Prevalence, incidence and risk factors for anogenital warts in Sub Saharan Africa: a systematic review and meta analysis
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Date
2013-08-27
Journal Title
Journal ISSN
Volume Title
Publisher
Infectious Agents and Cancer
Abstract
Abstract
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.
Keywords: Anogenital warts, Sub Saharan Africa, HIV, HPV vaccination
Description
Keywords
Anogenital warts, Sub Saharan Africa