Human papillomavirus genotype prevalence and distribution among Moroccan women

Kamal Birrou, Mohamed Rida Tagajdid, Hicham El annaz, Safae Elkochri, Rachid Abi, Mimoune Zouhdi, Saad Mrani


Background:Human papillomavirus (HPV) is the major etiologic agent of invasive cervical cancer, vulvar and vaginal cancer. It has been estimated that, worldwide, 70% of cervical cancers are due to HPV-16 and HPV-18. Malignant transformation appears to require the presence of additional cofactors such as pregnancy, smoking and immunosuppression. The aim of the present study was to determine the prevalence and distribution of HPV genotypes among Moroccan women.  

Methods:Between January 1, 2011, and December 31, 2012, 277 cervical samples collected from confirmed women who attended the department of gynecology and obstetrics at Mohamed V Military teaching hospital, Rabat, Morocco, were analyzed in the laboratory of virology for HPV in vitro diagnosis and genotyping and for cytology in laboratory of pathology.

Results:High-risk HPV DNA was detected in 101 (36%) samples, with higher prevalence in women ≥45 (43%) years. The overall prevalence of HPV infection and multiple infections in the study samples was 76% and 21%, respectively. The most frequent HPV genotypes were HPV-16 (31%). Human papillomavirus DNA detection was inversely related to maternal age. The risk of HPV infection was significantly reduced in women aged older than 30 years. The history of gynaecological problem showed significant association with the HPV positive test.

Conclusion:In Morocco, the diagnosis of cervical lesions rests exclusively on the cytology-based screening that offers substantial protection, although current coverage is low. The introduction of HPV DNA testing in cervical cancer management will greatly benefit early stage HPV detection and help prevent development of cervical lesions and cancer. Screening pregnant women offer a significant opportunity for the Moroccan National Program against cervical cancer to control.  



Human papillomavirus, Genotype, Pregnancy

Full Text:



Roberts CC, Tadesse AS, Sands J, Halvorsen T, Schofield TL, Dalen A, et al. Detection of HPV in Norwegian cervical biopsy specimens with type-specific PCR and reverse line blot assays. J Clin Virol. 2006;36:277-82.

Amrani M, Lalaoui K, El Mzibri M, Lazo P, Belabbas MA. Molecular detection of human papillomavirus in 594 uterine cervix samples from Moroccan women (147 biopsies and 447 swabs). J Clin Virol. 2003;27:286-95.

Kim YH, Park JS, Norwitz ER, Park JW, Kim SM, Lee SM, et al. Genotypic prevalence of human papillomavirus infection during normal pregnancy: a cross-sectional study. J Obstet Gynecol Res. 2014;(4):200-7.

Fife KH, Katz BP, Brizendine EJ, Brown DR. Cervical human papillomavirus deoxyribonucleic acid persists throughout pregnancy and decreases in the postpartum period. Am J Obstet Gynecol 1999;180:1110-4.

Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, et al. The 2001 Bethesda system: terminology for reporting results of cervical cytology. JAMA. 2002;287:2114-9.

Bouvard V, Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, et al. A review of human carcinogens: Part B: biological agents. Lancet Oncol. 2009;10:321-2.

Allhamany Z, El Mzibri M, Kharbach A, Malihy A, Abouqal R, Jaddi H, et al. Prevalence of human papillomavirus genotype among Moroccan women during a local screening program. J Infect Dev Ctries. 2010;4(11):732-9.

Hernandez-Giron C, Smith JS, Lorincz A, Lazcano E, Hernandez-Avila M, Salmeron J. High-risk human papillomavirus detection and related risk factors among pregnant and non-pregnant women in Mexico. Sex Transm Dis. 2005;32:613-8.

Aydin Y, Atis A, Tutuman T, Goker N. Prevalence of human papilloma virus infection in pregnant Turkish women compared with non-pregnant women. Eur J Gynecol Oncol. 2010;31:72-4.

Castellsague X, Muñoz N. Cofactors in human papillomavirus carcinogenesis-role of parity, oral contraceptives, and tobacco smoking. J Natl Cancer Inst Monogr. 2003;31:20-8.

Khair MM, Mzibri ME, Mhand RA, Benider A, Benchekroun N, Fahime EM, et al. Molecular detection and genotyping of human papillomavirus in cervical carcinoma biopsies in an area of high incidence of cancer from Moroccan women. J Med Virol. 2009;81:678-84.

Domza G, Gudleviciene Z, Didziapetriene J, Valuckas KP, Kazbariene B, Drasutiene G. Human papillomavirus infection in pregnant women. Arch Gynecol Obstet. 2011;284:1105-12.

Tamalet C, Le Retraite L, Leandri F, Heid P, Sancho Garnier H, Piana. Vaginal self-sampling is an adequate means of screening HR-HPV types in women not participating in regular cervical cancer screening. Clin Microbiol Infect. 2013;19:E44-50.

Tenti P, Zappatore R, Migliora P, Spinillo A, Maccarini U, De Benedittis M, et al. Latent human papillomavirus infection in pregnant women at term: a case-control study. J Infect Dis. 1997;176:277-80.

Wright TJ, Denny L, Kuhn L, Pollack A, Lorincz A. HPV DNA testing of self-collected vaginal samples compared with cytologic screening to detect cervical cancer. JAMA. 2000;283:81-6.

Wright T, Cox T, Stewart Massad L, Twiggs L, Wilkinson E. Consensus guidelines for the management of women with cervical cytological abnormalities. JAMA. 2002;287:2120-9.