Increased risk of HPV infection, but no increased risk of cervical dysplasia: HIV-negative commercial sex workers in Senegal

Abstract

Human papillomavirus (HPV) is a causative agent in cervical cancer development and commercial sex workers (CSW) are at high risk for exposure to STDs, including HPV. From October 1994-January 1998, CSW and non-CSW were interviewed, cervical swabs were taken for HPV DNA testing, and cervical cytology was conducted. We found that CSW have a higher prevalence of current HPV infection with high-risk HPV-16 (OR: 2.56, 95% CI: 1.46-4.46) and HPV-18 (OR:2.08, 95% CI:1.03-4.20) compared to non-CSW. Likewise, CSW had a higher rate of incident HPV-16 DNA detection (HR: 3.01, 95% CI: 1.20-7.54). However, prevalence of low and high grade squamous intraepithelial lesions (LSIL) and (HSIL) were not significantly higher in CSW compared to non-CSW (OR: 0.61, 95% CI: 0.32-1.16 and OR: 0.21, 95% CI: 0.07-0.65, respectively) and neither were incident cases of LSIL or HSIL (HR: 0.95, 95% CI: 0.0.51-1.77 and OR: 0.76, 95% CI: 0.30-1.91, respectively). We hypothesize that unmeasured immune responses in repeatedly exposed women may be responsible for the lack of association between commercial sex work and cervical dysplasia despite the increased risk of infection with high-risk types of HPV.