{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T13:22:22Z","timestamp":1790688142332,"version":"4.1.0"},"reference-count":39,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T00:00:00Z","timestamp":1646784000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001325","name":"Cancer Association of South Africa","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001325","id-type":"DOI","asserted-by":"crossref"}]},{"name":"University of Cape Town Research Fund"},{"name":"National Research Foundation of South Africa","award":["64815"],"award-info":[{"award-number":["64815"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Human papillomavirus (HPV) prevalence and genotype distribution data is important for HPV vaccine monitoring. This study investigated the prevalence and distribution of HPV genotypes in cervical lesions of unvaccinated women referred to Nelson Mandela Academic Hospital Gynaecology Department due to different abnormal cervical conditions. A total of 459 women referred to the Nelson Mandela Academic Hospital Gynaecology department were recruited. When the cervical biopsy was collected for histopathology, an adjacent biopsy was provided for HPV detection. Roche Linear Array HPV genotyping assay that detects 37 HPV genotypes was used to detect HPV infection in cervical biopsies. HPV infection was detected in 84.2% (383\/455) of participants. The six most dominant HPV types were HPV-16 (34.7%), followed by HPV-35 (17.4%), HPV-58 (12.1%), HPV-45 (11.6%), HPV-18 (11.4%) and HPV-52 (9.7%). HPV-35 was the third most dominant type among women with cervical intraepithelial lesion (CIN)-2 (12.6%; single infection: 5.7% and multiple infection: 6.9%), the second most dominant type among women with CIN3 (22.2%; single infection: 8.0% and multiple infection: 14.2%); and the fourth most dominant type among women with cervical cancer (12.5%; single infection: 7.1% and multiple infection: 5.4%). A proportion of 41.1% (187\/455) was positive for HPV types targeted by the Cervarix\u00ae, 42.4% (193\/455) by Gardasil\u00ae4, and 66.6% (303\/455) by Gardasil\u00ae9. There was a statistically significant increase when the prevalence of women infected with HPV-35 only or with other HPV types other than Gardasil\u00ae9 types was included to those infected with Gardasil\u00ae9 HPV types (66.6%, 303\/455 increase to 76.0%, 346\/455, p = 0.002). High HPV-35 prevalence in this population, especially among women with CIN3 warrants attention since it is not included in current commercially available HPV vaccines.<\/jats:p>","DOI":"10.1371\/journal.pone.0264498","type":"journal-article","created":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T13:37:14Z","timestamp":1646833034000},"page":"e0264498","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":42,"title":["High human papillomavirus (HPV)-35 prevalence among South African women with cervical intraepithelial neoplasia warrants attention"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9073-4777","authenticated-orcid":true,"given":"Zizipho Z. A.","family":"Mbulawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keletso","family":"Phohlo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mirta","family":"Garcia-Jardon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna-Lise","family":"Williamson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles B.","family":"Businge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,9]]},"reference":[{"key":"pone.0264498.ref001","article-title":"ICO\/IARC Information Centre on HPV and Cancer (HPV Information Centre)","author":"L Bruni","year":"2019","journal-title":"Human Papillomavirus and Related Diseases in South Africa"},{"key":"pone.0264498.ref002","unstructured":"National Cancer Registry South Africa. Cancer Incidence in South Africa, 2014. National Institute of Communicable Disease, National Cancer Registry of South Africa. [Accessed 06 June 2021]. Available from: https:\/\/www.nicd.ac.za\/wp-content\/uploads\/2019\/12\/2014-NCR-tables.pdf."},{"key":"pone.0264498.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1200\/JGO.19.00198","article-title":"Increasing Cervical Cancer Incidence in Rural Eastern Cape Province of South Africa From 1998 to 2012: A Population-Based Cancer Registry Study","volume":"6","author":"NI Somdyala","year":"2020","journal-title":"JCO Global Oncology"},{"key":"pone.0264498.ref004","unstructured":"UNAIDS. Global HIV statistics. 2021. [Accessed 10 June 2021]. Available from: https:\/\/www.unaids.org\/en\/regionscountries\/countries\/southafrica."},{"issue":"7","key":"pone.0264498.ref005","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S1473-3099(07)70158-5","article-title":"Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis","volume":"7","author":"S de Sanjose","year":"2007","journal-title":"The Lancet Infectious diseases"},{"issue":"4","key":"pone.0264498.ref006","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1002\/ijc.30716","article-title":"Worldwide burden of cancer attributable to HPV by site, country and HPV type","volume":"141","author":"C de Martel","year":"2017","journal-title":"International journal of cancer Journal international du cancer"},{"issue":"1","key":"pone.0264498.ref007","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s13643-020-01354-1","article-title":"The interplay of HIV and human papillomavirus-related cancers in sub-Saharan Africa: scoping review","volume":"9","author":"KMB Lekoane","year":"2020","journal-title":"Syst Rev"},{"issue":"20","key":"pone.0264498.ref008","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1056\/NEJMp058171","article-title":"The promise of global cervical-cancer prevention","volume":"353","author":"M Schiffman","year":"2005","journal-title":"New England Journal of Medicine"},{"issue":"8","key":"pone.0264498.ref009","doi-asserted-by":"crossref","first-page":"930","DOI":"10.5858\/2003-127-930-HPEAPH","article-title":"Human papillomavirus\u2014Epidemiology and public health","volume":"127","author":"M Schiffman","year":"2003","journal-title":"Archives of Pathology & Laboratory Medicine"},{"issue":"2","key":"pone.0264498.ref010","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1086\/524875","article-title":"Risk of female human papillomavirus acquisition associated with first male sex partner","volume":"197","author":"RL Winer","year":"2008","journal-title":"The Journal of infectious diseases"},{"issue":"2","key":"pone.0264498.ref011","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.jinf.2013.10.012","article-title":"Risk factors for oral human papillomavirus in heterosexual couples in an African setting","volume":"68","author":"ZZ Mbulawa","year":"2014","journal-title":"The Journal of infection"},{"issue":"4 Suppl","key":"pone.0264498.ref012","first-page":"S5","article-title":"Age-specific prevalence of infection with human papillomavirus in females: a global review","volume":"43","author":"JS Smith","year":"2008","journal-title":"The Journal of adolescent health: official publication of the Society for Adolescent Medicine"},{"issue":"7","key":"pone.0264498.ref013","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/S1473-3099(07)70158-5","article-title":"Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis","volume":"7","author":"S de Sanjose","year":"2007","journal-title":"Lancet Infectious Diseases"},{"issue":"9590","key":"pone.0264498.ref014","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1016\/S0140-6736(07)61416-0","article-title":"Human papillomavirus and cervical cancer","volume":"370","author":"M Schiffman","year":"2007","journal-title":"Lancet"},{"issue":"10","key":"pone.0264498.ref015","doi-asserted-by":"crossref","first-page":"1514","DOI":"10.1086\/598220","article-title":"Genital human papillomavirus prevalence and human papillomavirus concordance in heterosexual couples are positively associated with human immunodeficiency virus coinfection","volume":"199","author":"ZZ Mbulawa","year":"2009","journal-title":"The Journal of infectious diseases"},{"key":"pone.0264498.ref016","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.bpobgyn.2017.08.011","article-title":"Clinical implications of the interaction between HPV and HIV infections","volume":"47","author":"G. Dreyer","year":"2018","journal-title":"Best practice & research Clinical obstetrics & gynaecology"},{"issue":"4","key":"pone.0264498.ref017","doi-asserted-by":"crossref","first-page":"579","DOI":"10.3390\/jcm4040579","article-title":"The Interaction between Human Immunodeficiency Virus and Human Papillomaviruses in Heterosexuals in Africa","volume":"4","author":"A-L Williamson","year":"2015","journal-title":"Journal of Clinical Medicine"},{"key":"pone.0264498.ref018","doi-asserted-by":"crossref","first-page":"48","DOI":"10.3389\/fonc.2014.00048","article-title":"Distribution of Human Papillomavirus Genotypes among HIV-Positive and HIV-Negative Women in Cape Town, South Africa","volume":"4","author":"AC McDonald","year":"2014","journal-title":"Frontiers in oncology"},{"issue":"4","key":"pone.0264498.ref019","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1002\/ijc.25396","article-title":"Human papillomavirus type distribution in 30,848 invasive cervical cancers worldwide: Variation by geographical region, histological type and year of publication","volume":"128","author":"N Li","year":"2011","journal-title":"International journal of cancer"},{"issue":"3","key":"pone.0264498.ref020","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1002\/ijc.22527","article-title":"Human papillomavirus type distribution in invasive cervical cancer and high\u2010grade cervical lesions: a meta\u2010analysis update","volume":"121","author":"JS Smith","year":"2007","journal-title":"International journal of cancer"},{"issue":"6","key":"pone.0264498.ref021","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1002\/ijc.28425","article-title":"Human papillomavirus prevalence and type distribution in invasive cervical cancer in sub\u2010Saharan Africa","volume":"134","author":"L Denny","year":"2014","journal-title":"International journal of cancer"},{"key":"pone.0264498.ref022","article-title":"Association of HPV35 with cervical carcinogenesis among women of African ancestry: Evidence of viral\u2010host interaction with implications for disease intervention","author":"M Pinheiro","year":"2020","journal-title":"International Journal of Cancer"},{"issue":"7","key":"pone.0264498.ref023","doi-asserted-by":"crossref","first-page":"e453","DOI":"10.1016\/S2214-109X(16)30099-7","article-title":"Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis","volume":"4","author":"L Bruni","year":"2016","journal-title":"Lancet Glob Health"},{"issue":"11","key":"pone.0264498.ref024","article-title":"vaccine types and dose schedules for prevention of HPV-related disease in females and males","volume":"2019","author":"H Bergman","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0264498.ref025","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.coviro.2019.06.006","article-title":"Human papillomavirus vaccine disease impact beyond expectations","volume":"39","author":"S de Sanjose","year":"2019","journal-title":"Curr Opin Virol"},{"issue":"12","key":"pone.0264498.ref026","doi-asserted-by":"crossref","first-page":"2662","DOI":"10.1158\/1055-9965.EPI-20-0969","article-title":"HPV types in cervical precancer by HIV status and birth region: a population-based register study","volume":"29","author":"C Carlander","year":"2020","journal-title":"Cancer Epidemiology and Prevention Biomarkers"},{"issue":"1","key":"pone.0264498.ref027","first-page":"8","article-title":"Guidelines for cervical cancer screening in South Africa","volume":"9","author":"M Botha","year":"2017","journal-title":"Southern African Journal of Gynaecological Oncology"},{"issue":"180","key":"pone.0264498.ref028","first-page":"2","article-title":"A review of cervical cancer in South Africa: previous, current and future","volume":"4","author":"S Jordaan","year":"2016","journal-title":"Health Care Current Reviews"},{"issue":"3","key":"pone.0264498.ref029","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1016\/S1470-2045(18)30836-2","article-title":"Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020\u201399: a modelling study","volume":"20","author":"KT Simms","year":"2019","journal-title":"The lancet oncology"},{"issue":"3","key":"pone.0264498.ref030","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1071\/SH09137","article-title":"Monitoring the control of human papillomavirus (HPV) infection and related diseases in Australia: towards a national HPV surveillance strategy","volume":"7","author":"JM Brotherton","year":"2010","journal-title":"Sexual Health"},{"issue":"2","key":"pone.0264498.ref031","doi-asserted-by":"crossref","first-page":"280","DOI":"10.3390\/v13020280","article-title":"Distribution of Human Papillomavirus (HPV) Genotypes in HIV-Negative and HIV-Positive Women with Cervical Intraepithelial Lesions in the Eastern Cape Province, South Africa","volume":"13","author":"O Taku","year":"2021","journal-title":"Viruses"},{"issue":"1","key":"pone.0264498.ref032","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/0042-6822(91)90518-G","article-title":"Genome organization and nucleotide sequence of human papillomavirus type 39","volume":"181","author":"C Volpers","year":"1991","journal-title":"Virology"},{"issue":"10","key":"pone.0264498.ref033","doi-asserted-by":"crossref","first-page":"2349","DOI":"10.1002\/ijc.27485","article-title":"Human papillomavirus types in 115,789 HPV-positive women: a meta-analysis from cervical infection to cancer","volume":"131","author":"P Guan","year":"2012","journal-title":"International journal of cancer Journal international du cancer"},{"key":"pone.0264498.ref034","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1186\/s12879-015-1181-8","article-title":"Human papillomavirus prevalence in South African women and men according to age and human immunodeficiency virus status","volume":"15","author":"ZZ Mbulawa","year":"2015","journal-title":"BMC infectious diseases"},{"issue":"5","key":"pone.0264498.ref035","first-page":"313","article-title":"Age-specific prevalence of cervical human papillomavirus infection and cytological abnormalities in women in Gauteng Province, South Africa","volume":"103","author":"K Richter","year":"2013","journal-title":"South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde"},{"issue":"47","key":"pone.0264498.ref036","doi-asserted-by":"crossref","first-page":"e8752","DOI":"10.1097\/MD.0000000000008752","article-title":"HPV types in cervical cancer tissue in South Africa: A head-to-head comparison by mRNA and DNA tests","volume":"96","author":"A Rad","year":"2017","journal-title":"Medicine"},{"issue":"3","key":"pone.0264498.ref037","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/QAI.0000000000001113","article-title":"Effect of HIV infection on human papillomavirus types causing invasive cervical cancer in Africa","volume":"73","author":"GM Clifford","year":"2016","journal-title":"Journal of acquired immune deficiency syndromes (1999)"},{"issue":"6","key":"pone.0264498.ref038","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/PGP.0b013e31821bf2a6","article-title":"Subtype distribution of human papillomavirus in HIV-infected women with cervical intraepithelial neoplasia stages 2 and 3 in Botswana","volume":"30","author":"D Ramogola-Masire","year":"2011","journal-title":"International journal of gynecological pathology: official journal of the International Society of Gynecological Pathologists"},{"issue":"5","key":"pone.0264498.ref039","doi-asserted-by":"crossref","DOI":"10.1097\/IGC.0000000000000422","article-title":"Unique Human Papillomavirus\u2013Type Distribution in South African Women With Invasive Cervical Cancer and the Effect of Human Immunodeficiency Virus Infection","volume":"25","author":"MC Van Aardt","year":"2015","journal-title":"International Journal of Gynecologic Cancer"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264498","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,9]],"date-time":"2022-03-09T13:38:01Z","timestamp":1646833081000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0264498"}},"subtitle":[],"editor":[{"given":"Maria Lina","family":"Tornesello","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,9]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,9]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0264498","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,9]]}}}