Journal of Adolescent Health 43 (2008) S5–S25

Review article

Age-Specific Prevalence of Infection with Human Papillomavirus in

Females: A Global Review
Jennifer S. Smith, Ph.D.a,*, Amy Melendy, D.V.M., M.P.H.a,
Rashida K. Rana, M.S.b, and Jeanne M. Pimenta, Ph.D., B.Sc.b
a
University of North Carolina, Chapel Hill, North Carolina
b
GlaxoSmithKline Research and Development, Greenford, United Kingdom
Manuscript received April 12, 2008, manuscript accepted July 3, 2008

Abstract Purpose: Global data on age-specific prevalence of human papillomavirus (HPV) infection overall,
and for high-risk HPV types 16 and 18, are essential for the future implementation of HPV prophylac-
tic vaccines for cervical cancer prevention.
Methods: A systematic review of peer-reviewed publications was conducted to summarize world-
wide data on genital HPV-DNA prevalence in women. Studies with clear descriptions of polymerase
chain reaction or hybrid capture detection assays were included.
Results: A total of 346,160 women were included in 375 studies. Of 134 studies with age-stratified
HPV prevalence data (116 low sexual risk populations, 18 high sexual risk populations), over 50%
were from Europe and the Middle East (38%) and North America (19%), with smaller proportions
from Asia and Australia (21%), Central and South America (11%), and Africa (10%). Across all geo-
graphical regions, data on HPV prevalence were generally limited to women over 18 years of age. Con-
sistently across studies, HPV infection prevalence decreased with increasing age from a peak
prevalence in younger women (25 years of age). In middle-aged women (35–50 years), maximum
HPV prevalence differed across geographical regions: Africa (~20%), Asia/Australia (~15%), Central
and South America (~20%), North America (~20%), Southern Europe/Middle East (~15%), and
Northern Europe (~15%). Inconsistent trends in HPV prevalence by age were noted in older women,
with a decrease or plateau of HPV prevalence in older ages in most studies, whereas others showed an
increase of HPV prevalence in older ages. Similar trends of HPV 16 and/or 18 prevalence by age were
noted among 12 populations with available data.
Discussion: Genital HPV infection in women is predominantly acquired in adolescence, and peak
prevalence in middle-aged women appears to differ across geographical regions. Worldwide variations
in HPV prevalence across age appear to largely reflect differences in sexual behavior across geograph-
ical regions. Further studies of HPV prevalence in adolescents are needed for all geographic regions.
Ó 2008 Society for Adolescent Medicine. All rights reserved.
Key words: Human papillomavirus; Cervical cancer; Epidemiology

Highly effective prophylactic vaccines against human pap-
illomavirus (HPV) types 16 and 18 [1,2] (the most common
types in invasive cervical cancer [ICC]) [3,4]) are uniquely ef-
fective for the prevention of the majority (approximately 70%–
This study was funded by Worldwide Epidemiology, GlaxoSmithKline
(GSK).
*Address correspondence to: Jennifer S. Smith, Ph.D., Department of
Epidemiology, University of North Carolina, Chapel, Hill, NC 27599
E-mail address: jennifers@unc.edu
1054-139X/08/$ – see front matter Ó 2008 Society for Adolescent Medicine. All rights reserved.
doi:10.1016/j.jadohealth.2008.07.009
80%) of ICC cases worldwide. ICC is the second most com-
mon cancer in women worldwide, with most (83%) of the
493,000 estimated global cases occurring in less-developed
countries [5]. Vulvar, vaginal, oropharygeal, and anal cancers
in women are also manifestations of HPV infection [6,7].
HPV is one of the most common sexually transmitted in-
fections (STIs) worldwide [8] and in the United States (US),
where it is estimated that 24.9 million women aged 14 to 59
years are infected [9]. Although the estimated risk of HPV is
notably high over a woman’s lifetime (~80%) [10], most
S6 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25
women who acquire HPV infection do not develop more se-
rious high-grade cervical neoplasia or invasive cancer, as
most infections are transient [11].
Among cross-sectional population-based samples in dif-
ferent geographical areas, a broader range of HPV prevalence
and type-distribution has been detected in women with nor-
mal cytology than in women with ICC [12]. The prevalence
of HPV infection, overall and by age, varies by country, re-
gion within country, and population subgroup. To compare
HPV prevalence between geographic areas or countries,
data on age-specific or age-adjusted prevalence using sensi-
tive HPV detection methods are needed. Age-specific data
on HPV prevalence among female adolescents would also
be useful (in conjunction with data on age at first intercourse)
to inform future policies to maximize the potential benefits of
HPV prophylactic vaccination.
This review summarizes the available published data on the
prevalence of HPV-DNA based on highly sensitive HPV de-
tection techniques as well as associated HPV prevalence curves
by age for different female populations throughout the world.
Methods
Material reviewed
Source material was extracted from a systematic literature
search from January 1, 1989 through March 1, 2007, result-
ing in approximately 5000 abstracts generated by MEDLINE
(via PubMed) and references cited in the selected papers. Key
search words included papillomavirus, human, polymerase
chain reaction (PCR), hybrid capture I or II (HCI/II [Digene
Corporation, Gaithersberg, MD]), and DNA. The literature
search was restricted to peer-reviewed articles that provided
a clear description of PCR or HC methodology for the detec-
tion of HPV infection. Studies citing the use of relatively less
sensitive detection methods (i.e., in situ hybridization) or the
detection of HPV serum antibodies were excluded. Studies
were limited to those that provided data on age; sample sizes
were required to be at least 20 subjects per age group, and age
groups were combined when necessary. There were no lan-
guage restrictions on publications included. Of all publica-
tions, only approximately 3% were published in a foreign
language. For these, the data were extracted and confirmed
by a second, independent reviewer fluent in the language. As-
sistance with interpretation was requested when needed. In
addition, studies were only included if baseline cytology
was stated as normal, or if from a screening or population-
based study and had <30% of women with abnormal cytol-
ogy of low-grade squamous intraepithelial lesions (LSIL)
or greater. Articles were reviewed in full if study abstracts
gave an indication of fulfilling these criteria. Conference ab-
stracts and other unpublished manuscripts were excluded.
Data extraction and analysis
For each study, the following information was extracted:
first author, publication journal, and date; country and city
of study; dates of sample collection; HPV detection method-
ology (i.e., PCR primers or HCII); anatomical site and
methods of sample collection; population description (i.e.,
national survey, antenatal, or commercial sex worker
[CSW]); mean or median age of sample, with range when
available; sample size; and prevalence of HPV in the total
population sample (overall, high risk, low risk, HPV 16,
and HPV 18). Populations were stratified into ‘‘high risk’’
and ‘‘low risk.’’ Populations classified as ‘‘high risk’’ were
those at greater risk of having genital HPV infection, such
as HIV-positive women, CSWs, and women with other
STIs; all others were classified as ‘‘low-risk’’ populations
[13]. When published results were presented only graphi-
cally, prevalence was estimated from the graphs. In some
cases, age-stratified sample sizes were not available. In these
cases, overall HPV prevalence was reported, for which a sam-
ple size was available with the mean or median age. For arti-
cles that presented data on HPV prevalence for both PCR and
HC, all results were presented in the tables, although only the
PCR results were presented in the figures. For quality control,
all data were entered twice by two independent data abstrac-
tors, and every numbered reference in the text and tables was
crosschecked with those in the bibliography; any discordant
results were resolved by consensus. For studies that pre-
sented data on HPV with the same population in multiple
publications, the largest publication was chosen and refer-
ences to all corresponding publications were included in
data tables for that particular study. Where HPV data are de-
fined in the tables for individuals within an age group, the
mean of the age range was used as data points on the graphs.
Within each geographic area, studies were ordered by
country and city/region within the country, and are reported
in Tables 1 and 2 (refer to appendices at http://jahonline.
org). Studies with overall HPV prevalence data for specific
age groups are shown in Figures 1 to 5 for low-risk popula-
tions by geographic region. Figure 6 shows age-specific prev-
alence for HPV 16 and 18. Trends in HPV prevalence by age
were based on data presented in the smoothed curves shown
as insets in the upper right-hand corner of their respective fig-
ure. The curves were estimated using locally weighted regres-
sion of HPV prevalence by age with combined data for each
region and regression estimations were conducted using the
least-squared methods [14].
Results
Age-specific HPV prevalence in low-risk groups
Africa
In comparison with other geographical regions, few data
were available on HPV-DNA prevalence by age in Africa,
with a total of 15 countries surveyed. Available studies orig-
inated from countries in Northern Africa, Western Africa,
and south of the Sahara Desert (Table 1); no data were avail-
able from Central Africa. The 13 populations with HPV-
DNA data stratified by age were generally limited to women
aged 20 to 65 years (smoothed curve of Figure 1). Overall
 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25
Gambia, Farafenni18
Kenya, Nairobi31
Nigeria, Ibadan20
Senegal, Dakar Suburbs32
Tanzania, Mwanza23, 24
Tunisia, Sousse26
100 Zimbabwe, Chitungwiza and Greater Harare28-30
90
80
70
Prevalence (%)
60
50
40
30
20
10
0
0 20 40
Age (Years)
Figure 1. HPV prevalence by age in Africa among low-risk female populations by country, city, and study.
prevalence ranged from 12% in women without cervical can-
cer (mean age ¼ 39 years) in South Africa [15,16] to 46% in
women attending clinics for antenatal care or general genital
symptoms in Gabon (mean age ¼ 26 years) [17].
Stratified data on HPV prevalence in younger women
were limited. Studies on nine low-risk populations [18–27]
included women less than 25 years of age. The highest prev-
alence was 55% in women aged 14 to 20 years from a rural
community in Manhica, Mozambique [27].
Patterns of HPV prevalence by age appeared to differ
across surveyed countries (Figure 1). Only a few studies,
however, included a relatively wide age-band of reproductive
years (15–49 years). In Tunisia [25,26], Kenya [19], Uganda
[22], and Zimbabwe [28–30], HPV-DNA prevalence was
highest in young women and decreased steadily with age.
In Nigeria [20], Kenya [31], and Mozambique [27], HPV
positivity also declined with age but generally reached a pla-
teau at approximately 40 years of age. In contrast, HPV pos-
itivity increased slightly in older aged women in Senegal
(over 45 years of age) [32] and in South Africa (over 50 years
of age) [15,16]. In comparison, women surveyed in Gambia
seemed to have a relatively constant prevalence of HPV in-
fection among those aged 15 to 54 years [18]. Overall, the
highest prevalence of HPV was 58% in a study of family
planning clinic attendees aged 25 to 29 years in Nairobi,
Kenya [31].
Central and South America
Studies of 35 low-risk populations were included in the
Central and South America region. The highest HPV
S7
Kenya, Nairobi19
Mozambique, Manhica27
Senegal, Dakar21
South Africa, Khayelitsha15, 16
Tunisia, Sousse25
Uganda, Rakai District22
60
Prevalence (%)
40
20
0
20 30 40 50 60 70
Age
60 80 100
prevalence in South America (64%) was reported in a cervical
cancer screening sample of Guarani Indian women (mean age
15 years) in Argentina [33,34]. Age-stratified data showed
high prevalence rates of 54% and 59% from 14- to 24-year-
old females attending a gynecologic clinic in Argentina [35]
and an older group of cytologically normal women in Recife,
Brazil (mean age 43 years), respectively [36]. A similar trend
of high HPV prevalence was observed in the youngest age
groups of other age-stratified studies in South American
females [37–42] (Figure 2). In Central America, the highest
HPV prevalence was reported among clinic-based controls
aged 15 to 24 years in Tegucigalpa, Honduras (71%) [43–47].
Within the region, the majority of studies with age-specific
HPV prevalence data followed a slight U-shaped curve
(smoothed curve of Figure 2). Studies from Honduras [43–
47], Mexico [48–50], Colombia [39–41], Costa Rica [51–
60], Chile [42], and Brazil [38] found a high HPV prevalence
in women under 30 years old that steadily decreased thereafter
with an upward trend in older women (Figure 2). The age of the
second increase in HPV prevalence in older women in these
studies appeared to differ by geographical location, being
over 40 years in Honduras [43–47], Chile [42], Port Alegre,
Brazil [38], and Mexico [48–50], and over 50 years in Costa
Rica [51–60] and Colombia [39–41]. In contrast, Sao Paulo,
Brazil [61], and Concordia, Argentina [37], demonstrated
a consistent downward trend of HPV prevalence by age.
North America
Studies on 50 low-risk populations were conducted in
North America; approximately 80% of reported studies
S8 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

Argentina, Concordia37 Argentina, Ushuaia35 Brazil, Port Alegre38

42
Brazil, Sao Paulo 61
Chile, Santiago Columbia, Bogota39-41
52-60
Costa Rica, Guanacaste 51
Costa Rica, Guanacaste Honduras, Tegucigalpa43-47
48
Mexico, Mexico City 50 Mexico, Morelos Mexico, Morelos347
49
Mexico, Morelos 347 Mexico, Morelos
100 80

90

Prevalence (%)
60
80
40
70
Prevalence (%)

60 20

50
0
40 20 40 60 80
Age
30
20
10
0
0 20 40 60 80 100
Age (Years)

Figure 2. HPV prevalence by age in Central and South America among low-risk female populations by country, city, and study.

were from the US. A recent report of population-based age-
specific HPV prevalence in the US National Health and Nu-
trition Examination Survey showed a sharp increase from 14
to 19 years of age (24.5%) to peak prevalence at 20 to 24
years of age (44.8%), after which HPV prevalence declined
to 19.6% in 50- to 59-year-olds [9]. In terms of regional dif-
ferences within the US, HPV prevalence was particularly
high (55%-70%) in urban youths aged 13 to 20 years in At-
lanta, Georgia [62]. Similarly, HPV prevalence was high (ap-
proximately 24%–55%) among female college students in
Berkeley, California [63,64], Maryland [65], New Jersey
[66,67], and New Mexico [68,69].
Among age-stratified low-risk populations, there was
a clear peak in prevalence in younger women (approximately
20–25 years of age), with a downward trend as age increased
(smoothed curve of Figure 3) [9,70–82]. HPV prevalence
varied widely, ranging from 2% in women 50 to 59 years
of age in Douglas, Arizona [83], to 70% in females 16 years
of age in Atlanta, Georgia [62].
Overall, studies in Canada reflected a slightly lower prev-
alence of HPV compared with the US. Most studies had
a peak prevalence of approximately 20% to 25% in 20-
year-old females and a decline associated with increasing
age [84–86].
Asia (including Australia)
Seventy-one studies have been conducted in Australia
[87–91], China [92–101], India [102–114], Japan [115–
131], Korea [132–138], the Phillippines [139], Taiwan
[140–145], Thailand [146–155], and Vietnam [156] (Table
1). HPV prevalence generally tended to be lower than in other
areas of the world (smoothed curve of Figure 4), with the ex-
ception of studies in Japan [120], Australia [87,88,90], China
[97], and India [108,112] (Figure 4).
In 10 studies from China, HPV prevalence ranged from
5.5% among women aged 30 to 60 years (no city reported)
[100] to 53% among women aged 22 to 36 years in Shenyang
[97]. In Xiangyan and Yangchen [98], age-specific preva-
lence was essentially constant across women aged 30 to 50
years. In 15 studies from India, age-specific HPV was as
low as 0% in a study of 30 women in Vellore (median age
45 years) [113], and as high as 45% in a study of pregnant
women aged 30 to 39 years from Kolkata [108]. Of 17 studies
in Japan, HPV prevalence was generally low, with 12 studies
reporting a prevalence of less than 15% [115,118,121–
127,129–131]. In Australia, four populations [87–91] re-
ported prevalences ranging from 6% in women with
a mean age of 19 years (range ¼ 13–44 years) [89] to 41%
in women aged 18 to 20 years [87,88] (Table 1). No data
were reported from New Zealand.
Europe and the Middle East
Data from 111 low-risk populations were available for
many European countries [25,139,157–271]. For the Middle
East, information was available for Egypt [272], Lebanon
[273], and Turkey [274].
In Northern Europe (smoothed curve of Figure 5A), over-
all HPV prevalence was generally less than 20% and gener-
ally lower than in North America (smoothed curve of
Figure 3). In one large study of 4000 women in Germany,
HPV prevalence peaked at 14% in 18- to 25-year-olds, and
steadily decreased to 0% in 61- to 70year-olds [198]. One no-
table exception was a study of 90 women attending cervical
cancer screening in a gynecology clinic in Poland [241]. HPV
prevalence was 59% in women aged 45 to 55 years, and ap-
proximately 26% in women over age 55 [241].
In Southern Europe (smoothed curve of Figure 5B),
HPV prevalence was generally comparable to that in
 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25 S9

Canada, Newfoundland84 Canada, Nunavut, Non-Inuit-Unknown352 Canada, Nunavut, Inuit-Baffin352

Canada, Nunavut, Inuit-Keewatin352 Canada, Nunavut, Inuit-Unknown 352
Canada, Nunavut, Non-Inuit-Baffin352
Canada, Ontario353 Canada, Ontario85 Canada, Montreal86
USA, California, Berkeley63, 64 USA, Iowa, Iowa City73 USA, Iowa, Iowa City369, 370
USA, Iowa, Iowa City 371
USA, Maryland, College Park 65
USA, Massachusetts, Boston373
USA, New Jersey, New Brunswick66, 67 USA, New Mexico, Albuquerque74 USA, New Mexico, Albuquerque68
USA, Oregon, Portland75-80, 377 USA, Washington, D.C.81 USA, Washington State82
USA/Mexico 70-72
USA/Mexico 83
USA, Nationwide9

100

90
60
80

Prevalence (%)
70 40
Prevalence (%)

60
20
50

40 0
20 30 40 50 60 70
30
Age
20

10

0
0 20 40 60 80 100
Age (Years)

Figure 3. HPV prevalence by age in North America among low-risk female populations by country, city, and study.

Northern Europe (Figure 5A), and generally showed peak of females aged 14 to 75 years [247,248]. Studies in Italy
prevalences in women in their early 20s. In two studies in revealed differing age-specific prevalence trends. One
Reims, France [190,191], female adolescents from 15 study of women in Genova reported an HPV prevalence
years were sampled, with the peak prevalence observed of 15% in women 44 years of age and younger, and
in those aged 21 to 30 years (24% vs. 28%). In Spain, found the highest prevalence (19%) in women 60 years
HPV prevalence was low—1% to 11% in a large sample of age and older [215]. Another study in Turin, Italy,

Australia87, 88 China, Hong Kong96 China, Hong Kong96

China, Xiangyuan98 China, Yangcheng98 India, Dindigul111
India, Kolkata108 India, Manipur110 India, Sikkim110
India, West Bengal110 Japan, Multiple cities130 Japan, Chiba131
Japan, Hirara125 Japan, Ishikawa and Toyama121 Japan, Ishikawa120
Japan, Naha125 Japan, Okinawa124 Japan, Okinawa123
Japan, Osaka126 Japan, Tokyo127 Japan, Yonashiro125
South Korea, Busan137 South Korea, Busan 136
South Korea, Seoul135
Thailand, Kaoka District151 Thailand, Khon Kaen152 Vietnam, Hanoi156
Vietnam, Ho Chi Minh City156
100
90
Prevalence (%)

80 50
40
70
Prevalence (%)

30
60 20
50 10
0
40
20 40 60 80 100
30 Age

20
10
0
0 20 40 60 80 100
Age (Years)

Figure 4. HPV prevalence by age in Asia/Australia among low-risk female populations by country, city, and study.
S10 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

A Belgium, Antwerp159 Belgium, Brussels160, 161 Belgium, Wilrijk394

Denmark 171
Denmark, Copenhagen1 67170
England, London176, 178

England, Manchester 401

England, Nottingham 179
England, Nottingham180

Finland, Helsinki 182

Finland, Helsinki 182
Greenland171
Norway, Oslo 235
Poland, Poznan 241
Russia, St. Petersburg243, 244
Sweden, Stockholm255 Sweden, Umea256, 257 Sweden, Uppsala262
Switzerland, Multiple cities269 The Netherlands, Amstelveen229 The Netherlands, Amstelveen229
The Netherlands, Amstelveen 229
The Netherlands, Amstelveen 229
The Netherlands, Amsterdam227
228
The Netherlands, Amsterdam 227
The Netherlands, Amsterdam United Kingdom, Multiple cities271
100
90

Prevalence (%)
60
80
70 40
Prevalence (%)

60
20
50
40 0
20 40 60 80
30 Age
20
10
0
0 20 40 60 80 100
Age (Years)

B Austria, Vienna157 France, Amiens184 France, Besancon186

France, Poitiers 189
France, Reims190 France, Reims193
203, 204
France, Reims 191
Greece, Northern Region Greece, Thessaloniki207, 208
212 213
Hungary Hungary, Debrecen Italy, Genova215
Italy, Rome216 220
Italy, Turin Lebanon, Beirut273
Spain, Barcelona248
100
90
Prevalence (%)

80 50
70 40
Prevalence (%)

30
60
20
50 10
0
40
20 40 60 80
30 Age
20
10
0
0 20 40 60 80 100
Age (Years)

Figure 5. (A) HPV prevalence by age in Northern Europe among low-risk populations by country, city, and study. (B) HPV prevalence by age in Southern Europe
among low-risk female populations by country, city, and study.

showed a peak prevalence (14%) in women aged 35 to 39 63%) in Senegal [275], South Africa [276], and Tunisia
years that decreased thereafter [220]. [26]. When compared with HIV negative women, overall
HPV prevalence was more than three times higher in
HIV-positive women in Senegal [277] and twice as high
Age-specific HPV prevalence among high-risk groups
in HIV-positive women in rural Zimbabwe [278] (Table
Among the 86 high-risk populations studied, seven 1). The highest reported prevalence in Africa was 75%
were in Africa, nine in Central and South America, 19 in HIV-positive women attending infectious disease clinics
in North America, 14 in Asia and Australia, and 37 in Eu- (mean age ¼ 29 years) in Dakar, Senegal [277], with four
rope/Middle East (Table 2). In Africa, overall HPV preva- of seven studies reporting prevalences greater than 50%
lence was consistently high in female sex workers (39%– (Table 2).
 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25
Columbia, Bogota (HPV 16)39-41
England, Nottingham (HPV 16)179
Italy, Genova (HPV 16)215
Italy, Rome (HPV 16)216
Japan, Okinawa (HPV 16)124
Latvia, Riga (HPV 16/18)226
Mexico, Morelos (HPV 18)48
Poland, Poznan (HPV 16)241
Sweden, Uppsala (HPV 16)259-261
Thailand, Bangkok (HPV 16)304
The Netherlands, Amsterdam (HPV 16)228
50
40
Prevalence (%)
30
20
10
0
0 20 40
Age (Years)
Figure 6. HPV 16/18 prevalence by age in women by country, city, and study. HPV 16, solid black or gray lines; HPV 18, black or gray dashed lines; HPV 16/18,
closed gray symbol and solid gray line.
In Central and South America, the highest prevalence of
HPV was 88% in HIV-positive women in Sao Paulo, Brazil
(mean age ¼ 32 years) [279]. Four of nine studies, primarily
of HIV-positive women and/or CSWs, reported a prevalence
of greater than 50% [279–282]. Among studies from Central
America, three high-risk populations from Mexico [281,283,
284] and one from Honduras [285] were described. Peak
HPV prevalence was observed in the youngest age groups
in age-specific studies and generally decreased with increas-
ing age.
In North America, 63% (12 of 19) of the high-risk popu-
lations had a prevalence greater than 40%, and two-thirds of
the studies reported prevalences greater than 50%. The ma-
jority of studies in North America were conducted on STI
clinic attendees. The highest HPV prevalence (91%) was re-
ported in females aged 11 to 20 years attending STI and uni-
versity clinics in Baltimore, Maryland [286]. All studies in
North America that included HIV-positive women reported
an HPV prevalence of 50% or greater. The highest HPV prev-
alence rates were reported in a multicenter survey of metro-
politan areas (Women’s Interagency HIV Study [WIHS]
cohort) [287-293] and in a study of HIV positive women in
Canada [294,295], both of which had a prevalence of approx-
imately 63%.
Similar to data from low-risk populations, Asia had the
lowest overall HPV prevalence among high-risk populations
in comparison with other regions (Table 2). The highest prev-
alence reported was 69% in CSWs less than 18 years of age in
Bali, Indonesia [296]. Only one other population of STI
S11
Columbia, Bogota (HPV 18)39-41
England, Nottingham (HPV 18)179
Italy, Genova (HPV 18)215
Italy, Rome (HPV 18)216
Japan, Okinawa (HPV 18)124
Mexico, Morelos (HPV 16)48
Norway, Oslo (HPV 16)232-235
Poland, Poznan (HPV 18)241
Tanzania, Dar es Salaam (HPV 16/18)404
Thailand, Bangkok (HPV 18)304
The Netherlands, Amsterdam (HPV 18)228
60 80 100
clinic attendees in Sydney, Australia (mean age ¼ 28 years),
reported an HPV prevalence of greater than 50% [297], de-
spite the fact that the populations sampled included CSWs,
HIV-positive women, and women attending STI clinics.
High-risk studies in Europe had findings similar to those
of North America. The highest prevalence reported was
also 91% in HIV positive women (mean age ¼ 31 years) in
Milan, Italy [217]. Also similar to North America, approxi-
mately half of the 36 studies with high-risk populations had
a prevalence of greater than 50%, which included studies
of STI clinic attendees and/or CSWs. A particularly high
prevalence was observed in STI clinic attendees (85%) under
20 years of age in Greenland [38] and in Spanish CSWs
(75%) of the same age [298]. HIV-positive women in Paris
[299], Germany [196], and Italy [214,300–302] all reported
an HPV prevalence of 60% or greater.
HPV 16 and 18 prevalence stratified by age
Thirteen studies reported HPV 16 or 18 stratified by age
(Figure 6). Among those sampled in lower sexual risk popu-
lations (n ¼ 11), HPV 16 was generally less than one-quarter
of the overall prevalence (Table 1). Generally, type-specific
prevalence for either HPV 16 or 18 was less than 8% and
overall prevalence of any HPV type was less than 30%. How-
ever, there were a few notable exceptions, such as family
planning clinic attendees in Dalian City, China (mean age
29 years), who had a prevalence of 34% for HPV 16 [93].
Relatively higher prevalences for HPV 16 and 18 were
S12 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25
observed in Europe, with a few studies in Spain, Denmark,
Germany, and Italy reporting type-specific prevalences of
over 25% and 5% for HPV 16 and 18, respectively
[166,200,215,250]. In Poznan, Poland [241], cervical cancer
screening patients aged 45 to 78 years with an overall HPV
prevalence of 49% had a generally high prevalence of both
HPV 16 and 18; prevalence was the highest for women
aged 45 to 49 years, 39% and 27%, respectively, and de-
creased to 26% and 17%, respectively, in women aged 56
to 78 years [241]. One study in Khon Kaen, Thailand, also
reported an approximately 11% prevalence for HPV 18
among women 25 to 60 years of age, with a prevalence of
3.8% for HPV 16 [154].
Among the 85 studies conducted on high-risk populations,
44 had prevalence data for HPV 16 and/or 18. Across all re-
gions, prevalence of HPV 16 was approximately one-third
to one-half of the overall prevalence reported for the same
studies (Table 2). In some cases, type-specific prevalence
rates for HPV 16 and 18 were comparable with overall prev-
alence rates. In Europe, sex workers in Copenhagen, Den-
mark [303] (mean age ¼ 31 years), had an overall HPV
prevalence of 32% and an HPV 16 prevalence of 31%. HIV
positive women in Ancona, Italy [214], had an overall HPV
prevalence of 67% and an HPV 16 prevalence of 48%. Sex
workers in a brothel (mean age ¼ 19 years) in Bangkok, Thai-
land [304], had higher HPV prevalence (approximately 26%
and 9% for HPV 16 and 18, respectively) than massage parlor
sex workers (mean age ¼ 30 years; approximately 8% and 2%
for HPV 16 and 18, respectively) (Table 2). HPV 16 and 18
prevalence rates were highest in brothel workers 15 to 19
years of age (31% and 13%, respectively) [304]. These studies
suggest that oncogenic HPV types 16 and 18 (included in cer-
vical cancer vaccines) can comprise significant proportions of
HPV infection in many high-risk populations worldwide.
Discussion
This review represents, to our knowledge, the largest
study of HPV prevalence worldwide, including HPV-DNA
prevalence data from over 346,000 women from 70 countries
worldwide. Age-stratified HPV prevalence varied consider-
ably across geographical regions, and depended upon many
factors, including age, country and region, and type of popu-
lation surveyed. Across all geographical regions, observed
HPV prevalence was strongly associated with age, although
age curves of HPV infection differed notably across regions.
The shapes of the curves were declining in older ages, flat
across age, or characterized by a U shape, with a relatively
higher HPV prevalence in younger and older ages. Overall
HPV prevalence in most geographical regions consistently
peaked in women aged 25 years of age, with a decrease
in older age groups. In contrast, age curves of HPV preva-
lence among women in Central and South America and
Africa were characterized by an increased or stable HPV
prevalence among women aged 45 years or older. Given
that a second peak in HPV prevalence appears to be more
pronounced and occurs at different ages within different geo-
graphical regions, these data suggest that the higher preva-
lence in older age women is largely because of newly
acquired HPV infections, primarily reflecting differences in
sexual behavior across global regions. Alternatively, the
U-shaped curves of HPV by age may potentially be explained
by reactivation of latent HPV infections in older women.
A previous meta-analysis of 157,879 women by de San-
jose and colleagues [8] summarized the global literature
among women with normal cytology. The present review ex-
pands upon this previous work by presenting data on women
with normal cytology as well as those included in population-
based surveys or routine screening programs to provide
estimates that more closely represent those of the general
population. In the de Sanjose et al [8] review, age data
were grouped into five specific categories, beginning with
those aged 25 years or less to women greater than 54 years
of age [8]. In comparison, age ranges were further delineated
in the present review (15 years up to 90 years or older), pro-
viding a clearer understanding of HPV prevalence trends by
age within and among different geographical regions world-
wide.
Given the heterogeneity in laboratory assays employed for
HPV infection detection, populations surveyed, and the ob-
served variation in HPV positivity across the different stud-
ies, we have chosen not to present a summary estimate for
overall HPV prevalence for geographical regions or for
specific age groups [305]. Instead, this review provides
both age- and country-specific data on HPV infection preva-
lence to allow for the examination of age-specific trends of
HPV prevalence within a particular region or a population
subgroup of interest. Within specific regions, data trends ap-
pear to be generally similar to those presented by de Sanjose
et al [8]. Although for studies in Africa, HPV prevalence was
previously reported to be between 20% and 30% [8], whereas
we observed prevalences that ranged from approximately 7%
to 60%, with half of the studies showing less than 20% prev-
alence. For Central and South America, the highest HPV
prevalence was previously shown to be approximately
25%, with a nadir at 10% among females aged 35 to 44 years
[8]. This data curve was clearly U-shaped, suggesting a com-
parably higher HPV prevalence in older age groups. In com-
parison, the present review similarly shows a U-shaped
pattern by age in Central and South America, although rela-
tively flatter, with HPV prevalence ranging from less than 5%
to approximately 70%. For studies in North America, we
show a decline in HPV prevalence with increasing age; this
is in contrast to data obtained by de Sanjose et al [8] for fe-
males above 35 years of age. Also, in contrast to an HPV
prevalence of less than 25%, we observed prevalence rates
of 2% to approximately 56%. For studies in Europe, the
data were divided into northern and southern regions. HPV
prevalence was generally similar between these two geo-
graphical regions (up to 60%), yet prevalence estimates ap-
peared to be relatively higher than those observed by de
Sanjose et al [8] for all of Europe (<25%). In the present
 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25
study, data from Asia and Australia were grouped and ap-
peared to be in contrast, for Asia only, to results obtained
by de Sanjose et al [8]. HPV prevalence was previously re-
ported to be between 5% and 11%, and these present data
show specific Asian regions with higher positivity in Japan
(0%–50%) and Australia (20%–40%).
Both this present review and the review by de Sanjose et al
[8] consistently showed that HPV prevalence was highest
among younger women for all major world regions, reflect-
ing a higher probability of acquiring new infections at youn-
ger ages. We observed that HPV-DNA prevalence differed
across geographical regions, with peak HPV prevalence
among older aged women (35–50 years) differing somewhat
across geographical regions, being approximately 20% in
Africa, North America, and Central and South America,
and 15% in Asia/Australia, Southern Europe/Middle East,
and Northern Europe. Relative differences in HPV-DNA
prevalence from one geographical region to another, how-
ever, are not as striking as those seen for HSV-2 (herpes sim-
plex virus-2) seropositivity, which is characteristic of
a notably higher HSV-2 seropositivity in Africa, and lower
HSV-2 seropositivity within several geographical regions,
including Asia [306]. These differences are likely attributed
to differences in the ascertainment methods used to quantify
the burden of HSV-2 (serum antibody detection indicative of
cumulative exposure) and HPV (DNA detection indicative of
current, persistent, or reactivated HPV infection). At present,
currently available methods to detect HPV serum antibodies
[307] are not capable of accurately measuring a woman’s cu-
mulative exposure to HPV. Reliable data on a woman’s life-
time risk (cumulative, ever-exposure) of acquiring an HPV
infection would have been useful to assess the potential
long-term impact of prophylactic HPV vaccines.
Comparisons of HPV prevalence by geographical area or
country are generally hampered by differences among study
populations surveyed, laboratory methods used, and the var-
iation in HPV types detected (i.e., overall HPV positivity,
high-risk HPV types, low-risk HPV types, or type-specific
[i.e., HPV 16 or 18] positivity). To reduce the possibility of
an underestimation of overall or type-specific prevalence,
study criteria included the detection of HPV using PCR or
HCII detection assays. Although PCR and HCII detection as-
says have been shown to have a relatively higher sensitivity
for HPV detection than earlier detection assays (i.e., dot-blot
or Southern blot), the sensitivity of HPV-DNA detection for
studies presented here may not have been optimal if there
were differences in the ability of PCR primers to detect spe-
cific HPV types, or if there was an underdetection of HPV be-
cause of in-house laboratory testing procedures. Across
geographical regions, HPV-DNA was generally detected us-
ing GP5þ/6þ, MY09/11, HCII, or type-specific PCR primer
systems, with the exception of Japan, where a relatively
larger proportion of studies used L1 primers. The sensitivity
of detecting HPV may also vary based on the type of speci-
men analyzed. Although not commonly used in this survey,
urine specimens may allow for easier sampling within the
S13
population than the collection of cervicovaginal samples.
However, urine-based samples have also resulted in a lower
sensitivity for HPV-DNA detection than sampling from other
sites in the cervicovaginal tract [308].
The present systematic review, to our knowledge, repre-
sents the largest to date, with a comprehensive examination
of HPV-DNA prevalence in all major geographical regions.
For quality assurance, data were extracted and double-
checked by two independent abstractors, and a complete list-
ing of country and age-specific HPV prevalence data are
presented in appendices located at http://jahonline.org (Ta-
bles 1 and 2). Results are further presented for global regions
of the Caribbean, Western Asia, and Australia, for which data
were not previously presented for women with normal cytol-
ogy [8]. Given that few data are available in the literature on
trends in HPV prevalence over time within specific popula-
tions, data provided in this present review may be useful as
baseline, prevaccination HPV prevalence data. This may be
most beneficial for future HPV vaccine evaluation efforts if
sequential HPV testing is conducted within individual popu-
lations postvaccination.
Among study limitations, type-specific data for individual
carcinogenic HPV types other than 16 and 18 (i.e., HPV 45,
31, 33, 52, 58, etc.) were not included in the present review,
although these data have been presented for women with nor-
mal cytology in the de Sanjose et al [8] review. HPV preva-
lence estimates presented here are also largely limited to
sexually active or married women. Prevalence results for
low-risk populations may not entirely reflect those of the gen-
eral population. To provide estimates that may be more rep-
resentative of general female populations, and because
previous reviews have focused on comparing HPV type-dis-
tribution in these female populations with women with low-
and high-grade cervical precancerous lesions, data were not
limited to women with normal cytology [3,309]. Further,
this review is limited to cross-sectional prevalence rather
than the ascertainment of persistent HPV, which has been
shown to be highly predictive of a woman’s future risk of
high-grade cervical neoplasia or cancer [170,310,311].
Few population-based prevalence surveys of HPV infec-
tion have been conducted worldwide. This is likely because
of expense as well as the difficulty in collecting physician-
based samples, which are associated with relatively higher
HPV-DNA detection than currently available self-collected
sampling techniques [9,312]. Further, detailed data presented
on different types of HPV detection assays focused on the
type of PCR consensus primers used, rather than on differ-
ences in typing methods employed for HPV-positive speci-
mens, which may notably differ across testing laboratories.
A limited number of studies provided data on dual DNA
positivity to HPV types 16 and 18 in exfoliated cell speci-
mens. Available data presented here on HPV-DNA preva-
lence for HPV types 16 and 18 worldwide have
implications for vaccination programs. In a randomized trial
of women in Costa Rica who were HPV-DNA-positive for
types 16 and 18, prophylactic HPV vaccination had no
S14 J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25
therapeutic effect against these two types among women with
these prevalent HPV 16 or 18 infections [313]. L1 virus-like
particle-based vaccines are thus not expected to provide max-
imum benefit to women who are currently DNA positive to
HPV vaccine types (Figure 6). It would have been beneficial
to determine the proportion of women within different popu-
lation groups who were DNA positive and serological posi-
tive for HPV vaccine types 16 and/or 18 within specific
age stratifications. These data would help clarify the potential
usefulness of vaccination against HPV 16 and 18 in females
[314], given that among women previously exposed to infec-
tion with HPV vaccine types (seropositive/DNA negative to
HPV vaccines types), available vaccine efficacy data suggest
a potential protective effect that needs to be confirmed with
larger sample sizes. Clearly, HPV vaccines are optimally ef-
ficacious in women who are dually seronegative and DNA
negative to included HPV vaccine types.
Conclusions
Age-specific prevalence data on HPV are essential in un-
derstanding the trends in HPV prevalence in all major world
regions. There is a peak in HPV prevalence among younger
females, with a second peak among older individuals in
some, but not all, specific geographical regions. Despite dif-
ferences in techniques and collection methods, age-stratified
data on high-risk HPV types 16 and 18 (included in current
generation HPV prophylactic vaccines) show similar age-re-
lated trends across major regions. HPV 18 is typically less
prevalent than HPV 16, and prevalence differs notably by
geographical region. Further data are needed among adoles-
cent populations and among population-based samples, as
many countries currently have limited available data.
Acknowledgments
We thank Sarah Landis for her critical review of the data.
We also thank Michael Hudgens for his help with statistical
advice, and Jie Ting, Yuli Chang, Marcus Lynch, and
Tammy Rahim for their valuable assistance in manuscript
preparation.
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Table 1

S25.e1
HPV prevalence estimates in women from low-risk populations by continent, country, and study year.
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Africa
Algeria, Algiers, 1997–9 [315] GP5þ/6þ Ectocervix—spatula Hospital-based controls 52 (30–88) 145 12.4 6.2 0.7
Endocervix—brush
Gabon, Libreville, 2001 [17] MY09/11 Cervicovaginal—lavage Women attending clinics for 26.4 (18–44) 354 46.0 25.4 10.2 4.5 1.1
antenatal check-up or for
general genital symptoms
Gambia, Farafenni, 1999 [18] GP5þ/6þ Cervix—brush Population-based sample in rural 33.0a (15–54) 710 13.4

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

community
15–24 184 14.7
25–34 213 10.3
35–44 191 14.1
45–54 122 15.6
Ivory Coast, Abidjan, 1995–6 MY09/11 Endocervix—brush Community-based clinic controls 28a b (20–50) 391 24.3 1.8 0.3
[316,317]
Kenya, Nairobi, 1994 [19] GP5þ/6þ Endocervix—brush Family planning clients 29.7, 29b (19– 513 17.0 15.8 1.2 4.1 2.3
54)
19–25 118 22.9
26–29 197 17.3
30–54 198 13.1
Kenya, Nairobi, 1998–2000 [31] SPF10 Cervix—brush Family planning clients 35.2 (25–54) 429 44.3 30.6 6.5 6.3 2.6
25–29 76 57.9a 39a
30–34 143 40.0a 28a
35–39 103 50.0a 39a
40–44 65 30.0a 20a
45–54 37 30.0a 15a
Malawi, No city reported, 1991 MY09/11 Cervicovaginal—lavage Annual visit among urban women 24 (13–45) 244 34.0
[318,319] in Malawi
Morocco, Rabat, 1991–3 [320] GP5þ/6þ Cervix—brush Cytologically normal hospital- 40.7 (18–70) 185 20.5 4.3 1.1
based controls
Mozambique, Manhica, 1999 [27] MY09/11 Cervix—smear Population-based sample in rural 14–61 253 40 27 5.5 4.7
community
14–20 51 55 49.0
21–30 61 48 45.9
31–40 53 38 30.1
41–50 47 30 23.4
51 41 22 21.9
Nigeria, Ibadan, 1999–2000 [20] GP5þ/6þ Ecto/endocervix—brush Population-based sample 44.9a 932 24.8 18.2 6.5 3.2 1.9
<25 120 30.8
25–34 189 25.4
35–44 134 26.9
45–54 196 26.0
55–64 172 24.4
65 121 25.6
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Senegal, Dakar, 1990–1 [277] PCR with consensus Cervix—smear HIV- women 30.6 53 20.8
primers
Senegal, Dakar, 1996 [321] MY09/11 Ecto/endocervix—swab Women attending gynecology 37.2a 158 13.9 5.7 1.3
clinic with various
gynecological complaints
Senegal, Dakar, 1996 [21] Type-specific PCR (6, 11, 16, 18, Cervix—spatula Pregnant women 28 (13–71) 72 23.6 16.7 6.9
31, 33, 45, 35, 52, 58, 68)

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

13–25 29 13.8
26–43 43 30.2
Senegal, Dakar suburbs, 1998– Type-specific primers (16, 18, 26, Cervix—brush Community-based (health clinic 42.7 (35) 1639 12.5 4.9 3.1 1.0 0.9
2000 [32] 31, 33, 35, 39, 42, 45, 51–59, attendees)
66, 68, 73, 82, 83, 84, 6, 11, 40)
and
MY09/11
Cytologically normal 35–39 575 11.3 4.3 3.1
40–44 501 14.2 5.6 3.6
45–49 356 9.3 3.4 2.2
50–54 126 15.9 7.1 4.0
55 81 19.8 8.6 2.5
South Africa, Cape Town, 1998–9 HCII Self-collected vaginal swab Outpatient clinic 39b (35–65) 1269 17.1
[322]
HCII Clinician-collected sample Outpatient clinic 39b (35–65) 1269 15.5
South Africa, Khayelitsha, 1996– HCI Cervix—smear Community-based primary 39 (35–65) 2680 12.2
7 [15,16] cervical cancer screening
(cytologically normal)
HCII Cervix—smear Community-based primary 39 (35–65) 243 18.1
cervical cancer screening
(cytologically normal); all
screening sample
35–39 17.0
40–49 14.0
50–59 17.0
60–65 18.0
Tanzania, Mwanza, 1994 [23,24] MY09/11 Endocervix—brush Pregnant women attending 23.4 (15–44) 612 34.2 19.6 6.5
antenatal clinic
15–19 144 34.7
20–29 388 35.6
30–44 80 26.3
Tunisia, Sousse, 1999 [25] MY09/11 and GP5þ/6þ Endocervix— brush Family planning clients 25.5 (18–53) 103 13.6 6.8 3.9 4.9 0.0
18–30 16.1
31–40 13.8a

S25.e2
41–53 10.3
(Continued )
Table 1

S25.e3
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Tunisia, Sousse, 2002 [26] MY09/11, pu-1M/pu-2R, Cervix—brush Family-planning clients 35 (20–45) 96 14.6
and pu-31B/pu-2R
20–30 17.0a
31–40 14.0a
41–45 13.0a
Uganda, Rakai District, 1996–7 HCII Vagina—swab Community-based trial for HIV 31.3a (15–59) 737 16.3
[22] prevention

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

15–19 118 25.4
20–29 277 20.6
30–39 177 12.4
40–59 165 6.7
Zimbabwe, Chitungwiza and HCII Cervix—brush Cervical cancer screening 34.1a (25–55) 2139 42.7
Greater Harare, 1996–7 [28– program
30]
25–34 1343 48.5
35–44 624 34.9
45–55 172 25.6
Zimbabwe, Mupfure, 2004 [278] GP5þ/6þ Cervicovaginal— lavage Population-based rural (15–49) 174 27.0 3.4 3.4
community screening
Central/South America
Argentina, No city reported, 2002 MY09/11 and GP5þ/6þ Ectocervix— scrape Women with normal cytology 32.4 90 37.8
[323]
Argentina, Concordia, 1998 [37] GP5þ/6þ Cervical external os—spatula Population-based sample 38.9a (15) 987 16.8 12.1 2.5 0.5
Endocervix—brush
15–24 151 25.3
25–34 201 22.0a
35–44 207 18.0a
45–54 199 13.0a
55 179 9.5a
15–25 151 20.0a 4.0a
25–34 201 17.0a 5.0a
35–44 207 11.0a 7.0a
45–54 199 7.0a 6.0a
55–64 5.0a 5.0a
65 5.0a 4.0a
Argentina, La Plata, 1998–2000 MY09/11 and GP5þ/6þ Ecto/endocervix—brush Women with normal cytology 34 (15–67) 79 30.4 11.4 19.0 8.9 1.3
[324] or spatula
Argentina, La Platac [325] MY09/11 and GP5þ/6þ Ecto/endocervix—brush Anonymous specimens from 41a (15–67) 79 30.4 10.1 22.8 8.9 1.3
or spatula public hospital data bank
Argentina, Misiones, 2000–2 [33] MY09/11 Cervix—spatula Cervical cancer screening among 32b (17–69) 458 52
indigenous rural and urban
population
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Argentina, Misiones, 2002 [34] MY09/11 and GP5þ/6þ Ecto/endocervix—brush Cervical cancer screening among 15 (12–64) 207 64.3 19.8 6.3
Guarani Indians
Rural 16 (26–40) 214 43
Urban 33 (21–65) 244 60
Argentina, Jujuy, 2001 [326] MY09/11 Cervix—smear Tribal women undergoing 35 (14–64) 108 51.9 14.8 0.9
cervical screening
Argentina, Ushuaia, Province of MY09/11 and GP5þ/6þ Ecto/endocervix—brush Normal women attending 31.6a 87 26 16 5 5.7 1.1

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

Tierra del Fuego, a gynecology clinic
2002–3 [35]
14–24 39 54.0
25–34 45 38.0
35–54 45 33.1a
Bolivia, Amazonc [327] PCR with L1 primers Cervix—swab Population-based random sample 36.3a (16–71) 135 5.9
San Ramon 36.5 (16–71) 63 3.2
Caranavi 34.9 (16–65) 51 7.8
Palos Blancos 38 (23–67) 9 0.0
Rurrenabaque 40.1 (20–70) 12 16.7
Brazil, Joao Pessoa and Paraiba, MY09/11 Ecto/endocervix—brush Population-based attendees of 41.2, 40b 525 18.3 11.6 9.7 5.3 2.1
1988–90 [328] cervical cancer screening
Brazil, Porto Alegre, 2002 [38] MY09/11 Cervix—brush Attendees of cervical cancer 15–70 975 16.0
screening
15–25 27.9
25–34 17.0
35–49 12.6
50–70 14.4
Brazil, Porto Alegrec [329] LIPA Cervix—brush and spatula Population recruited from 20.3 (15–25) 394 39.8
multicenter prophylactic
vaccine trial
Brazil, Recife, 2000 [36] HCI Ecto/endocervix—swab Cytologically normal women 43 (35–60) 70 58.6
from screening program
Brazil, Recife, 2001 [330] MY09/11 Ectocervix—spatula Randomly selected screening 38 (16–88) 253 28.9 13.0 0.8
Endocervix— brush sample
Tampon (self-sampled) 22.9 8.3 0.4
Brazil, Rio de Janeiro, 2000 [331] HCII Cervix—brush Women undergoing routine 31.5 1055 48.3 42.7 22.8
gynecological exam
Brazil, Sao Paulo, 1990–1 [61] GP5þ/6þ and type-specific PCR Ectocervix—spatula Hospital-based controls 52.4 (25–79) 190 16.8 5.3 1.1
(6, 11, 16, 18, 31, 33) Endocervix—brush
25–44 49 20.4
45–54 58 20.7
55–64 52 11.5
65–79 31 12.9

S25.e4
(Continued )
Table 1

S25.e5
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Brazil, Sao Paulo, 1993–7 MY09/11 Ecto/endocervix—smear Population-based cohort 33.3, 33 (18–60) 1425 13.8 2.7 0.8
[332,333]
18–34 17.1
35–60 9.8

Chile, Santiago, 2000–1 [42] GP5þ/6þ Ectocervix—spatula Population-based random sample 41.0a (15–69) 955 12.8 9.1 3.7 2.6 0.5
Endocervix—brush

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

15–24 134 22.4
25–34 185 11.9
35–44 215 8.4
45–54 168 10.1
55–64 157 12.7
65–69 96 15.6
Colombia, Bogota, 1993–5 [39– GP5þ/6þ Cervix—spatula, brush Population-based cervical cancer 32 (13–85) 1845 14.9 11.4 3.2 2.4 0.4
41] screening sample
<20 230 26.1 20.4 5.2
20–24 220 22.7 18.2 4.1
25–29 337 12.8 10.4 1.8
30–34 404 16.6 11.9 4.2
35–39 284 8.1 6.0 2.1
40–44 192 8.3 7.8 0.5
45–54 86 2.3 2.3 0.0
55 106 13.2 5.7 7.6
<25 2.7 0.9
25–34 2.7 0.5
35 1.9 0.0
Colombia, Cali, 1985–8 Type-specific PCR (6, 11, 16, 18, Cervix—scrape Population-based controls 39.2 (19–70) 181 10.5 3.3 0.0
[4,155,334–341] 31, 33, 35)
Costa Rica, Guanacaste, 1993–4 MY09/11 Cervix or vaginal cuff—swab Population-based 54 (27–88) 569 28.6 13.4 17.7
[51] hysterectomized women
27–34 40.0a 9.0a 30.0a
35–44 34.0a 8.0a 29.0a
45–54 27.0a 8.0a 22.0a
55–64 31.0a 13.0a 25.0a
65–74 29.0a 9.0a 24.0a
75–88 25.0a 11.0a 23.0a
Costa Rica, Guanacaste, 1994–5 MY09/11 and HMBO1 Cervix—brush Population-based screening 37 (18–94) 2308 16.0 7.6 6.7 3.3 0.8
[52–60]
18–24 296 21.0a 9.5a 6.0a
25–34 658 14.0a 5.5a 5.0a
35–44 573 6.0a 2.5a 2.0a
45–54 364 6.5a 3.0a 2.0a
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
55–64 212 14.0a 4.0a 4.0a
65–94 205 19.0a 3.5a 11.0a
Ecuador, Quito, 1985–1992 [115] Type-specific PCR (6/11, 16, 18, Cervix—biopsy Cytologically normal women 50.2a 40 20.0 2.5 0.0
33, 52b, 58)
Honduras, Tegucigalpa, 1993–5 MY09/11 Cervix—spatula Clinic-based controls 40.4 (20–65) 438 38.8 11.0 4.1
[43–47]
15–24 21 71.4

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

25–34 122 38.5
35–44 145 33.8
45–54 111 38.7
55–65 39 41.0
Jamaica, Kingston, 1996–7 [342] MY09/11 and GP1/2 Cervix—spatula, brush Women undergoing routine 37 94 14.0
cervical cancer screening
Mexico, No city reported, 1987– Type-specific PCR (6, 11, Biopsy Women with a normal cervix 49.5 (24–89) 117 31.4
92 [343] 16, 18)
Mexico, Mexico City, 1990–2 PCR with E6/E7 primers (16,18) Cervix—smear Population-based random sample, 44.3 (25–75) 204 13.2
[344] controls
Mexico, Mexico City, 1997 [345] MY09/11 and HMBO1 Cervix—spatula Cytologically normal women 39.7 (15–85) 71 16.9 9.9 7.0 2.8 0.0
attending gynecology clinic for
routine check-up or
gynecological complaint
Mexico, Mexico City, 1997–9 MY09/11 Ecto/endocervix—brush Population-based cervical cancer (26–88) 181 11.0
[346] screening sample
Mexico, Mexico City, HCII Endocervix—brush Outpatient clinic-based controls 38 182 19.8
1998–2000 [50] with negative Pap smear
<25 5.0
25–34 14.6
35–44 19.7
45–54 34.5
55–70 42.9
Mexico, Morelos, 1996–9 [48] PCR with LI primers Cervix—brush Population-based random sample 35.6a 1340 14.5 1.7 1.0
<25 276 16.7 16.3 0.4
25–34 280 9.5a 8.0a 1.0a
35–44 269 3.7 3.0a 0.5a
45–54 179 12.3 10.0a 2.4a
55–64 175 16.0a 10.2a 5.8a
65 161 23.0 16.8 6.2
<35 2.2 0.4
35–54 0.7 0.7
55 1.8 0.6
Mexico, Morelos, 1999 [49] HCII Cervix—brush (nurse-sampled) Cervical cancer screening 42.5, 41b (15– 7736 9.4

S25.e6
population 85)
(Continued )
Table 1

S25.e7
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Vagina—swab (self-sampled) 15–24 495 14.0a
25–34 2035 10.0a
35–44 2047 7.0a
45–54 1602 8.5a
55–64 992 11.0a
65–85 565 12.0a
Mexico, Morelos, 1999–2000 HCII Vagina—swab (self-sampled) Cross-sectional screening study of 25.7 (16–39) 274 37.1

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

[347] pregnant women
16–24 122 49.5
25–29 91 27.7
30–39 61 22.8
Nonpregnant women 26.2 (17–39) 1060 14.2
16–24 493 55.6
25–29 333 24.5
30–39 234 19.9
Paraguay, Asuncion, 1988–90 MY09/11 and GP5þ/6þ Ectocervix—spatula Cancer hospital-based controls 45 (18–85) 91 19.8 17.6 1.1 5.5 0.0
[348] Endocervix—brush
Peru, Lima, 1996–7 [349–351] GP5þ/6þ Cervix—swab Hospital-based controls 50.3a (21–84) 127 13.4 1.6 3.1
North America
Canada, Newfoundland, 1996–8 HCI and HCII Ecto/endocervix—brush, spatula Women presenting for routine 30, 35b, (18–69) 2098 10.8
[84] screening
<25 401 16.7
25–34 1098 11.7
35–44 536 5.0
45 59 3.6
Canada, Nunavut, 1999 [352] HCII Ecto/endocervix—broom Population-based screening of 31, 28b, (13–79) 1290 25.8
aboriginal women
Inuit—Baffin 13–20 100 43
21–30 182 34.1
31–40 110 12.7
>40 80 16.3
Inuit—Keewatin 13–20 28 35.7
21–30 74 29.7
31–40 47 6.4
>40 25 12
Inuit—Unknown 13–20 102 42.2
21–30 162 28.4
31–40 116 15.5
>40 75 13.3
Non-Inuit—Baffit 13–30 32 55.75
31–40 34 20.6
>40 40 17.5
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Non-Inuit—Unknown 13–30 23 34.5
>30 30 6.3
Canada, Ontario, No city reported HCII Cervix—brush Cervical cancer screening with 32.6a (15–49) 955 12.7
(6 health-planning regions), family physician
1998–9 [85]
15–19 89 15.7
20–24 125 24.0

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

25–29 159 16.4
30–34 163 12.3
35–39 157 9.6
40–44 144 8.3
45–49 118 3.4
Type-specific PCR (16, 18, 31, Cervix—brush Cervical cancer screening with 32.5a (15–49) 824 13.5
33, 35, 39, 45, 51, 52, 56, 58, family physician
59, 68, 6, 11, 42, 53)
15–19 80 20.0
20–24 108 23.1
25–29 143 14.7
30–34 136 11.8
35–39 136 11.0
40–44 121 3.3
45–49 100 13.0
Canada, Ontario, No city HCII Cervix—brush Women attending routine 56.2a 156 8.3
reported, 1999–2000 [353] cytological screening
50–54 56 8.0a
55–59 47 4.0a
60 53 12.0a
Canada, Montreal, 1992–3 [86] MY09/11 Ectocervix— spatula Routine gynecology visit, 21.4a 375 22.7 11.8 6.2 4.7 0.9
Endocervix— brush university students
<19 64 22.0 14.3 14.3
20–21 123 24.5 13.2 15.6
22–23 92 20.0 8.5 11.8
>24 92 21.1 13.4 12.3
Canada, Montreal, 1996–9 [354] MY09/11 and HMBO1 Ecto/endocervix University students 23, 21b (17–42) 621 29.0 21.8 14.8 7.0 3.1
Canada, Quebec City, 1991–2 MY09/11 Ectocervix—swab Women undergoing routine (18–49) 1493 12.0 2.8 2.0
[355] gynecological screening
Canada, Quebec City, 1995–7 HCI Cervix—swab Women attending gynecology 22.5 369 20.9 14.1 4.9
[356] clinic with various
gynecological complaints
Canada, Toronto, 1990 [357] Type-specific PCR (6/11, 16, 18, Cervix—spatula Cytologically normal university 23 (21–27) 105 18.1 10.5
33) students undergoing routine

S25.e8
exam
(Continued )
Table 1

S25.e9
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
USA, Nationwide, 1998–9[358] MY09/11 (16, L1) Cervicovaginal—avage and swab Population-based sample 20a (16–25) 2392 5.4
USA, Nationwide, 2003–4 [9] MY09/11 Self-collected cervicovaginal Population-based sample— (14–59) 1921 26.8 15.2 17.8 1.5 0.8
sample women from NHANES
14–19 652 24.5 17.0a 14.0a
20–24 189 44.8 29.0a 31.0a
25–29 174 27.4 14.0a 22.0a
30–39 328 27.5 16.0a 17.0a

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

40–49 324 25.2 14.0a 15.0a
50–59 254 19.6 7.0a 16.0a
USA, New York, New York; MY09/11 Cervicovaginal—lavage Healthy women from clinical and 34 (28–40) 343 27 5 22
Illinois, Chicago; California, outreach sources
Los Angeles and San
Francisco; Washington, DC,
1994–5 [359]
USA, Arizona, Southern Arizona, HCII Ectocervix—spatula Women undergoing routine 24.2 (18–35) 1280 26.2
1996–9 [360] Endocervix— brush gynecological care at Planned
Parenthood clinic
USA, Arizona, Douglas; Mexico, MY09/11 Ecto/endocervix—brush Population-based sample 51.2 (40) 304 9.2 5.9 3.3 2.0
Agua Prieta and Sonora, 1999–
2000 [83]
40–49 155 12.3 7.7a 4.5a
50–59 98 2.0 0.0a 2.0a
60–82 51 13.7 11.8a 2.0a
USA, Arizona, Tucson; Mexico, MY09/11 Ecto/endocervix— brush Family planning clinic sample 33.1 (15) 2246 14.4 11.5 2.9
Sonora, 1997–8 [70–72]
15–19 117 20.5 7.0
20–24 348 20.1 4.5
25–34 784 11.6 3.1
35–44 560 7.5 3.4
45–79 279 6.8 1.1
USA, California, Berkeley, 1989 MY09/11 Vulva and cervix— swab University students 22.9 (17–50) 467 46.0 8.8 5.3
[63,64]
17–19 79 48.1
20–21 135 43.7
22–23 93 54.8
24–25 58 51.7
26–29 77 35.1
30–50 25 32.0
USA, Colorado, Boulder, 1989 MY09/11 Cervix—biopsy Normal cervical biopsy samples 32.0 (16–63) 20 10.0
[361]
USA, Georgia, Atlanta, MY09/11 Ecto/endocervix—smear Urban adolescent population 16.1 (12.8–19.9) 312 64.1 49.4 10.3 5.1
1999–2001 [62]
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
<15 110 54.5
15 53 67.9
16 100 70.0
17 49 69.4
USA, Hawaii, Oahu, 1992–6 MY09/11 and type-specific PCR Cervix—smear Hospital-based controls 39.2 (18–84) 191 19 1.6 0.5
[362,363] (6/11, 16, 18, 45,
31/33/35/39)

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

USA, Hawaii, Oahu, 1999–2004 MY09/11 and HMB01 Ecto/endocervix—swab, brush Random multiethnic population 38.3 (18) 1566 26.2
[364] sample
USA, Indiana, No city reported, MY09/11 Cervicovaginal—lavage Cytologically normal; hospital- 31.7 (20–58) 55 54.5 9.1
1999 [365] based obstetrics clinic
(pregnant women, routine
prenatal care), hospital-based
gynecology clinic (routine
care), and patients undergoing
pretransplant evaluation or
transplantation follow-up
USA, Indiana, Indianapolisc HCII Cervicovaginal—lavage Gynecology clinic attendees 29.2 246 18.7 11.4 9.4
[366–368]
Obstetrics clinic attendees 22.8 245 22.8 24.9 12.7
USA, Iowa, Iowa City, Type-specific PCR (6,11, 16, 18, Cervix—swab Postmenopausal women 56.1a (45–64) 105 38.1
1989–91 [369,370] 31, 33, 35, 39, 45, 51, 52)
46–55 46 32.6
56–65 59 42.4
USA, Iowa, Iowa City, 1997–9 MY09/11 and GP5þ/6þ Ecto/endocervix—swab Postmenopausal women attending 58 (42–85) 260 13.8 5.8 10.0 2.3 0.4
[371] routine exam
42–53 74 13.5
54–59 89 15.7
60–85 97 12.4
USA, Iowa, Iowa City, 1998– MY09/11 and GP5þ/6þ Ecto/endocervix and posterior Pregnant women seeking routine 29 (18–45) 574 28.6 17.9 12.5 6.1 2.6
2001 [73] vaginal fornix—swab care
18–24 140 47.1
25–45 434 24.2
USA, Louisiana, New Orleansc MY09/11 (GP5þ/6þ for nested Cervix and vagina —swab Women referred to colposcopy 30.9 111 41.7 34.7 12.5
[372] PCR) clinic with normal Pap smears
USA, Maryland, College Park, MY09/11 Cervix—brush University students attending 22.5 (17–44) 414 35.0 14.3 5.1 7.7 1.9
1992–3 [65] routine gynecological exam
17–19 74 32.0
20–24 260 37
25–29 53 19
30–44 27 26

S25.e10
(Continued )
Table 1

S25.e11
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
USA, Maryland, College Park, MY09/11, GP1/2, and type- Cervix—spatula and brush US students undergoing routine 23 (18–40) 79 29.0
1996–7 [342] specific PCR (15 types from L1 cervical exam
region)
USA, Massachusetts, Boston, HCII Cervix—smear Healthy subjects; normal cytology 38.9 (30–45) 1000 3.9
2005 [373]
30–35 300 6.7
36–40 200 3.0

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

41–45 500 2.6
USA, New Jersey, New MY09/11 and HMBO1 Cervicovaginal—avage University students 20 604 26.0 11.1 3.8 2.0
Brunswick, 1992–4 [66, 67]
20 486 23.7
21–23 71 50.7
>23 47 36.2
USA, New Mexico, No city Type-specific PCR (6, 11, 16, 18, Cervix—swab Cytologically normal controls 28.6 (18–45) 326 30.4
reported, 1994–7 [374] 26, 31, 33, 35, 39, 40, 42, 45,
51, 52, 53, 54, 55, 56, 57, 58,
59, 66, 68, MM4, MM7, MM8,
MM9)
USA, New Mexico, Albuquerque, Type-specific PCR (6/11, 16, 18, Cervix—swab University students attending 23 (18–47) 357 44.3 7.8
1992 [68] 31, 33, 35, 39, 45, 51, 52, 54, clinic for routine gynecological
59, pap88, pap238a, papw13B) exam
18–20 79 43.0
21–25 152 48.7
26–30 57 33.3
31–47 69 44.9
USA, New Mexico, Type-specific PCR (6/11, 16, 18, Cervix—swab and lavage University students 27 (18–35) 72 36.1
Albuquerquec [69] 31, 33, 35, 39, 45, 51, 52, 54,
59, pap88, pap238a, papw13B)
HCII 35 14.3
USA, New Mexico, Albuquerque, MY09/11 Cervix—swab Gynecology clinic attendees 38.5 (18–40) 3863 39.2 7.5 2.3
1996–2000 [74]
18–22 910 50.5 39.1 21.6
23–27 1015 44.8 31.6 18.0
28–32 848 33.0 20.6 8.6
33–40 1090 29.4 16.5 10.5
USA, New York, New York, MY09/11 Cervix—smear Clinic-based 15–51 35 22.9
1998–9 [375]
HCII Clinic-based 15–51 35 14.2
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)

USA, North Carolina, No city Type-specific PCR with L1 Cervix—swab Pregnant and postpartum women 22.5 (12–50) 215 78.1 17.7
reported, 1989 [376] primers (6, 11, 16, 18)
Nonpregnant women 26.4 160 25.6 5.6
USA, Oregon, Portland, 1989–90 Type-specific PCR (6/11, 16, 18, Cervicovaginal—lavage Cytologically normal women 34 (16–81) 453 17.7 7.1 10.6 2.6 0.2
[75–80,377] 26, 31, 33, 35, 39, 40, 42, 45, presenting for routine Pap
51, 52, 53, 54, 55, 57, 59, smear

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

pap88, pap155, pap238a,
pap251, pap291, W13B)
16–24 81 32.1
25–29 84 27.4
30–34 71 11.3
35–39 65 10.8
40–44 61 19.7
45–81 91 4.4

USA, Oregon, Portland, 1989–90 HCII Cervicovaginal—lavage Routine Pap smear 34.0b 16 20514 13.9 2.2 0.8
[79,378]
USA, Pennsylvania, Philadelphia, HCI Women undergoing routine care 25.6 (18–70) 93 34.6
1999 [379] or colposcopy
Cervicovaginal—tampon (self- 46 29.0 17.2 3.2
sampled)
Ecto/endocervix—swab 47 25.8 14.0 3.2
(physician-sampled)
USA, South Carolina, No city HCI Cervix—smear Family planning clinic-based 28.1 (16–45) 427 18.5
reported, 1995–8 [380] normal controls
USA, South Carolina, Trident PCR with E6 primers (6, 11, 16, Cervix—spatula, brush Routine smear at family planning 23.5 223 2.7
Health District, 1991 [381] 18, 33) visit
USA, South Carolina, Trident MY09/11 Cervix—spatula, brush Routine family planning clinic 29.3 1083 32.5 23.4 9.2
Health District, 1991–2 [382] visit
USA,Texas, Harris County, Type-specific PCR with L1 Cervix—brush Family planning and screening 26.9 (18) 270 19.3
1991–4 [383,384] primers (16, 18, 31, 33, 45, 51, attendees
52, 56)
USA, Washington; Pennsylvania; MY09/11 Cervicovaginal—swab Random sample of population- 40.9a (18–69) 285 17.2 12.6 4.6
Connecticut, 1992–6 [385,386] based controls
USA, Washington, No city MY09/11 and HMBO1 Endocervix—swab Planned Parenthood clinic sample 25a (18–50) 4075 18.3 3.9 5.3 1.5
reported, 1997–2000 [82]
18–19 21.0a
20–24 22.0a
25–29 18.0a
30–34 12.0a

S25.e12
35–50 5.0a
(Continued )
Table 1

S25.e13
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
USA, Washington, Seattle, 1990– MY09/11 and HMBO1 Cervix and vulvovaginal—swab University-based random sample 19.2 (18–20) 553 19.7
7 [387]
USA, Washington, Seattle, 1990– MY09/11 (6, 11, 16, 18) Ecto/endocervix and University students (18–20) 588 8.2 4.1
8 [388–391] vulvovaginal—swab
USA, Washington, Seattle, 1994– L1 primers Cervix—brush spatula, swab University students 19.2 305 16.0
6 [392]
USA, Washington, DC. 1984–7 PCR, MY09/11, HMBO1, GH20, Cervicovaginal—lavage Women undergoing routine 26 (16–72) 404 33.7

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

[81] and PC04 screening at gynecology clinic
16–24 110 53.6
25–29 57 31.6
30–39 59 22.0
40 37 27.0
USA, Washington, D.C. Metro, HCI and HCII Cervix—smear Outpatient population, women 44 76 9.2 0.0
1998–2001 [393] attending gynecology clinic,
university health clinic, and
indigent patients (cytology
within normal limits)
Asia/Australia
Australia, No city reportedc [90] MY09/11 Tampon (self-sampled) Women in smoking cessation trial 38 (20–60) 197 28.9
Australia, Cook Islands, 1994 Type-specific PCR (16, 18) Cervix—swab Cytologically normal women 27 (17–49) 21 14.3
[91]
Australia, Melbourne, 1992–3 PCR with L1 consensus primers Tampon (self-sampled) Women attending gynecology 27 (18–35) 298 30.9
[87,88] clinic
18–20 27 40.7
21–25 81 37.0
26–30 108 31.5
31–35 74 24.3
Australia, Melbournec [89] PCR with L1 consensus primers Tampon (self-sampled) Virgins and cytologically normal 19.4 (13–44) 67 6.0
women attending outpatient
clinic
China, No city reported, 1992 Type-specific PCR with L1 Cervix—smear Controls undergoing (30–60) 55 5.5
[100] primers (6, 11, 16, 18, 31, 33, hysterectomy for uterine
45) leiomyoma
China, No city reported, 1992 [99] Type-specific PCR with E6 Cervix—smear Histologically normal cervix 42 30 16.7
primers (16)
China, Sichuan and Chengdu, Type-specific PCR (16, 33) Ectocervix—swab Gynecology clinic-based controls 51.7 146 1.4
1987 [92]
China, Dalian City, 1994–5[93] Type-specific PCR (16) Cervix—smear Family planning clinic attendees 29a (24–41) 99 34.1
China, Guangdong and Jiangxi, HCII Cervix—smear Healthy controls in clinical study 36.5 (29–60) 68 25.0
2000–4 [94] of cervical disease patients
China, Shanxi, 1999 [101] HCII Self-collected vaginal swab Rural population 39.1 (35–45) 1997 17
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
HCII Clinician-collected cervical Rural population 39.1 (35–45) 1997 18
sample
China, Hong Kong, 1991–2 [95] MY09/11 (6, 11, 16, 18, 31, 33) Cervix—spatula General gynecology clinic 41.6 (16–81) 170 4.1
China, Hong Kongc [96] MY09/11 Cervix—brush Pregnant women, routine 28.9 (17–44) 308 10.1 5.8 1.0 2.9 0.0
antenatal visit
17–25 78 14.1
26–35 198 8.6

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

36–44 32 9.4
Population-based cervical cancer 29.1 (19–40) 308 11.4 7.8 2.9 2.6 1.6
screening
19–25 78 7.7
26–35 198 14.1
36–40 32 3.1

China, Shenyang, 1993 [97] Type-specific PCR with L1 Cervical secretions Pregnant women hospitalized for 22–36 30 53.3
primers (6, 11, 16, 18, 31, 33, delivery
35, 38)
China, Xiangyuan and HCII Cervix—smear Population-based study 30–50 9683 27.4
Yangcheng Countyc [98]
Xiangyuan 30–34 148 25.0
35–39 2566 26.4
40–44 1892 26.5
45–50 1491 26.0
Yangcheng 30–34 93 23.7
35–59 1536 28.9
40–44 1028 31.3
45–50 929 29.6
India, No city reported, 2001 HPV 16 with E6 and E2 PCR Cervix—spatula Clinic-based controls (24–45) 31 34.1
[102] primers
India, No city reportedc [112] Type-specific PCR (16, 18) Cervix—scrape Normal controls attending (16–80) 201 41.8
reproductive clinic
India, Chennai, 1998–9 [107] GP5þ/6þ Ectocervix—spatula Cancer institute-based controls 34 (16–81) 184 27.7 21.7 6.0 18.5 2.2
Endocervix— brush
India, Dindigul, 2003 [111] GP5þ/6þ Cervix—broom, brush Population-based controls 33.1a (16–59) 1891 16.9 12.5 6.0 3.8 1.0
<25 334 16.8
25–34 847 16.2
35–44 446 18.4
45–54 228 17.1
55 36 16.7
India, Kolkata, 1999–2001 [108] MY09/11 Endocervix— brush Pregnant women 26.5a (20–39) 135 28.1 9.6 5.2
20–29 106 23.6

S25.e14
30–39 29 44.8
(Continued )
Table 1

S25.e15
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
India, Kolkata, 1999–2003 [114] HCII Ecto/endocervix—broom, brush Population-based controls 25–65 17365 5.8
India, Maharastra, 1999–2003 HCII Cervix—brush Healthy women attending primary 39.3 (30–59) 2841 10.3
[109] village healthcare center
India, Manipur, 2001–6 [110] MY09/11 Ectocervix—spatula Women attending free 41.05 (20–80) 692 7.4 1.4 2.0
Endocervix—brush annual cervical screening
and general health
exam

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

<26 41 4.9
26–30 80 6.3
31–35 99 4.0
36–40 156 7.0
41–45 114 5.3
46–50 80 7.5
>50 102 10.8
India, New Delhic [103] Type-specific PCR (16, 18) Cervix—smear Cytologically normal women (40–60) 22 18.2
attending gynecology
department
India, New Delhic [104] Type-specific PCR (6, 11, 16, 18) Cervix—scrape Healthy pregnant antenatal 29 (25–40) 200 32.5 10.5
clinic attendees and
nonpregnant women
India, New Delhi c [105] Type-specific PCR (16) Cervix—swab Hospital-outpatient 28 (15–44) 30 13.3
sample
India, New Delhic [106] Type-specific PCR with L1 Urine Self-reported virgin university 21.5a (18–25) 100 6.0 4.0 0.0
primers (11, 16, 18) students
Cervix—scrape Healthy age-matched married 26.5a b (18–35) 104 10.6 6.7 0.0
women
India, Sikkim, 2002–5 [110] MY09/11 Ectocervix— spatula Population-based sample 36.36 (19–75) 415 12.5 5.1 0.2
Endocervix— brush
<26 50 8.0
26–30 72 8.3
31–35 74 17.6
36–40 68 8.8
41–45 54 12.9
46–50 27 7.4
>50 14 14.3
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)

India, Vellore, 2001–3 [113] MY09/11 Cervix—biopsy Women undergoing hysterectomy 45.3 (37–62) 30 0.0
not
associated with
HPV
India, West Bengal, MY09/11 Endocervix—brush Women attending gynecology 30.67 (14–80) 1112 13.0 8.5 0.9
1999–2002 [110] Ectocervix—spatula clinics for routine contraception

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

and reproductive healthcare
<26 429 13.5
26–30 216 9.7
31–35 154 11.0
36–40 88 7.9
41–45 51 13.7
46–50 32 15.6
>50 37 5.4
Japan, No city reported, 1995–6 L1C1/L1C2 Cervix—smear Controls with normal cytology 40.7 130 14.6 1.5 3.1 0.8 0.8
[129] undergoing Pap test screening
Japan, Multiple cities, 2000–1 L1C1/L1C2 Cervix—smear Pregnant women—cooperative 30.0a (19–40) 1183 12.5 1.3 0.5
[130] study group
~19–24 124 22.6
25–29 429 12.4
30–34 432 11.6
35–39 173 7.5
~40 25 16.0
Japan, No city reported, 1985–92 Type-specific PCR (6/11, 16, 18, Cervix—biopsy Cytologically normal women with 46.8a 30 10.0 0.0 0.0
[115] 33, 52b, 58) myoma of the uterus
Japan, Akita, 1992–2000 [116] Type-specific PCR with L1 Ectocervix—swab Women with normal cytology 43.5 (20–81) 132 12.1
primers (16) attending gynecology clinic for
routine screening
Japan, Akita, 1995 [117] Type-specific PCR (16) Cervix—swab Cytologically normal women 33.5 (24–42) 192 5.2
undergoing in vitro fertilization

Japan, Chiba, 1998–2003 [131] HCII Cervix—swab Hospital-based population 35 (17–73) 420 12.1 10.2 2.9
<19 15 46.7 33.3 26.7
20–29 115 21.7 19.1 4.3
30–39 101 9.9 7.9 1.9
40–49 108 1.9 1.9 0
50–59 62 11.3 9.7 1.6
60–69 14 0 0 0
>70 5 0 0 0
Japan, Hokuriku, 1995–9 [118] PCR with E7 primers (11, 16, 18, Cervix—smear Routine cervical cancer screening 16–72 1562 9.7

S25.e16
31, 51, 56, 58, 72, 72)
(Continued )
Table 1

S25.e17
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Japan, Hokkaido, 1990 [119] Type-specific PCR (16, Cervix—swab Cytologically normal obstetrics/ 38.5 (18–73) 83 6.0
18, 33) gynecology department
attendees
Japan, Ishikawa, 1998–2002 Type-specific PCR (16, 18, 31, Ecto/endocervix—brush Cytologically normal women 31 120 44.2
[120] 45) visiting outpatient gynecology
clinic
17–23 29 48

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

24–29 31 45
30–39 40 40
>39 20 45
Japan, Ishikawa and Toyama, pu-1M/pu-2R and pU31BM (6, Cervix—brush Population-based random sample 40.8a (16–82) 901 14.8 6.4 1.3
1995–6 [121] 11, 16, 18, 31, 33, 35, 52, 58)
16–24 113 11.5
25–34 289 12.5
35–44 167 16.2
45–54 177 14.7
55–82 155 20.0
Japan, Kanagawa, 1981–97 [122] Type-specific PCR (16, 18) Cervix—biopsy Cytologically normal cervical 46.3a (23–72) 24 0.0
tissue
Japan, Okinawa, 1993–2000 L1C1/L1C2 Cervix—swab Hospital-based controls and 52.4 (18–85) 3249 10.2 0.5 0.2
[123] population-based cervical
cancer screening
18–29 5.1
30–39 14.2
40–49 20
50–59 25.9
60–69 25.6
70–79 8.9
80–85 0.4
Japan, Okinawa, 1994–7 [124] PCR with L1 primers 6, 11, 16, Cervix—swab Population-based cervical cancer 17–85 4089 10.7 0.3 0.0
18, 31, 33, 52, 58) screening and women
attending the obstetrics/
gynecology department for
various complaints
17–29 286 20.6 1.0 0.0
30–39 564 9.0 0.0 0.0
40–49 802 9.1 0.2 0.0
50–59 1039 10.0 0.2 0.1
60–69 1029 10.9 0.3 0.1
70–85 372 10.2 0.3 0.0
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Japan, Okinawa Islands, 2001 Type-specific PCR with L1 Cervix—scrape Routine cervical cancer screening 30–85 3963 10.0 0.3 0.1
[125] primers (6, 11, 16, 18, 31, 35,
52, 58)
Yonashiro 591 9.3 0.3 0.2
30–39 9a
40–49 10.0a
50–59 9.8a

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

60–69 9.5a
70–85 5.9a
Naha 1225 10.1 0.2 0.0
30–39 11.5a
40–49 9.2a
50–59 9.5a
60–69 10a
70–85 11.8a
Hirara 2147 10.2 0.4 0.0
30–39 8.2a
40–49 9.0a
50–59 11.0a
60–69 11.5a
70–85 11.5a

Japan, Osaka, 1989–92 [126] PCR with E6 primers Cervix—smear Hospital clinic attendees 40.9 (18–72) 800 6.6
(16, 18)
18–29 142 5.6
30–39 182 7.7
40–49 308 7.5
50–59 111 6.3
60–72 57 1.8
Japan, Tokyo, 1997–2002 [127] Type-specific PCR (6, 11, 16, Cervix—smear Autopsy subjects without 82.7 (60–105) 335 2.7 2.1 0.6
18, 31, 33, 35, cervical
52b, 58) cancer
60–69 25 0.0 0.0 0.0
70–79 104 3.8 3.8 0.0
80–89 133 2.3 0.8 1.5
90–105 73 2.7 2.7 0.0
Japan, Urayasu and Ichikawa MY09/11 and GP5þ/6þ Cervix—swab Histologically normal women 41.5 (17–73) 56 32.1
City, 1997–8 [128] with previous abnormal
smear or routine
screening
(Continued )

S25.e18
Table 1

S25.e19
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Philippines, Manila, 1991–3 GP5þ/6þ Cervix—brush Hospital-based controls 46.8 381 9.2 1.3 1.3
[139]
South Korea, Bundang, 2001–2 GP5þ/6þ Cervix—swab Hospital-based population 30–54 1143 35.1 2.4 16.1
[138]
South Korea, Busan, 1999–2000 Type-specific PCR and GP5þ/6þ Ecto/endocervix—brush Population-based random sample 38.1a (15þ) 863 10.4 6.3 4.2 0.8 0.1
[136]
15–34 156 14.1

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

35–44 278 9.0
45–54 235 11.1
55–59 94 13.8
60 100 4.0
South Korea, Busan, 2002 [137] Type-specific PCR of 25 types Cervix—swab (self-sampled) University students 19 (16–29) 672 15.2 12.5 5.7 1.3 1.2
16–17 108 13.0
18–19 355 14.4
20–21 148 14.2
22–29 61 26.2
South Korea, Seoul, 1996 [135] Type-specific PCR (16, 18, 31, Cervix—brush Annual health check-up, health 23–72 1305 4.1 2.5 0.4
33) clinic sample
21–40 278 6.1
41–50 831 3.1
51–60 175 3.4
61–72 21 19.0
South Korea, Seoul, 1992–5 [132] GP5þ/6þ Cervix—swab Hospital-based population of 49.4a 746 7.2
cytologically normal women
South Korea, Seoul, 1996 [133] Type-specific PCR (16, 18, 33) Cervix—scrape Cytologically normal women 46 (25–65) 87 10.3
admitted to gynecology
department
South Korea, Seoul and GP5þ/6þ Cervicovaginal—swab Outpatient clinic sample 45.5 213 32.4 25.4 4.2
Sungnam City, 2000
[134]
Taiwan, No city reported, 1991–2 MY09/11 Cervix—swab Cytologically normal controls 43 (30–64) 260 9.2 0.8 4.2
[145] from community-based
screening
Taiwan, Northern Taiwan, 1997– HCII Community-based population of 51.3 1194
9 [143] handicapped women living in
rural areas, or elderly women
Vagina—swab (self-sampled) 12.1
Cervix—spatula, brush 13.0
(physician-sampled)
Taiwan, Kaohsiung County, HCII and GP5þ/6þ Cervix—brush, swab Population-based age-matched 44.9a 20 175 16.6 10.9 2.9
2003–4 [142] control
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Taiwan, Taichung and Changhua MY09/11 and type-specific PCR Cervix—scrape Women with normal cervical 39 (21–56) 29 0.0
City, 1997–2001 [140] (6, 11, 16, 18, 31, 33, 35, 45, scrapings, controls
58)
Taiwan, Taipeic [144] Type-specific PCR (6, 11, 16, 18, Cervix—smear Cytologically normal family 28.7 22 14.0 9.3 4.7
33) planning clinic attendees
Taiwan, Taipei, 1994–5 [141] Type-specific PCR (16, 18) Cervix—spatula Pregnant women 27.9 301 22.6 17.6 1.3
Thailand, Bangkok, 1991–3[146] MY09/11 Cervix—swab Hospital-based controls 43 291 6.9 2.1 0.0

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

Thailand, Bangkok, 1995–6[147] MY09/11 Cervix—biopsy Outpatient clinic attendees with 43.9, 44.5b 50 6.0
chronic cervicitis and normal
histology
Thailand, Bangkok, 1995–8 [148] MY09/11 and type-specific PCR Cervix—biopsy Obstetrics and gynecological 44.1 (20–75) 147 2.7
(6, 11, 16, 18, 33) outpatient clinic
Thailand, Bangkok, 1997 [149] MY09/11 and type-specific PCR Cervicovaginal—lavage Women with normal cytology 32 (16–59) 102 4.9 1.0 1.0
(6, 11, 16, 18, 31, 33, 35) attending cervical cancer
screening
Thailand, Hat-Yai and Songkla, GP5þ/6þ Ectocervix—spatula Hospital-based controls 49.7 261 15.7 4.6 2.7
1990–3 [150] Endocervix—brush
Thailand, Kaoka District, 1997–8 GP5þ/6þ Ectocervix—spatula Population-based random sample 46.2a 1741 6.3 4.4 1.9 0.5 0.4
[151] Endocervix—brush
<25 198 10.6
25–34 293 9.2
35–44 301 5.0
45–54 300 6.0
55–64 335 4.5
65 314 4.5
Thailand, Khon Kaen, 1990–2001 GP5þ/6þ Cervix—spatula Controls within a cohort study of 54.5 (35) 113 10.6 8.0 5.3
[153] diet and lifestyle
Thailand, Khon Kaen, 1994–5 Type-specific PCR (6, 11, 16, 18, Cervix—scrape Asymptomatic women visiting an 34.8a 260 23.1 3.1 3.8
[152] 33) obstetrics and gynecological
outpatient clinic
<30 76 31.6
30–39 115 19.1
40 69 20.3
Thailand, Khon Kaen, 2002–4 RFLP Cervix—smear Clinic-based controls 25–60 105 18.1 3.8 11.4
[154]
Thailand; Philippines; Spain, GP5þ/6þ Ectocervix—scrape Cytologically normal women
1995–6 [155]
Thailand 49 115 12.2
Philippines 48 115 3.5
Spain 49 99 3.0
Vietnam, 1997 [156] GP5þ/6þ Ectocervix—spatula

S25.e20
Endocervix—brush
(Continued )
Table 1

S25.e21
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Ho Chi Minh City Family-planning clinic sample 41 922 11.0 3.3 1.2
<25 157 22.3
25–34 174 10.9
35–44 185 7.6
45–54 154 7.1
55–64 167 8.4
65 85 9.4

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

Hanoi Population-based sample 45 994 2.0 0.2 0.2
<25 123 1.6
25–34 182 2.7
35–44 184 3.3
45–54 164 2.4
55–64 213 1.4
65 128 0.0

Europe/Middle East
Austria, Vienna, 1997–8 [157] HCII Cervix—swab Pregnant women undergoing 29.5 (15.3–46.2) 179 24.6 20.7 10.1
chorionic villus sampling
15–25 46 39.1
26–30 59 22.0
31–35 42 16.7
35–46 32 18.8
Belgium, No city reported, 1993 MY09/11 and GP1/2 Cervix—brush Gynecological outpatient 34.2 (19–43) 200 4.0 1.5 0.5
[164] population
Belgium, Antwerp, 2000 [158] GP5þ/6þ and type-specific PCR Cervix—brush Routine cervical cancer screening 39.4 (17–78) 286 10.8 2.8 1.4
(6, 11, 16, 18, 31, 33)
Belgium, Antwerp, 2001–2[159] GP5þ/6þ Cervix—smear Women undergoing routine 58.4a 1907 4.1 1.5 0.5
screening
50–54 701 5a
55–59 492 3.2a
60–64 321 3.5a
65–69 171 4.2a
70 222 4.5a
Belgium, Brusselsc [160,161] PCR (16, 18, 33) Cervix—scrape Routine cervical cancer screening 36 (20–70) 323 14.2 5.0 1.9
20–30 15.0a
31–40 13.0a
41–50 8.5a
51–60 10.0a
61–70 0.8a
Belgium, Flanders, 2000–1[162] MY09/11 Cervix—brush Population-based sample 40.1 (17–85) 287 24.0 4.2 1.7
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Belgium, Flanders, 2000– MY09/11 Cervix—brush Women with normal cytology 39.6 (17–85) 581 26.7 17.9
2[139,163] referred after routine exam or
screening
Belgium, Wilrijk, 2001–3 [394] GP5þ/6þ Cervix—smear Routine cervical cancer screening 35.8 2293 6.9 2.1 0.8
20–24 314 8.9
25–29 396 9.1
30–34 411 9.2

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

35–39 361 4.7
40–44 343 4.7
45–50 468 4.9
Czech Republic, No city reportedc MY09/11 Cervix—brush Cytologically normal gynecology 32.4 (20–77) 165 23.0 10.3 1.2
[165] clinic attendees
Czech Republic, Prague, 1975–83 MY09/11 and GP5þ/6þ Cervix—spatula Healthy controls from 31.3a 208 5.3
[25] observational study
Controls for cervical neoplasia 35 147 4.8
cases
Controls for borderline or normal 34 108 3.7
cases
Denmark, Copenhagen, 1991–3 GP5þ/6þ Ecto/endocervix—brush Population-based cohort 25 (20–29) 956 15.4 11.3 4.6
[167–170]
20–23 288 19.4
24–36 311 14.1
27–29 357 13.1
Denmark, Skejby, 1997–8 [166] Type-specific PCR (16) Cervix—brush Controls presenting for legal 37 (21–64) 61 33.3
abortion, hysterectomy, or
screening for cervical disease
Egypt, Ain Shams, 1997–9[272] Type-specific PCR (16) Cervix—biopsy Controls undergoing 48 (36–72) 20 25.0
hysterectomy for nonmalignant
conditions
Finland, Helsinki, 2001–3 [182] HCII Vaginal swab—self-collected First year university students 22.7 (19–47) 919 33.7 29.5
<19 68 23.5
20–24 671 33.5
25–29 128 41.4
30–34 24 37.5
35–40 28 25.0
Asymptomatic university students 24.8 (19–40) 550 31.8 25.1
<19–24 312 34.3
25–29 217 27.2
30–40 21 42.9
Finland, Kuopio, 1981 [181] MY09/11 Cervix—brush Pregnant women at delivery 29.2 (18.5–40.5) 105 19.0
(Continued )

S25.e22
Table 1

S25.e23
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Finland, Turku, 1998–2000 MY09/11 and GP5þ/6þ Cervix—brush Third trimester pregnant women 25 (18–35) 76 16a
[183,395]
France, No city reported, 1999– HCII Cervix—brush Women attending screening at 34.5 1785 30.1 22.6 3.2
2000 [195] gynecology clinic
France, Amiens, 2000–1 [184] HCII Cervix—brush Women undergoing routine 38.9 (20–62) 3832 14.3
screening
20–24 513 16.6

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

25–29 610 18.9
30–34 570 13.5
35–39 585 15.6
40–44 627 14.0
45–49 611 12.5
50–54 508 13.4
55–59 263 8.2
60–64 94 8.0
France, Besancon, 1997–8 [186] MY09/11 Cervicovaginal—brush Routine cervical cancer screening 35 (16–76) 596 37.8
and 103 patients from
colposcopy clinic
HCII Routine cervical cancer screening 35 (16–76) 466 22.7 17.8
16–24 49 28.6 20.4
25–34 173 25.4 21.9
35–44 159 23.3 17.6
45–76 85 12.9 8.2
France, Besancon, 1997–2002 HCII Endocervix—brush Hospital-based cohort of normal 35.7 (16–76) 781 33.0
[185] women
16–19 22 63.6
20–29 189 51.9
30–39 301 27.9
40–49 192 25.5
50–76 77 16.9
France, Besancon, 1998–9 [187] MY09/11 Endocervix—brush Cytologically normal Caucasian 35 (16–76) 50 24.0 20.0
women visiting department of
obstetrics and gynecology
France, Paris, 1993 [188] Type-specific PCR (16) Cervix—scrape Cytologically normal women 38.45 120 4.2 0.0
France, Poitiers, 2001–4 [189] MY09/11 Cervix—brush Women presenting for routine 44 (17–77) 657 8.2 5.3 2.4 1.8 0.9
health exam
17–24 88 18.2
25–44 262 9.2
45–77 307 2.6
France, Reims, 1996–7 [191] HCII Cervix—scrape, brush, spatula Women undergoing routine 36.1 (14–68) 1028 10.5 8.8 1.8
screening
14–20 50 12.0 12.0 0.0
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
20–29 270 17.8 15.6 2.2
30–39 310 10.3 8.4 1.9
40–49 261 6.5 4.2 2.3
50–59 102 4.9 3.9 1.0
60–68 35 2.9 2.9 0.0
France, Reims, 1997–9 [193] HCII Cervix—brush Women attending for routine 36 (15–85) 2778 20.4 15.6 4.8
cervical cancer screening

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

15–20 218 23.9 20.2 3.7
21–30 958 28.0 23.8 4.2
31–40 1094 19.8 14.7 5.1
41–50 855 16.0 10.9 5.1
51–60 414 14.5 9.4 5.1
61–85 239 15.5 10.9 4.6
France, Reims, 1997–2001 [190] HCII Cervix—brush Women attending routine 34 (15–76) 7932 15.3 15.3
screening clinics
15–20 418 20.1
21–30 1843 23.6
31–40 2076 13.9
41–50 1925 12.2
51–60 1014 10.8
61–76 656 9.3
France, Reims, 1997–2002[192] HCII Cervix—brush Women undergoing routine 39 (17–77) 3091 21.3
screening (cytology within
normal limits)
France, Strasburg, 1992[194] Type-specific PCR (6, 11, 16, 18) Cervix—biopsy Women receiving contraception 27.1 22 9.1
counseling
Germany, No city reported, 1991– MY09/11 Cervix—swab Routine cancer screening 39.5 65 24.6
2 [196] programs
Pregnancy care unit 29.3 36 19.4
Germany, No city reported, 1992– HCI Cervix—smear Routine screening at gynecology 36.2 (15–72) 967 18.5
3 [201] clinic
15–34 444 25.2
35–72 523 12.8
Germany, No city reported, 1998 GP5þ/6þ Cervix—brush Cytologically normal women 32 (22–45) 294 7.8
[202] entering an in vitro fertilzation
program
Germany, Bonn-Region, 2002 MY09/11 and GP5þ/6þ Ecto/endocervix—swab or Routine cervical cancer screening 36b (17–81) 1393 30.0
[197] spatula
Germany, East Thuringia, 1996–8 GP5þ/6þ Ecto/endocervix—swab, brush Routine cervical cancer screening 35 (18–70) 4671 7.8
[198]
18–25 916 14.0a

S25.e24
26–30 697 9.5a
(Continued )
Table 1

S25.e25
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
31–35 881 7.5a
36–40 776 6.0a
41–45 574 6.5a
46–50 350 4.5a
51–55 272 3.0a
56–60 179 2.0a
61–65 80 0.0a

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

66–70 36 0.0a
Germany, Hannover and HCII Cervix—swab Routine cervical cancer screening 42.7 (30) 8083 6.4
Tuebingen, 1998–2000 [199]
Germany, West Rhine, 2004 MY09/11 and GP5þ/6þ Cervix—brush Population-based sample 40.5 (17–83) 2916 32.5 26.2 5.3
[200]
Greece, Northern Region, 2000–1 MY09/11 Cervix—spatula, cytobrush Women attending clinics for 43 (17–67) 1296 2.9
[203,204] yearly gynecological exam
17–29 101 12.9
30–40 459 2.6
41–67 736 1.6
Greece, Northern Region, 2000–1 MY09/11 Endocervix—cytobrush Outpatient gynecology clinic— 44 (17–65) 379 6.0
[205] Vagina—cytobrush routine screening
Greece, Ioannina, 1997–9 [206] MY09/11 Ectocervix—spatula Outpatient obstetrics and 38 (17–79) 1000 23.8 6.7 1.3
Endocervix—brush gynecologic clinic; no history of
cervical disease
Greece, Thessaloniki, 1992 Type-specific PCR (16, 18) Ecto/endocervix—brush Women attending outpatient (20–55) 226 36.3 6.6 1.3
[207,208] gynecology clinic for routine
smear
20–34 45.3
35–50 25.3
50–55 43.3
Greenland; Denmark, 1988 [171] Cpl/CPIIG (16, 18, 31, 33, 58) Endocervix—spatula, brush Population-based sample (20–39)
Greenland 28.9a (20–39) 118 33.1 21.2 2.5
20–24 39 46.2
25–29 34 32.0
30–39 45 22.0
Denmark 30.2a (20–39) 119 22.7 8.4 2.5
20–24 29 31.0
25–29 24 29.2
30–39 66 15.2
Greenland; Denmark, 1993 [172] Type-specific PCR with E6/E7 Cervix—brush, swab Population registry
primers (11, 16, 18, 33)
Greenland 28.0a 129 43.4
Denmark 31.9a 126 38.9
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Hungary, No city reported, 1998– HCII Cervix—smear Outpatient clinic attendees— 31.1b (20–60) 464 4.3 3.0 1.3
2002 [212] healthy women
20–24 104 7.7
25–29 104 4.8
30–34 77 2.6
35–39 43 4.7
40–44 56 1.8

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

45–49 44 2.3
>50 36 2.8
Hungary, Budapest, 1999 [209] HCI Cervix—swab Routine cytology screening 31.9a 1100 17.5
Hungary, Debrecenc [211] PCR with E6 and E7 primers (16) Ecto/endocervix—swab Cytologically normal family 37 102 8.8
planning attendees
Hungary, Debrecenc [213] PCR with L1 primers (6, 11, 16, Ecto/endocervix—brush Cytologically normal women 28.4 (17–51) 163 21.5 3.7 1.8
18, 31, 33, 52, 58) attending gynecology clinic
17–24 66 34.8
25–32 47 14.9
33–51 50 10.0
Hungary, Debrecenc [210] L1 primers (6, 11, 16, 1,8, 31, 33, Ecto/endocervix—brush Cytologically normal first tri- 23.9 (18–37) 39 17.9
52, 58) mester pregnant women
Italy, No city reported, 1990–1 Type-specific PCR with L1 Cervix—scrape Cytologically normal women 19–65 124 8.9
[221] primers (16)
Italy, Multicenter, 1997–9 [225] MY09/11 Cervix—smear, spatula HIV negative women; 32.5 (21–48) 48 27.1 29.2 16.7
Endocervix—brush DIANAIDS project
Italy, No city reported, 2001 [224] MY09/11 Ecto/endocervix—swab Women presenting for routine Pap 39 (22–74) 94 21.3
smear
Italy, Ancona, 1994 [214] PCR with L1 primers Ecto/endocervix Clinic-based controls 32.9a (22–41) 473 7.2
Italy, Genova, 1992–3 [215] MY09/11 Cervix—swab Routine cytological screening 51 (20–81) 503 15.9 9.1 5.8
44 119 15.1 6.7 3.4
45–52 120 17.5 8.3 9.2
53–59 122 11.5 9.0 8.2
60 142 19.0 12.0 7.0
Italy, Milan, 1995–7 [217] MY09/11 Cervicovaginal—swab Primary cervical cancer screening 35 (25–64) 100 48.0
Italy, Padua, 1997–9 [218] MY09/11 Cervix—brush Routine cytology screening 31 (19–74) 106 6.6 8.8 7.1 1.7 2.6
Italy, Pavia, 1997 [223] MY09/11 Cervicovaginal—lavage Pregnant women 30 (16–43) 751 5.5 0.9
Italy, Rome, 1996 [216] Type-specific PCR (16, 18) Cervix—spatula Cytologically normal women 37.7 (17–70) 143 11.9 2.1
attending routine
gynecological exam
17–25 48 22.9 2.1
26–35 30 10.0 3.3
36–50 32 6.3 3.1
51–70 33 3.0 0.0

S25.e26
Italy, Rome, 1998 [219] MY09/11 Cervix—spatula, swab Routine cytology screening 34 (21–48) 24 33.3
(Continued )
Table 1

S25.e27
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Italy, Turin, 2002 [220] GP5þ/6þ Cervix—brush Population-based sample (25–64) 1013 8.8 7.1 1.7 2.6 0.1
25–29 115 13.0 11.5a 1.8a
30–34 110 13.6 12.5a 1.0a
35–39 115 13.9 11.5a 2.8a
40–44 113 11.5 8.0a 3.5a
45–49 114 5.3 3.5a 1.8a
50–54 115 6.1 4.5a 1.8a

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

55–59 114 7.9 6.0a 1.8a
60–64 115 2.6 1.8a 1.0a
65–70 102 4.9 4.9a 0.0a
Italy, Udine, 1994–5 [222] MY09/11 Cervicovaginal—lavage Cytologically normal women 37.7 (18–67)c 197 20.3 5.1
attending clinical department
Latvia, Riga, 1998–2001 [226] Type-specific PCR with L1, E6, Cervix—brush Population-based controls 50.8 (18–89) 236 5.1 3.8
and E7 primers
40 75 17
41–50 42 4.7
51–60 43 2.3
>60 76 3.9
Lebanon, Beirut, 2002 [273] MY09/11 and GP5þ/6þ Ectocervix—spatula Routine gynecological exam 41.2a (18–79) 1026 4.9 3.0
Endocervix—brush, swab
18–29 4.0a
30–39 3.8a
40–49 6.5a
50–59 4.0a
60–69 10.0a
70–79 0.0a
The Netherlands, Amstelveenc GP5þ/6þ and type-specific PCR Cervix—scrape, brush Routine cervical cancer screening 35–55 1346 3.5 0.4 0.5
[396]
The Netherlands, Amstelveen, Type-specific PCR (6, 11, 16, 18, Cervix—brush Cytologically normal 15–34 156 14.1 3.8
1992 [229] 31, 33) and GP5þ/6þ gynecological check-up
15–24 29 25.0a
25–29 66 14.0a
30–34 61 10.0a
Population-based cervical cancer 35–54 1555 4.1 0.9
screening
35–39 536 4.0a
40–44 387 5.0a
45–49 246 6.0a
50–54 386 3.0a
Outpatient clinic attendees for 15–34 2320 13.9 3.3
contraception/ gynecological
complaints
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
15–19 169 17.0a
20–24 486 22.0a
25–29 775 14.0a
30–34 890 11.0a
Outpatient clinic attendees for 35–54 1826 6.6 1.5
contraception/ gynecological
complaints

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

35–39 734 7.0a
40–44 538 8.0a
45–49 356 7.0a
50–54 198 6.0a
The Netherlands, Amsterdam, GP5þ/6þ Cervix—brush Routine cervical cancer screening 42 (34–54) 1622 6.0 4.6 0.7 1.8 0.9
1988–91 [397,398] in a population-based sample
The Netherlands, Amsterdam, Type-specific PCR (6, 11, 16, 18, Cervix—brush Pregnant women 29.3a 709 9.6 3.1
1994 [227] 31, 33) and GP5þ/6þ
15–19 33 18.2
20–24 136 14.0
25–29 188 9.0
30–34 222 6.8
35–39 99 10.1
40–49 31 3.2
Nonpregnant women 33.1a 3948 10.9 2.9
15–19 169 17.2
20–24 486 20.8
25–29 775 13.7
30–34 890 9.7
35–39 734 6.8
40–49 894 6.7
The Netherlands, Amsterdam, GP5þ/6þ Cervix—brush Routine cervical cancer screening 46.1a (15–69) 3305 4.6 3.0 0.7 0.9 0.5
1995–8 [228] program
15–24 26 19.2 12.5a 0.0 7.7 0.0
25–29 46 23.9 15.0a 8.0a 0.0 2.2
30–34 389 13.6 9.0a 0.5a 2.8 1.0
35–39 316 7.0 2.5a 2.4a 1.6 0.3
40–44 679 3.8 2.4a 0.2a 0.1 0.4
45–49 708 6.1 3.0a 1.3a 1.3 0.8
50–54 431 3.7 2.0a 1.0a 0.0 0.0
55–59 488 3.3 1.5a 1.0a 0.0 0.2
60–69 222 3.2 2.2a 0.5a 1.4 0.0
The Netherlands, Amsterdam, GP5þ/6þ Cervix—brush Population-based cervical cancer 42.8 (29–61) 21245 3.6
1999–2002 [399] screening

S25.e28
29–33 246 8.3
(Continued )
Table 1

S25.e29
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
59–61 38 2

The Netherlands, Utrecht, 1976– PCR with L1 primers Cervix—smear Population-based controls 38.6 (35–54) 270 11.5 8.5 3.0 1.1
84 [230]
The Netherlands, Zeeland, 1976– GP5þ/6þ Cervix—smear Population-based cervical cancer 43 (34–54) 104 6.7 1.8 1.8
96 [231] screening

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

Norway, Oslo, 1991–2[232–235] PCR (6, 11, 16, 18, 31, 33) Cervix—brush Population-based controls 32.8, 32b (20– 222 17.1 7.7
44)
20–29 77 24.7 11.7
30–34 68 14.7 7.4
35–39 48 10.4 6.3
40–44 29 13.8 0.0
Norway, Oslo, 2001 [236] GP5þ/6þ (16, 18, 31, 33, 45) Cervix—smear, brush Outpatient population-based 48.9 (30–91) 4136 10.4 1.3 0.8
screening study
30–39 1023 15.3
40–49 1211 9.4
50–59 1208 8.2
>60 694 8.7

Norway, Trondheim, 1992 [237] GP5þ/6þ and Cpl/CPIIG Cervix—smear Archived, normal cervical smears 33 (21–67) 48 16.7
Poland, Gdansk, 2001 [238] PCR with L1 primers (6, 11, 16, Cervix—scrape, swab Healthy women undergoing 58a (28–82) 229 1.7 0.4
18, 31, 33) routine gynecological exam
Poland, Krakow, 2001 [239] HCII Cervix—smear Population-based, pregnant 18–37 145 13.1
women
Population-based, nonpregnant 18–37 145 9.7
women—screening for
cervical cancer
Poland, Krakow, 2006 [240] SPF10 Cervix—brush Healthy controls undergoing 28 (23–33) 42 21.4
preventative exam before
planned pregnancy
Poland, Poznan, 2002 [241] Type-specific PCR (2, 5, 6, 8, 11, Cervix—brush Cervical cancer screening (45–78) 90 48.9 33.3 22.2
13, 16, 18, 26, 27, 30, 31, 32, gynecology clinic
33, 35, 39, 40, 41, 42, 43)
45–49 41 58.5 39.0 26.8
50–55 26 53.8 30.8 19.2
56–78 23 26.1 26.1 17.4
Poland, Warsaw, 2000–02 [242] Type-specific PCR (6, 11, 16) Vaginal discharge Pregnant women with and without 28a (18–38) 45 26.7 20.0 11.1
insulin-dependent diabetes
mellitus
Russia, Latvia and Belarus, 1998– HCII Cervix—smear Women attending gynecology 37.5a (15–60) 448 46.7
2002 [245] clinics or STI clinics for
cervical screening
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Russia, St. Petersburg, MY09/11 Cervix—swab Healthy attendants at gynecology 30.2 (15–45) 309 29.1 6.6 1.6
1999[243,244] practice
15–20 29 31.0
21–25 64 37.5
26–30 67 28.4
31–35 59 27.1
36–40 46 26.1

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

41–45 44 22.7

Spain, Alava, Girona, Guipuzcoa, Type-specific PCR (6, 11, 16, 18, Cervix—scrape Population-based controls 36.1 (18–68) 193 4.7 0.5 0.0
Murcia, Navarra, Salamanca, 31, 33, 35)
Sevilla, Vizcaya, Zaragoza,
1985–8 [4,155,334–340]
Spain, Barcelona, 1992 [247] Type-specific PCR (16, 18) Cervicovaginal—spatula Cytologically normal controls 29 (16–40) 64 10.9
Spain, Barcelona, 1998–2000 GP5þ/6þ Random sample (population- 43 (14–75) 973 3.0 2.2 0.5 0.6
[248] based sample)
14–24 174 7.0a
25–34 147 2.8a
35–44 175 3.0a
45–54 177 1.0a
55–64 175 1.8a
54–75 125 2.2a
Spain, Basque Region, 1991 Type-specific PCR (6, 11, 16, 18) Cervix—spatula Cytologically normal women 34 (16–82) 75 11.0
[249] attending family planning
clinic
Spain, Basque Region, 1994[250] Type-specific PCR (16) Cervix—spatula Women undergoing routine smear 32 (18–57) 38 42.1
Sweden, No city reported, 1993 Type-specific PCR (6, 11, 16, 18, Ectocervix—brush Women attending routine (20–29) 230 13.0 6.1 1.7
[266] 31, 33, 35) screening
Sweden; Finland; Holland, 1994 GP5þ/6þ and type-specific PCR Cervix—brush, spatula Cytologically normal women 28 (18–35) 366 10.9
[268] (6, 11, 16, 18, 31, 33) participating in a clinical trial
for a contraceptive device
Sweden, Nationwide, 2001[267] GP5þ/6þ Cervix—brush Population-based cervical 32–38 6123 6.8 2.1 0.6
screening program
Sweden, Karlstad, 1989–90[251] MY09/11 and type-specific PCR Cervix—brush Upper secondary school students 16.3 (15–17) 52 11.5
(6, 11, 16, 18, 31, 33)
Sweden, Malmo, 1992 [252] Type-specific PCR (6, 11, 16, 18, Cervix—brush Controls with normal cytology 25.1 (17–39) 30 10.0 3.3
31, 33) presenting for contraceptive
counseling
Sweden, Stockholm and MY09/11 and Cpl/CPIIG Cervix—smear Population-based cervical cancer 44 (20–74) 118 2.5
Vasterbotten, 1969–95 [254] screening
(Continued )

S25.e30
Table 1

S25.e31
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
Sweden, Stockholm and Uppsala, MY09/11 Cervix—swab Virgins attending adolescent and 18 (10–25) 130 1.5
1994 [253] primary healthcare clinic
Sweden, Stockholm, 1994 [255] MY09/11 and type-specific PCR Cervix—brush Population-based gynecologic 25 478 13.4 3.1 1.5
health screening
30 15.7
31–40 2.2a
41 11.1

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

Sweden, Umea, 1989[256,257] MY09/11 Cervix—swab Population-based study 22.5 (19–25) 581 20.3 12.2 3.8
19 55 20.0
21 139 17.3
23 205 19.0
25 127 33.1
Sweden, Umea, 1991 [258] Type-specific PCR (16) Ecto/endocervix and vagina— Women attending outpatient care 40 (17–42) 99 21.2
smear for gynecologic disorder or
regular check-up
Sweden, Uppsala, 1969–95[259– Type-specific PCR (16, 18) Cervix—smear Population-based screening 35 (20–70) 617 5.8
261]
<25 236 6.4
25–29 178 5.6
30 203 5.4
Sweden, Uppsala, 1997–9 [400] GP5þ/6þ (16, 18, 31, 33) Cervix—smear Routine gynecological screening (25–59) 197 9.1

Sweden, Uppsala, 2007 [262] GP5þ/6þ andHCII Self-sampled vaginal smear Healthy women who have not 40.8a (35–50) 369 25.6
been screened in 6 years
35–42 264 31.3
43–50 105 13.5
Sweden, Vasterbotten, 1993–6 MY09/11 and GP5þ/6þ (11, 16, Cervix—brush Population-based cervical cancer 40 (20–63) 315 7.0
[263,264] 18, 33) screening
Sweden, Wuzburg, 1989–90[265] MY09/11 Cervix—brush Adolescents at healthcare 16.1 (15–17) 89 4.9 2.4
program
Switzerland, Multiple cities, 2005 HCII Cervix—brush Women attending gynecology 44.4 (17–93) 13842 8.2
[269] clinics
16–20 21.0a
21–25 18.0a
26–30 15.0a
31–35 10.0a
36–40 9.0a
41–45 7.0a
46–50 8.0a
51–55 6.0a
56–60 7.0a
61–65 6.0a
(Continued )
Table 1
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
66–70 7.0a
71–75 6.0a
76 10.0a
Switzerland, Genevac [270] HCI Ecto/endocervix—brush Outpatient adolescent clinic; 17.5a (14–20) 134 14.2
sexually active
Turkey, Istanbul, 1996 [274] MY09/11 Cervix—brush Pregnant women 17–36 21 9.5
UK, Multiple cities, 1998– HCII Cervix—brush, spatula Women attending screening 42 (30–60) 10358 7.5

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

2001[271] clinics
30–34 2319 14.5
35–39 2157 8.6
40–44 1931 6.0
45–49 1461 4.4
50–54 1343 3.4
55–60 1147 3.8
UK, England, Birmingham, GP5þ/6þ and MY09/11 Cervix—smear Cytologically normal women at 17.5 (15–19) 1725 14.1
1988–92 [174] baseline screening
UK, England, London, 1987[175] Type-specific PCR (16) Cervix—scrape Women attending cervical cancer 38.4 (18–76) 249 18.9
screening
UK, England, London, 1992–4 Type-specific PCR (16, 18, 31, Cervix—spatula, brush Women attending center for 29 (20–45) 1904 4.5 1.6 0.8
[176,178] 33) routine smear
<24 372 10.4a
25–29 644 10.3a
30–34 477 5.0a
35–39 247 6.0a
40–44 132 1.8a
45–49 71 3.0a
50 25 0.0a
UK, England, London, 1999[177] MY09/11 Cervix—spatula Routine cervical cancer screening 46 (35) 2988 6.0 0.7 0.2
34–39 7.8a
40–44 5.5a
45–49 4.5a
50–54 5.3a
55–59 6.5a
60–64 7.5a
UK, England, Manchester, 1988– MY09/11 Cervix—spatula Routine cervical cancer screening 15–69 6128 7.3 5.1
93 [401]
15–19 319 20.1 17.2
20–24 466 19.1 16.1
25–29 586 13.8 10.4
30–34 1191 8.1 4.5
35–39 914 3.9 2.5

S25.e32
40–44 926 2.8 1.6
(Continued )
Table 1

S25.e33
Continued
Prevalence (%)d
Study location, dates, Assay Site of specimen Group tested Mean or median Sample Overall High Low HPV HPV
reference age, size HPV risk risk 16 18
years (range)
45–49 508 3.5 2.2
50–54 1104 2.9 1.6
55–69 114 1.8 0.9

UK, England, Nottingham, 1988– GP5þ/6þ (16, 18) Cervix—smear Clinic-based controls with normal 591 15.4 3.0 2.9
92 [179] smears
<20 100 18 5.0 3.0

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

20–39 269 18.6 3.8 2.3
40 222 10.4 1.4 3.6
UK, England, Nottingham, 1990– GP5þ/6þ Cervix—smear Stored specimens from regional 42.6a (21–51) 656 18.8
2 [180] screening laboratory collected
from general practitioners
21 86 15.1
31 98 15.3
41 100 14.0
51 372 21.8
UK, England, Sheffield, 1992–3 Type-specific PCR (16) Anus Hospital-based controls 43b (22–56) 95 12.4
[173]
UK, Scotland, Edinburgh, 2000 GP5þ/6þ Cervix—smear Women undergoing routine 36.6 (16.5–78) 3089 12.7 8.3 3 3.4 1.4
[246] screening
HC ¼ hybrid capture; HPV ¼ human papillomavirus; PCR ¼ polymerase chain reaction; STI ¼ sexually transmitted infection; NHANES ¼ National Health and Nutrition Examination Survey; DIANAIDS ¼
Diagnosi Iniziale Anomalie Neoplastiche AIDS Collaborative Study Group.
a
Estimate.
b
Median.
c
Date of sample collection was not specified.
d
Merged columns indicate a combined prevalence rate for 16 and 18.
Table 2
HPV prevalence estimates in women from high-risk populations by continent, country, and study year
Prevalence (%)d
Study location, dates, Assay (PCR consensus Site of specimen Group tested Mean or median age, Sample Overall High risk Low HPV HPV
reference primer or HCI/II) years (range) size HPV risk 16 18
Africa
Ivory Coast, Abidjan, 1994 HCI Cervicovaginal—lavage Maternal group at risk for 29 (18–48) 258 5.8 28.7
[402,403] HIV
HCI Cervicovaginal—lavage Sex workers 29 (15–54) 273 7.0 30.0
Senegal, Dakar, 1990–1 Southern transfer Ecto/endocervix—smear Women attending infectious 31.6a 84 40.5
[277] hybridization (6, 11, 16, disease clinic
18, 31, 33, 35) and PCR
with consensus primers

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

HIV-1þ women 28.7 16 75.0
HIV-2þ women 38.1 15 73.3

Senegal, Dakar, Thies, and Hybridization of genomic Cervix—swab Sex workers 30.9a 681 43.0 10.7 (16, 18, 45)
Mbour, 1990–3 [275] DNA with type-specific
probes
South Africa, Kwazulu, MY09/11 Cervix—smear Commercial sex workers 26 (16–48) 99 62.6 10.5
1998 [276]
Tanzania, Dar es Salaam, GP5þ/6þ Cervix—swab Gynecologic in-patient 30.2 (15–70) 359 58.8 7.8 10.3
1991 [404] population with various
gynecologic complaints
14–24 20.5
25–34 16.5
35–44 14.7
45–70 3.2
Tunisia, Sousse, 2002 [26] MY09/11, pU-1M/pU-2R, Cervix—brush Legal prostitutes 30 (20–45) 51 39.2 23.5 7.8 11.8
and pU-31B/pU-2R
Zimbabwe, Mupfurec [278] GP5þ/6þ Cervix—lavage HIVþ population-based (15–49) 61 54.1 3.3 9.8
rural community
screening
Central and South
America
Brazil, Sao Paulo, 1997–8 HCI Cervix—smear Prison inmates 32.4 209 34 16.3 4.8
[405]
Brazil, Sao Paulo, 1997–9 MY09/11 and PC04/GH20 Cervix—scrape Routine gynecology visit, 32 (18–67) 223 87.5 27.1 13.3
[279] HIVþ women
Brazil, Sao Paulo, 1997–9 SPF10 Cervix—brush Routine gynecology visit, 32.1 (18–67) 22 4.5 9.1
[406] HIVþ women
Brazil, Sao Paulo, 1997–9 HCII Cervicovaginal—brush Routine gynecology visit, 32.4, 32b (18–67) 265 65.3 33.6 7.5
[280] HIVþ women
Honduras, Tegucigalpa, GP5þ/6þ Cervix—spatula HIVþ and HIV prostitutes 32 51 35.3
1994–5 [285]
Mexico, Mexico City, 1998 MY09/11 and HMB01 Cervix and vagina—swab Sex workers 28.6 (18–62) 495 48.9 11.1 3.6
[281]

S25.e34
18–22 107 75.7
(Continued )
Table 2

S25.e35
Continued
Prevalence (%)d
Study location, dates, Assay (PCR consensus Site of specimen Group tested Mean or median age, Sample Overall High risk Low HPV HPV
reference primer or HCI/II) years (range) size HPV risk 16 18
23–27 165 57.6
28–32 97 40.2
33–62 126 21.4
Mexico, Mexico City, 1998– Type-specific PCR (5, 6, 8, Cervix—smear Cytologically normal, HIVþ 37.2 (20–60) 24 41.7
9 [283] 11, 16, 18, 31, 33, 35, 39, women
45, 51, 56, 58)
Mexico, Hermosillo; Peru, MY09/11 Endocervix—brush (self- Cytology normal women 36.9a (18–67) 144 17.4
Lima; USA, Arizona, sampled) attending colposcopy

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

1999–2000 [284] clinics
Endocervix—spatula, brush 18.7
(physician-sampled)
Venezuela, Caracas, 2001 MY09/11 Ecto/endocervix—swab Women attending uterine 26 (18–35) 60 55.0
[282] cervix clinic
North America
Canada, No city reported, MY09/11 Endocervix—brush, spatula HIVþ women and hospital- 32.5 262 62.6 32.1 5.0
1993 [294,295] based sample with no
dysplasia
<30 131 74.8
30–39 177 64.4
40 67 59.7
USA, New York, New York; MY09/11 Cervicovaginal—lavage HIVþ women from clinical 36 (31–41) 855 52 19 33
Chicago, Illinois; and outreach sources
California, Los Angeles
and San Francisco;
Washington, DC, 1994–5
[359]

USA, Baltimore; Rhode PCR with L1 primers Cervicovaginal—lavage HERS cohort: women at risk 35 1157 51.5 15.2 22.8 5.1 4.6
Island, Providence; for HIV
Detroit; New York,
Bronx, 1993–5 [407–409]
USA, New York, Bronx, MY09/11 and HMB01 Cervicovaginal—lavage WIHS cohort: HIVþ women 37 (17–73) 1778 63.4
Manhattan, and Brooklyn;
Chicago; California, Los
Angeles and San
Francisco; Washington,
DC, 1994–5 [287–293]
WIHS cohort: HIV women 35 (17–62) 500 29.8
17–29 512 73.6
30–39 1035 57.2
40–62 718 52.5
(Continued )
Table 2
Continued
Prevalence (%)d
Study location, dates, Assay (PCR consensus Site of specimen Group tested Mean or median age, Sample Overall High risk Low HPV HPV
reference primer or HCI/II) years (range) size HPV risk 16 18
USA (13 cities in the US), MY09/11 and HMB01 Cervicovaginal—lavage REACH cohort: cervical 13–18 188 70.7 47.3 5.3
1996–7 [410] samples from high-risk
adolescent girls
USA (13 cities in the US)c MY09/11 and HMB01 Anus—swab REACH cohort: cervical 16.9a (13–18) 265 26.4 14.7 8.3 4.9 5.3
[411] samples from high-risk
adolescent girls
13–16 94 25.5
17–18 171 26.9

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

USA, Indiana, No city MY09/11 Cervicovaginal—lavage STI clinic attendees 28.1 (18) 295 49.2 42.4 19.7 15.6 2.7
reported, 2001 [412]
USA, Indiana, Indianapolisc HCII Cervicovaginal— lavage STI clinic attendees 28.2 248 17.7 13.3 8.9
[367, 368]
USA, Louisiana, New GP5þ/6þ Cervix—swab HIV outpatient clinic sample 34.1a 53 50.9 41.5
Orleans, 2001 [413]
USA, Maryland, Baltimore, MY09/11 and HMB01 Cervix—swab Adolescents attending an 17.5 (11–20) 80 91.3 40.0 51.3 21.3 8.8
1996–7 [286] STI clinic and university
adolescent clinic
USA, Maryland, Baltimore, MY09/11 and HMB01 Cervicovaginal—lavage, ALIVE cohort: high-risk 36.2 (18) 268 56.0 6.0 5.2
1998 [407] brush, spatula population injection drug
user, HIVþ/

USA, Michigan, Ann Arbor, PCR with E1 primers Cervix—swab Women attending clinic for 31.8 (18–50) 273 21.2 5.5 1.8
1990–2 [414–417] symptoms of vaginitis

USA, New York, Brooklyn, Hybridization with HPV- Cervicovaginal—lavage Attendees of medical/drug 31 (18–50) 221 16.7
1990–1 [418] DNA probes treatment clinics and
community health centers
<30 110 27.3
30–39 74 9.5
40 37 0

USA, New York, New York, PCR with L1 primers (16, Cervicovaginal—lavage STI clinic attendees 34a 669 48.4 6.0 2.8
1991–3 [419–421] 18)

USA, New York, New York, PCR with L1 primers Cervicovaginal—lavage, Cytologically normal renal 43.9 (26–63) 21 4.8
1995 [422] brush transplant patients
USA, North Carolina, Fort MY09/11, HMB01, and Vagina—swab Military women with 24 (18–59) 768 36.5
Bragg, 1997–8 [423] type-specific PCR (6, 11, genitourinary symptoms
16, 18, 26, 31, 33, 35, 39, or STI screening
40, 45, 51–56, 58, 59, 66,
68, 73)
USA, Washington, Seattle, MY09/11 Cervix and perianal area— STI clinic attendees 26.5 50 72.0 20.0

S25.e36
1991–2 [424] swab
(Continued )
Table 2

S25.e37
Continued
Prevalence (%)d
Study location, dates, Assay (PCR consensus Site of specimen Group tested Mean or median age, Sample Overall High risk Low HPV HPV
reference primer or HCI/II) years (range) size HPV risk 16 18
<25 25 84.0
25 25 60.0
USA, Washington, Seattle, MY09/11 Cervix and vulvovaginal Pregnant women from high 22.7a 144 41.0 11.8 3.5
1997 [425] area—swab HPV prevalent
populations attending
obstetrics clinic
USA, Washington, Seattle, MY09/11 and HMB01 Cervix and vagina—broom Women who have sex with 31 (17–56) 248 12.5 9.3 4.8 2.8 0.8
1998 [426] women

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

Asia and Australia

Australia, Melbourne, 1991– MY09/11 Cervix—spatula Renal transplant patients 43 69 21.7

2 [427]
Women undergoing dialysis 44 89 20.2
Women with mild renal 47 22 4.5
impairment
Australia, Sydney, 1988 Type-specific PCR (6/11, 16, Cervix—lavage STI clinic attendees 28 (16–48) 109 51.4 11.9 29.4
[297] 18, 33)
China, Hong Kong, 1991–2 MY09/11 and GH20/PC04 Cervix—spatula Women with inflamed or 35.8 (17–76) 105 10.5 5.7 1.0
[95] normal cervixes attending
colposcopy clinic
17–20 0.0
21–30 6.0a
31–40 12.0a
41–50 22.0a
51–60 0.0
61–70 0.0
71–80 0.0
China, Hong Kong, 2000 MY09/11 Cervix—swab STI clinic attendees 34.6 (15–71) 553 30.6 14.8 10.8 5.1 0.9
[428]
15–25 94 37.2 14.9 11.7
26–35 240 28.3 14.2 10.8
36–45 138 27.5 17.4 8.0
46–71 81 34.6 12.3 14.8
China, Hong Kong, 2000 MY09/11 Cervix—scrape Cytologically normal 40.4 (16–88) 201 5.0d 5.0 7.0
[429] women attending
colposcopy clinic
India, New Delhic [105] Type-specific PCR (16) Cervix—swab STI clinic attendees 27.2 (15–44) 50 30 30
India, New Delhic [430] Type-specific PCR (16, 18) Ectocervix—spatula Cytologically normal 35.8 (20–60) 160 10.0 9.4
women with
inflammation attending
gynecology outpatient
clinic
20–39 108 11.1
(Continued )
Table 2
Continued
Prevalence (%)d
Study location, dates, Assay (PCR consensus Site of specimen Group tested Mean or median age, Sample Overall High risk Low HPV HPV
reference primer or HCI/II) years (range) size HPV risk 16 18
40–59 52 7.7
Indonesia, Bali, Denpasar, Type-specific PCR (6, 11, Cervix—swab Sex workers 25.3 541 38.6 6.7
1997–8 [296] 16, 18, 31, 33, 35, 45, 52)
<18 26 69.2
18–24 216 44.9
25–30 199 34.7
>31 97 21.6
Japan, Osaka, 1993 [431] Type-specific PCR (16, 18) Ectocervix—swab Women presenting for 30.2 (20–48) 53 43.3

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

evaluation of infertility
Mongolia, Ulaanbaatarc MY09/11, type-specific Vagina—tampon (self- STI clinic sample—routine 26.7 110 35.5 15.5 6.4 8.2
[432] PCR, and GH20/PC04 sampled) screening or gynecologic
symptoms
Singapore, No city reported, PVCOU/PVCOD (11, 16, Ectocervix—spatula Sex workers 35 (19–71) 187 14.4 2.1 1.1
1995–6 [433] 18) Endocervix—brush
Taiwan, Taipeic [144] Type-specific PCR (6, 11, Cervix—smear STI clinic attendees 26.9 37 37.8 24.3 8.1
16, 18, 33)
Thailand, Bangkok, 1991–3 Type-specific PCR (6, 11, Cervix—swab Sex workers; brothel 19 (15–24) 82 25.6 8.5
[304] 16, 18, 31, 33, 35, 39, 45)
15–19 48 31.3 12.5
20–24 34 17.6 2.9
Sex workers; massage parlor 30 169 8.3 2.4
20–24 40 10.0 2.5
25–29 39 7.7 7.7
30–34 41 7.3 2.4
35 49 8.2 6.1
Thailand, Chiang Mai, HCI Cervicovaginal—lavage Women whose male partners 26 481 9.1 5.2 4.0
1992–6 [434] were HIVþ
Europe and the Middle
East
Multiple countries (12), GP1/GP2 and type-specific Cervix—brush HIVþ women 31 (17–68) 397 53.7
1993–8 [435] PCR (16, 18, 33, 6, 11, 42,
31, 35, 39)
Denmark, Copenhagen and PCR with L1 primers and Cervix—spatula Women attending HIV 27.5 (19–53) 151 54.0
Aarhus, 1991–3 [436] type-specific PCR (6, 11, screening clinics
16, 18, 31, 33, 35, 45, 39,
51, 52, 2)
HCI 25.3
Denmark, Copenhagen, GP5þ/6þ Cervicovaginal—lavage Sex workers 30.9a 182 32.4 30.5
1992–3 [303]
18–24 27 63.0
25–29 47 42.6
30–34 48 18.8

S25.e38
35–39 33 24.2
(Continued )
Table 2

S25.e39
Continued
Prevalence (%)d
Study location, dates, Assay (PCR consensus Site of specimen Group tested Mean or median age, Sample Overall High risk Low HPV HPV
reference primer or HCI/II) years (range) size HPV risk 16 18
40–44 13 23.1
45 14 14.3
Denmark, Copenhagen, GP5þ/6þ Cervix—swab STI clinic attendees 27.2 124 35.8
1993 [38]
<20 56.0a
20–24 44.0a
25–29 41.0a
30–34 7.0a

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

35 32.0a

Finland, Helsinki, 2000–1 HCII Ectocervix/vagina— Women with gynecologic 38.3 (15–86) 1999 23.0
[437] spatulaEndocervix— disorders attending
brush outpatient clinics
France, Paris, 1992 [299] MY09/11 Cervix, vagina, and vulva— HIVþ women 29 (21–40) 30 63.3 13.3 16.7
biopsy
France, Paris; French PCR with L1 and E6 primers Cervix—brush STI clinic attendees 31 320 21.3 5.0
Guyana, 1993–5 [438] and GP1/GP2
MY09/11 and GP5þ/6þ Ectocervix— spatula, brush HIVþ women 32 (19–72) 307 49.5
Endocervix—swab
France, Reims, 1997–8 [439] HCII Cervix—scrape, brush, Women undergoing routine 37 (15–72) 1518 22.3 16.7 5.6
spatula screening, family
planning clinic attendees,
and women at high risk
for STIs
15–20 85 25.9 20.0 5.9
21–30 411 31.1 25.1 6.1
31–40 484 19.6 14.7 4.9
41–50 369 17.6 11.4 6.2
51–60 128 17.2 10.9 6.2
61–72 41 14.6 14.6 0.0

Germany, No city reported, MY09/11 Cervix—swab Women with previous 33.8 550 56.2
1991–2 [196] cervical lesions or
partners of men with HPV
HIVþ women 32.9 61 62.3
Greenland, Nuuk, 1993 [38] GP5þ/6þ Cervix—swab STI clinic attendees 27.4 153 23.5
<20 85.0a
20–24 25.0a
25–29 12.0a
30–34 19.0a
35 19.0a
(Continued )
Table 2
Continued
Prevalence (%)d
Study location, dates, Assay (PCR consensus Site of specimen Group tested Mean or median age, Sample Overall High risk Low HPV HPV
reference primer or HCI/II) years (range) size HPV risk 16 18
Israel, No city reported, 1997 MY09/11 Vagina—biopsy Women undergoing 17–55 86 53.5
[440] perineoplasty for vulvar
vestibulitis
Italy, Multicenter, 1994–5 MY09/11 Endocervix—brush Women at risk for HIV 26.9 236 36.4
[441–443] infection
17–29 116 40.5
30–45 118 32.2

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

Italy, Multicenter, 1997–9 MY09/11 Cervix—smear, spatula HIVþ women; DIANAIDS 33.5 (21–48) 89 38.2 7.9 0.0
[225] Endocervix—brush project
Italy, Ancona, 1994 [214] PCR with L1 primers Ecto/endocervix—smear HIVþ women 29.2 (22–38) 21 66.7 47.6
Italy, Milan, 1995–7 [300] MY09/11 Cervix—brush HIVþ women 33.6 (20–68) 163 16.0 1.2
HCII 65.0
Italy, Milan, 1995–7 [217] MY09/11 Cervix—swab HIVþ women 33.6 (21–62) 168 91.0
Italy, Padua, 1997–9 [218] MY09/11 Cervix—brush HIVþ women 35 (24–76) 104 53.8
Italy, Palermo, 1997–9 [301] MY09/11 and GP5þ/6þ Cervix—spatula HIVþ women 32a (15–44) 110 60.9 25.5 11.8
Italy, Pavia, 1998–9 [302] MY09/11 Cervicovaginal—swab, HIVþ women, cytologically 31.9 124 63.7 2.4 7.3
lavage normal
Italy, Rome, 1998 [444] MY09/11 Cervix—spatula, brush Colposcopy clinic attendees 31 (19–54) 48 54.8
with past/present
inflammation, but
negative colposcopy
findings
The Netherlands, GP5þ/6þ and type-specific Cervix—scrape, brush Gynecologic outpatient 18–80 239 9.2
Amstelveen, 1991 [396] PCR population with various
gynecologic complaints
The Netherlands, GP1/2 and GP5þ/6þ Cervix—scrape, spatula Cytologically normal 16–60 83 25.3 8.4 2.4
Amsterdam, 1989 [445] women attending the
gynecology department
for various gynecologic
complaints
The Netherlands, Type-specific PCR (6/11, 16, Cervix—spatula or swab STI clinic attendees 30 162 15.4
Amsterdam, 1988–90 18, 33)
[446]
The Netherlands, Type-specific PCR (6, 11, Cervix, anus, and rectum— STI clinic attendees 28 (18) 111 13.5 6.3 4.5
Amsterdam, 1989–90 16, 18, 33) swab
[447]
The Netherlands, Class 1989 and type-specific Cervix—spatula or brush Drug-using sex worker 30.2 121 17.4 5.8 1.7
Amsterdam, 1991–2 PCR (6/11, 16, 18, 33)
[448]
(Continued )

S25.e40
Table 2

S25.e41
Continued
Prevalence (%)d
Study location, dates, Assay (PCR consensus Site of specimen Group tested Mean or median age, Sample Overall High risk Low HPV HPV
reference primer or HCI/II) years (range) size HPV risk 16 18
Norway, Porsgrunnc [449] Type-specific PCR (6, 11, Cervix—biopsy Women undergoing 30 (15–54) 100 5.0 0.0 4.0
16, 18, 33) dilatation and curettage
for either termination of
pregnancy or benign
conditions
Russia; Latvia; Belarus, HCII Cervix—smear STI clinic attendees 27.5 706 44.9
2000 [450]
Spain, Oviedo, 2003 [298] MY09/11 Cervix—smear Sex workers attending 187 27.7 10.2 3.7

J.S. Smith et al. / Journal of Adolescent Health 43 (2008) S5–S25

dermatology or STI
clinics
<20 75.0a
21–25 45.0a
26–30 30.0a
31–35 25.0a
36–40 18.0a
>41 0.0a
Sweden, Gothenburg, 1992 MY09/11 (6, 11, 16, 18, 33) Cervix—brush STI clinic attendees 25 (20–58) 91 33.0
[451]
Sweden, Malmo, 1991 [452] Type-specific PCR (6, 11, Cervix—brush Cytologically normal 18.3 (15–21) 25 16.0 8.0 16.0
16, 18, 33) women attending an STI
clinic
Sweden, Stockholm, 1997 MY09/11 and type-specific Cervix—brush Cytologically normal 24.9a (15–74) 171 69.0 13.0 6.0
[453] PCR (6, 16, 18, 31, 33) women with a previous
history of condyloma or
dysplasia
Sweden, Uppsala, 1991–2 MY09/11 and GP5þ/6 þ Cervix, vulva, introitus, STI clinic attendees 24 (17–47) 66 24.2
[454] perineum, and perianal
area
Sweden, Uppsala, 1997–9 GP5þ/6þ (16, 18, 31, 33) Cervix—smear In vitro fertilization sample 32 (20–40) 214 7 2.3 2.8
[400]
Turkey, Ankara, 1997 [141] MY09/11 Cervix—biopsy Sex workers 29 88 2.3 1.1
UK, England, Sheffield, Type-specific PCR (16) Anus Renal allograft patients 47b (23–68) 53 3.8
1992–3 [173]
UK, England, Cambridge, GP5þ/6þ Cervix—scrape Women attending 26 (16–57) 136 77.9 8.6 3.9
1999 [455] genitourinary department
HC ¼ hybrid capture; HPV ¼ human papillomavirus; PCR ¼ polymerase chain reaction; STI ¼ sexually transmitted infection; ALIVE ¼ AIDS Link to Intravenous Experiences; DIANAIDS ¼ Diagnosi Iniziale
Anomalie Neoplastiche AIDS Collaborative Study Group; REACH ¼ Reaching for Excellence in Adolescent Care and Health; WIHS ¼ Women’s Interagency HIV Study.
a
Estimate.
b
Median.
c
Date of sample collection was not specified.
d
Merged columns indicate a combined prevalence rate for 16 and 18.