 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
  10. 10Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  11. 11Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
  1. Correspondence to Catharina J Alberts, Public Health Service, Department of Infectious Diseases, Nieuwe Achtergracht 100, Amsterdam 1018 WT, The Netherlands; nalberts{at}


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.

  • HPV

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  • Handling editor Jackie A Cassell

  • Contributors MBS and MP conceived and designed the HELIUS study and obtained funding. WV performed laboratory analyses of the samples. WV, CJA, RAV and HB organised sample logistics. CJA and HB participated in data collection. All authors participated in designing the vaginal swab study within HELIUS and/or laboratory assay development. CJA and RAV performed data management and statistical analyses. CJA wrote the manuscript. MFSvdL (principal investigator) contributed to the design, statistical analyses and writing the manuscript. All authors contributed to data interpretation, reviewed successive drafts and approved the final version of the manuscript.

  • Funding The HELIUS study is conducted by the Academic Medical Center Amsterdam and the Public Health Service of Amsterdam. Both organisations provided core support for HELIUS. The HELIUS study is also funded by the Dutch Heart Foundation (2010T084), the Netherlands Organization for Health Research and Development (ZonMw) (200500003), and the European Union (FP-7) (278901). This study was funded by grant 7115 0001 and 204005002 (Academic Collaborative for Public Health) from ZonMw and an internal grant of the Public Health for Research & Development, the Netherlands.

  • Competing interests MFSvdL received research funding from Sanofi Pasteur MSD; he is a co-investigator in a Merck-funded investigator-initiated study on Gardasil; he is an investigator on a Sanofi Pasteur MSD sponsored HPV vaccine trial; he served on a vaccine advisory board of GSK; he received in-kind contribution for another study from Stichting Pathologie Onderzoek en Ontwikkeling (SPOO); his institution receives research funding from Janssen Infectious Diseases and Vaccines.

  • Ethics approval The study was approved by the Medical Ethics Committee of the Academic Medical Center Amsterdam (protocol number: 10/100; amendment 10/100# 10.17.1729; NL32251.018.10).

  • Provenance and peer review Not commissioned; externally peer reviewed.