Prevalence and Genotype Distribution of Genital Human Papillomavirus Infection in Female Sex Workers in the World: a Systematic Review and Meta-Analysis

Abstract Background: Female sex workers (FSWs) are amongst the most susceptible groups to acquire Human papillomavirus (HPV) infection and consequently, to develop cervical intraepithelial neoplasia and cervical cancer. This is the first systematic review and meta-analysis to provide estimates of the pooled prevalence of HPV infection and distribution of HPV types among FSWs across the world. Methods: Five computerized databases were searched for relevant studies published since the inception date of databases to September 2019. The pooled HPV prevalence was calculated by the random effect model described by DerSimonian-Laird. Subgroup analysis was performed to identify the probable source of heterogeneity. The meta-analysis was performed using the “Metaprop” function in the R package Meta. Results: Sixty-six studies involving 22938 FSWs from 34 countries were included in this meta-analysis, and the pooled HPV prevalence was 41.97% (95% confidence interval (CI): 37.99%-46.05%). HPV-16 (10.42%, 95% CI: 8.61%–12.55%), HPV-52 (7.76%, 95% CI: 5.75%–10.39%), and HPV-53 (6.09%, 95% CI: 4.55%–8.12%) were the most common high-risk HPV types identified among FSWs. Geographically, the highest and the lowest prevalence of HPV were obtained from Hungary (82.35%, 95%CI: 65.90%–91.85%) and Mexico (13.30%, 95%CI: 1.67%–58.06%), respectively. Conclusion: Due to the high prevalence of HPV infection, particularly with high-risk types, FSWs have a great susceptibility to the development of cervical and vaginal cancers. Furthermore, they can transmit their infection to their clients, which may result in a high prevalence of HPV and incidence of HPV-associated malignancies among the general population.