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Burden of Human Papillomavirus–Related Cervical Disease in the Extended Middle East and North Africa—A Comprehensive Literature Review

Seoud, Muhieddine MD, FACOG, FACS

Journal of Lower Genital Tract Disease: April 2012 - Volume 16 - Issue 2 - p 106–120
doi: 10.1097/LGT.0b013e31823a0108
Review Article

Objective This study aimed to analyze the burden of human papillomavirus (HPV) in the Extended Middle East and North Africa (EMENA) region and to discuss the potential impact on HPV-related diseases derived from changing sexual behaviors and perceptions.

Materials and Methods A comprehensive retrospective review of the available epidemiological data (publications in the past 30 years until January 2011) on HPV and its related diseases (especially as they relate to the cervix) in the EMENA region was carried out.

Results Analysis of the burden of HPV in the EMENA region highlights an unexpectedly high prevalence of HPV, with rates of HPV ranging from 0% to 25% in low-risk women with normal cytology and up to 98% in those with genital warts and preinvasive and invasive lesions. In addition, cervical cancer screening practices are, at best, opportunistic in most countries of the region; therefore, the observed change in social and sexual behavior in the EMENA population, particularly in youths, could lead to an increase in HPV and its related diseases especially cervical cancer.

Conclusions This article emphasizes the need for the introduction and standardization of screening practices in the region. Moreover, surveillance studies are needed to enable the identification of HPV type distribution and to determine the potential impact of the introduction of HPV vaccines. These socio-epidemiological data are of marked value to health care decision and policymakers in prioritizing available public health interventions.

Human papillomavirus and its related cervical disease are relatively common, and screening practices are scarce in the countries of the Extended Middle East and North Africa.

Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon

Correspondence to: Muhieddine Seoud, MD, FACOG, FACS, Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Medical Center/C-746 C-838, Beirut, Lebanon. E-mail:

Preparation of this report was supported by an educational grant from GlaxoSmithKline Biologicals (GSK Bio).

Dr Seoud has served as a speaker and on advisory boards for GSK Bio and was actively involved in the selection and review of all content. Editorial assistance was provided by Shelley Lindley and Sandra Boswell from Wells Healthcare, funded with support from GSK Bio. GSK Bio was given the opportunity to revise the document and to provide comments. The author was, nevertheless, in full control of all content and editorial decisions.

©2012The American Society for Colposcopy and Cervical Pathology