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Published in: BMC Infectious Diseases 1/2013

Open Access 01-12-2013 | Research article

Human papillomavirus and other genital infections in indigenous women from Paraguay: a cross-sectional analytical study

Authors: Laura Mendoza, Pamela Mongelos, Malvina Paez, Amalia Castro, Isabel Rodriguez-Riveros, Graciela Gimenez, Patricia Araujo, Gloria Echagüe, Valentina Diaz, Florentina Laspina, Wilberto Castro, Rosa Jimenez, Ramón Marecos, Santiago Ever, Gerardo Deluca, María Alejandra Picconi

Published in: BMC Infectious Diseases | Issue 1/2013

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Abstract

Background

The incidence of cervical cancer in Paraguay is among the highest in the world, with the human papillomavirus (HPV) being a necessary factor for cervical cancer. Knowledge about HPV infection among indigenous women is limited. This cross-sectional study analyzed the frequency of HPV and other genital infections in indigenous Paraguayan women of the Department of Presidente Hayes.

Methods

This study included 181 sexually active women without cervical lesions. They belonged to the following ethnicities: Maká (n = 40); Nivaclé (n = 23); Sanapaná (n = 33); Enxet Sur (n = 51) and Toba-Qom (n = 34). The detection of HPV and other gynecological infectious microorganisms was performed by either molecular methods (for Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis), gram staining and/or culture (for Gardnerella vaginalis, Candida sp, Trichomonas vaginalis, Neisseria gonorrhoeae), serological methods (for Treponema pallidum, human immunodeficiency virus [HIV]) or cytology (cervical inflammation).

Results

A high prevalence (41.4%) of women positive for at least one sexually transmitted infection (STI) was found (23.2% any-type HPV, 11.6% T pallidum, 10.5% T vaginalis, 9.9% C trachomatis and 0.6% HIV) with 12.2% having more than one STI. HPV infection was the most frequent, with 16.1% of women positive for high-risk HPV types. There was a statistically significant association observed between any-type HPV and C trachomatis (p = 0.004), which indicates that the detection of one of these agents should suggest the presence of the other. There was no association between any-type HPV and other genital infections or cervical inflammation, suggesting that other mechanism could exist to favor infection with the virus.

Conclusion

This multidisciplinary work suggests that STIs are frequent, making it necessary to implement control measures and improve diagnosis in order to increase the number of cases detected, especially in populations with poor access to health centers.
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Literature
1.
go back to reference Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010, 127 (12): 2893-2917. 10.1002/ijc.25516.CrossRefPubMed Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM: Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010, 127 (12): 2893-2917. 10.1002/ijc.25516.CrossRefPubMed
2.
go back to reference Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H: Sexually transmitted infections among U.S. Women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013, 40 (3): 187-193. 10.1097/OLQ.0b013e318286bb53.CrossRefPubMed Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, Su J, Xu F, Weinstock H: Sexually transmitted infections among U.S. Women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013, 40 (3): 187-193. 10.1097/OLQ.0b013e318286bb53.CrossRefPubMed
3.
go back to reference Muñoz N, Bosch FX, de Sanjose S, Herrero R, Castellsague X, Shah KV, Snijders PJ, Meijer CJ, International Agency for Research on Cancer Multicenter Cervical Cancer Study Group: Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003, 348 (6): 518-27. 10.1056/NEJMoa021641.CrossRefPubMed Muñoz N, Bosch FX, de Sanjose S, Herrero R, Castellsague X, Shah KV, Snijders PJ, Meijer CJ, International Agency for Research on Cancer Multicenter Cervical Cancer Study Group: Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med. 2003, 348 (6): 518-27. 10.1056/NEJMoa021641.CrossRefPubMed
4.
go back to reference Oakeshott P, Aghaizu A, Reid F, Howell-Jones R, Hay PE, Sadiq ST, Lacey CJ, Beddows S, Soldan K: Frequency and risk factors for prevalent, incident, and persistent genital carcinogenic human papillomavirus infection in sexually active women: community based cohort study. BMJ. 2012, 344: e4168-10.1136/bmj.e4168.CrossRefPubMedPubMedCentral Oakeshott P, Aghaizu A, Reid F, Howell-Jones R, Hay PE, Sadiq ST, Lacey CJ, Beddows S, Soldan K: Frequency and risk factors for prevalent, incident, and persistent genital carcinogenic human papillomavirus infection in sexually active women: community based cohort study. BMJ. 2012, 344: e4168-10.1136/bmj.e4168.CrossRefPubMedPubMedCentral
5.
go back to reference Veldhuijzen NJ, Braunstein SL, Vyankandondera J, Ingabire C, Ntirushwa J, Kestelyn E, Tuijn C, Wit FW, Umutoni A, Uwineza M, Crucitti T, van de Wijgert JH: The epidemiology of human papillomavirus infection in HIV-positive and HIV-negative high-risk women in Kigali, Rwanda. BMC Infect Dis. 2011, 11: 333-10.1186/1471-2334-11-333.CrossRefPubMedPubMedCentral Veldhuijzen NJ, Braunstein SL, Vyankandondera J, Ingabire C, Ntirushwa J, Kestelyn E, Tuijn C, Wit FW, Umutoni A, Uwineza M, Crucitti T, van de Wijgert JH: The epidemiology of human papillomavirus infection in HIV-positive and HIV-negative high-risk women in Kigali, Rwanda. BMC Infect Dis. 2011, 11: 333-10.1186/1471-2334-11-333.CrossRefPubMedPubMedCentral
6.
go back to reference Castle PE, Giuliano AR: Chapter 4: genital tract infections, cervical inflammation, and antioxidant nutrients–assessing their roles as human papillomavirus cofactors. J Natl Cancer Inst Monogr. 2003, 31: 29-34.CrossRefPubMed Castle PE, Giuliano AR: Chapter 4: genital tract infections, cervical inflammation, and antioxidant nutrients–assessing their roles as human papillomavirus cofactors. J Natl Cancer Inst Monogr. 2003, 31: 29-34.CrossRefPubMed
7.
go back to reference da Silva Barros NK, Costa MC, Alves RR, Villa LL, Derchain SF, Zeferino LC, Dos Santos Carneiro MA, Rabelo-Santos SH: Association of HPV infection and Chlamydia trachomatis seropositivity in cases of cervical neoplasia in Midwest Brazil. J Med Virol. 2012, 84 (7): 1143-50. 10.1002/jmv.23312.CrossRefPubMed da Silva Barros NK, Costa MC, Alves RR, Villa LL, Derchain SF, Zeferino LC, Dos Santos Carneiro MA, Rabelo-Santos SH: Association of HPV infection and Chlamydia trachomatis seropositivity in cases of cervical neoplasia in Midwest Brazil. J Med Virol. 2012, 84 (7): 1143-50. 10.1002/jmv.23312.CrossRefPubMed
8.
go back to reference Roeters AM, Boon ME, van Haaften M, Vernooij F, Bontekoe TR, Heintz AP: Inflammatory events as detected in cervical smears and squamous intraepithelial lesions. Diagn Cytopathol. 2010, 38 (2): 85-93.PubMed Roeters AM, Boon ME, van Haaften M, Vernooij F, Bontekoe TR, Heintz AP: Inflammatory events as detected in cervical smears and squamous intraepithelial lesions. Diagn Cytopathol. 2010, 38 (2): 85-93.PubMed
9.
go back to reference Oliveira FA, Pfleger V, Lang K, Heukelbach J, Miralles I, Fraga F, Sousa AQ, Stoffler-Meilicke M, Ignatius R, Kerr LF, Feldmeier H: Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a population-based study. Mem Inst Oswaldo Cruz. 2007, 102 (6): 751-756. 10.1590/S0074-02762007000600015.CrossRefPubMed Oliveira FA, Pfleger V, Lang K, Heukelbach J, Miralles I, Fraga F, Sousa AQ, Stoffler-Meilicke M, Ignatius R, Kerr LF, Feldmeier H: Sexually transmitted infections, bacterial vaginosis, and candidiasis in women of reproductive age in rural Northeast Brazil: a population-based study. Mem Inst Oswaldo Cruz. 2007, 102 (6): 751-756. 10.1590/S0074-02762007000600015.CrossRefPubMed
10.
go back to reference Almonte M, Murillo R, Sánchez GI, Jerónimo J, Salmerón J, Ferreccio C, Lazcano-Ponce E, Herrero R: New paradigms and challenges in cervical cancer prevention and control in Latin America. Salud Publica Mex. 2010, 52 (6): 544-559. 10.1590/S0036-36342010000600010.CrossRefPubMed Almonte M, Murillo R, Sánchez GI, Jerónimo J, Salmerón J, Ferreccio C, Lazcano-Ponce E, Herrero R: New paradigms and challenges in cervical cancer prevention and control in Latin America. Salud Publica Mex. 2010, 52 (6): 544-559. 10.1590/S0036-36342010000600010.CrossRefPubMed
11.
go back to reference Golshani M, Eslami G, Mohhammadzadeh Ghobadloo S, Fallah F, Goudarzi H, Soleimani Rahbar AA, Fayaz F: Detection of chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum by multiplex PCR in semen sample of infertile Men. Iranian J Publ Health. 2007, 36 (2): 50-57. Golshani M, Eslami G, Mohhammadzadeh Ghobadloo S, Fallah F, Goudarzi H, Soleimani Rahbar AA, Fayaz F: Detection of chlamydia trachomatis, Mycoplasma hominis and Ureaplasma urealyticum by multiplex PCR in semen sample of infertile Men. Iranian J Publ Health. 2007, 36 (2): 50-57.
12.
go back to reference McIver CJ, Rismanto N, Smith C, Naing ZW, Rayner B, Lusk MJ, Konecny P, White PA, Rawlinson WD: Multiplex PCR testing detection of higher-than-expected rates of cervical mycoplasma, ureaplasma, and trichomonas and viral agent infections in sexually active australian women. J Clin Microbiol. 2009, 47 (5): 1358-1363. 10.1128/JCM.01873-08.CrossRefPubMedPubMedCentral McIver CJ, Rismanto N, Smith C, Naing ZW, Rayner B, Lusk MJ, Konecny P, White PA, Rawlinson WD: Multiplex PCR testing detection of higher-than-expected rates of cervical mycoplasma, ureaplasma, and trichomonas and viral agent infections in sexually active australian women. J Clin Microbiol. 2009, 47 (5): 1358-1363. 10.1128/JCM.01873-08.CrossRefPubMedPubMedCentral
14.
go back to reference Almonte M, Albero G, Molano M, Carcamo C, García PJ, Perez G: Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine. 2008, 26 (11): L16-36.CrossRefPubMed Almonte M, Albero G, Molano M, Carcamo C, García PJ, Perez G: Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine. 2008, 26 (11): L16-36.CrossRefPubMed
15.
go back to reference Rovira C, Monzón I, Almirón M: Hepatitis virales en diferentes grupos étnicos del Paraguay. Mem Inst Invest Cienc Salud. 2005, 1 (1): 5-8. Rovira C, Monzón I, Almirón M: Hepatitis virales en diferentes grupos étnicos del Paraguay. Mem Inst Invest Cienc Salud. 2005, 1 (1): 5-8.
16.
go back to reference Aguayo N, Espínola H, Aguilar G, Barboza A, Estigarribia G, Giménez L: Estudio de Prevalencia de Sífilis/VIH y Características Sociocomportamentales de la Población Indígena, Caaguazú 2011. Rev Inst Med Trop. 2011, 6: 21- Aguayo N, Espínola H, Aguilar G, Barboza A, Estigarribia G, Giménez L: Estudio de Prevalencia de Sífilis/VIH y Características Sociocomportamentales de la Población Indígena, Caaguazú 2011. Rev Inst Med Trop. 2011, 6: 21-
17.
go back to reference Solomon D, Davey D, Kurman R, Moriaty A, O’Connor D, Prey M, Raab S, Sherman M, Wilbur D, Wright T, Young N, Forum Group Members; Bethesda 2001 Workshop: The Bethesda System. Terminology for reporting results of cervical cytology. JAMA. 2002, 267 (16): 2114-2119.CrossRef Solomon D, Davey D, Kurman R, Moriaty A, O’Connor D, Prey M, Raab S, Sherman M, Wilbur D, Wright T, Young N, Forum Group Members; Bethesda 2001 Workshop: The Bethesda System. Terminology for reporting results of cervical cytology. JAMA. 2002, 267 (16): 2114-2119.CrossRef
18.
go back to reference Mendoza LP, Arbiza J, Paez M, Kasamatsu E, Castro A, Giménez G, Basiletti J, Gonzalez J, Mongelós P, Picconi MA: Distribution of human papillomavirus genotypes in Paraguayan women according to the severity of the cervical lesion. J Med Virol. 2011, 83 (8): 1351-1357. 10.1002/jmv.22112.CrossRefPubMed Mendoza LP, Arbiza J, Paez M, Kasamatsu E, Castro A, Giménez G, Basiletti J, Gonzalez J, Mongelós P, Picconi MA: Distribution of human papillomavirus genotypes in Paraguayan women according to the severity of the cervical lesion. J Med Virol. 2011, 83 (8): 1351-1357. 10.1002/jmv.22112.CrossRefPubMed
19.
go back to reference Saiki RK, Scharf S, Faloona F, Mullis KB, Horn GT, Erlich HA, Arnheim N: Enzymatic amplification of beta-globin genomic sequences and restriction site analysis for diagnosis of sickle cell anemia. Science. 1985, 230 (4732): 1350-1354. 10.1126/science.2999980.CrossRefPubMed Saiki RK, Scharf S, Faloona F, Mullis KB, Horn GT, Erlich HA, Arnheim N: Enzymatic amplification of beta-globin genomic sequences and restriction site analysis for diagnosis of sickle cell anemia. Science. 1985, 230 (4732): 1350-1354. 10.1126/science.2999980.CrossRefPubMed
20.
go back to reference Estrade C, Menoud PA, Nardelli-Haefliger D, Sahli R: Validation of a low-cost human papillomavirus genotyping assay based on PGMY PCR and reverse blotting hybridization with reusable membranes. J Clin Microbiol. 2011, 49 (10): 3474-3481. 10.1128/JCM.05039-11.CrossRefPubMedPubMedCentral Estrade C, Menoud PA, Nardelli-Haefliger D, Sahli R: Validation of a low-cost human papillomavirus genotyping assay based on PGMY PCR and reverse blotting hybridization with reusable membranes. J Clin Microbiol. 2011, 49 (10): 3474-3481. 10.1128/JCM.05039-11.CrossRefPubMedPubMedCentral
21.
go back to reference Koneman E, Procop G, Schreckenberger P, Woods G: In Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th edition. Edited by Darcy P. 2006, USA: Lippincott Williams & Wilkins Koneman E, Procop G, Schreckenberger P, Woods G: In Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th edition. Edited by Darcy P. 2006, USA: Lippincott Williams & Wilkins
23.
go back to reference Tonon SA, Picconi MA, Zinovich JB, Nardari W, Mampaey M, Badano I, Di Lello F, Galuppo JA, Alonio LV, Teyssie AR: Human papillomavirus cervical infection in Guarani Indians from the rainforest of Misiones, Argentina. Int J Infect Dis. 2004, 8 (1): 13-9. 10.1016/j.ijid.2003.03.001.CrossRefPubMed Tonon SA, Picconi MA, Zinovich JB, Nardari W, Mampaey M, Badano I, Di Lello F, Galuppo JA, Alonio LV, Teyssie AR: Human papillomavirus cervical infection in Guarani Indians from the rainforest of Misiones, Argentina. Int J Infect Dis. 2004, 8 (1): 13-9. 10.1016/j.ijid.2003.03.001.CrossRefPubMed
24.
go back to reference Picconi MA, Gronda J, Alonio LV, Villa LL, Sichero L, Miranda S, Barcena M, Teyssie A: Human Papilloma virus in Quechua women from Jujuy with high frequency of cervical cancer: viral types and HPV-16 variants. Medicina (B Aires). 2002, 62 (3): 209-20. Picconi MA, Gronda J, Alonio LV, Villa LL, Sichero L, Miranda S, Barcena M, Teyssie A: Human Papilloma virus in Quechua women from Jujuy with high frequency of cervical cancer: viral types and HPV-16 variants. Medicina (B Aires). 2002, 62 (3): 209-20.
25.
go back to reference Brito EB, Silva ID, Stávale JN, Taromaru E, Menezess RC, Martins SJ: Amerindian women of the Brazilian Amazon and STD. Eur J Gynaecol Oncol. 2006, 27 (3): 279-281.PubMed Brito EB, Silva ID, Stávale JN, Taromaru E, Menezess RC, Martins SJ: Amerindian women of the Brazilian Amazon and STD. Eur J Gynaecol Oncol. 2006, 27 (3): 279-281.PubMed
26.
go back to reference Ong CK, Bernard HU, Villa LL: Identification of genomic sequences of three novel human papillomavirus sequences in cervical smears of Amazonian Indians. J Infect Dis. 1994, 170: 1086-1088. 10.1093/infdis/170.5.1086.CrossRefPubMed Ong CK, Bernard HU, Villa LL: Identification of genomic sequences of three novel human papillomavirus sequences in cervical smears of Amazonian Indians. J Infect Dis. 1994, 170: 1086-1088. 10.1093/infdis/170.5.1086.CrossRefPubMed
27.
go back to reference Nicita G, Reigosa A, Torres J, Vázquez C, Fernández Y, Maritza A, Núñez N, Magris M: Infección por virus del papiloma humano (VPH) en una población indígena del Amazonas venezolano. Revista de la Facultad de Ciencias de la Salud. Universidad de Carabobo. 2010, 14 (1): 51-9. Nicita G, Reigosa A, Torres J, Vázquez C, Fernández Y, Maritza A, Núñez N, Magris M: Infección por virus del papiloma humano (VPH) en una población indígena del Amazonas venezolano. Revista de la Facultad de Ciencias de la Salud. Universidad de Carabobo. 2010, 14 (1): 51-9.
28.
go back to reference Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, de Sanjosé S: Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010, 202 (12): 1789-99. 10.1086/657321.CrossRefPubMed Bruni L, Diaz M, Castellsagué X, Ferrer E, Bosch FX, de Sanjosé S: Cervical human papillomavirus prevalence in 5 continents: meta-analysis of 1 million women with normal cytological findings. J Infect Dis. 2010, 202 (12): 1789-99. 10.1086/657321.CrossRefPubMed
29.
go back to reference Bosch FX, Burchell AN, Schiffman M, Giuliano AR, de Sanjose S, Bruni L, Tortolero-Luna G, Kjaer SK, Muñoz N: Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia. Vaccine. 2008, 26 (10): K1-16.CrossRefPubMed Bosch FX, Burchell AN, Schiffman M, Giuliano AR, de Sanjose S, Bruni L, Tortolero-Luna G, Kjaer SK, Muñoz N: Epidemiology and natural history of human papillomavirus infections and type-specific implications in cervical neoplasia. Vaccine. 2008, 26 (10): K1-16.CrossRefPubMed
30.
go back to reference Kasamatsu E, Páez M: Cervical cancer and human papiloma virus in Paraguay prospects for primary prevention. Mem Inst Investig Cienc Salud. 2006, 4 (2): 58-63. Kasamatsu E, Páez M: Cervical cancer and human papiloma virus in Paraguay prospects for primary prevention. Mem Inst Investig Cienc Salud. 2006, 4 (2): 58-63.
31.
go back to reference Kitchener HC, Castle PE, Cox JT: Chapter 7: achievements and limitations of cervical cytology screening. Vaccine. 2006, 24 (suppl 3): S63-S70.CrossRef Kitchener HC, Castle PE, Cox JT: Chapter 7: achievements and limitations of cervical cytology screening. Vaccine. 2006, 24 (suppl 3): S63-S70.CrossRef
32.
go back to reference Sankaranarayanan R, Thara S, Sharma A, Roy C, Shastri S, Mahé C, Muwonge R, Fontanière B, Multicentre Study Group on Cervical Cancer Early Detection in India: Accuracy of conventional cytology: results from a multicentre screening study in India. J Med Screen. 2004, 11 (2): 77-84. 10.1258/096914104774061056.CrossRefPubMed Sankaranarayanan R, Thara S, Sharma A, Roy C, Shastri S, Mahé C, Muwonge R, Fontanière B, Multicentre Study Group on Cervical Cancer Early Detection in India: Accuracy of conventional cytology: results from a multicentre screening study in India. J Med Screen. 2004, 11 (2): 77-84. 10.1258/096914104774061056.CrossRefPubMed
33.
go back to reference Menéndez C, Castellsagué X, Renom M, Sacarlal J, Quintó L, Lloveras B, Klaustermeier J, Kornegay JR, Sigauque B, Bosch FX, Alonso PL: Prevalence and risk factors of sexually transmitted infections and cervical neoplasia in women from a rural area of southern Mozambique. Infect Dis Obstet Gynecol. 2010, 2010: 1-9.CrossRef Menéndez C, Castellsagué X, Renom M, Sacarlal J, Quintó L, Lloveras B, Klaustermeier J, Kornegay JR, Sigauque B, Bosch FX, Alonso PL: Prevalence and risk factors of sexually transmitted infections and cervical neoplasia in women from a rural area of southern Mozambique. Infect Dis Obstet Gynecol. 2010, 2010: 1-9.CrossRef
34.
go back to reference Smith JS, Bosetti C, Muñoz N, Herrero R, Bosch FX, Eluf-Neto J, Meijer CJ, Van Den Brule AJ, Franceschi S, Peeling RW, IARC multicentric case–control study: Chlamydia trachomatis and invasive cervical cancer: a pooled analysis of the IARC multicentric case-control study. Int J Cancer. 2004, 111 (3): 431-439. 10.1002/ijc.20257.CrossRefPubMed Smith JS, Bosetti C, Muñoz N, Herrero R, Bosch FX, Eluf-Neto J, Meijer CJ, Van Den Brule AJ, Franceschi S, Peeling RW, IARC multicentric case–control study: Chlamydia trachomatis and invasive cervical cancer: a pooled analysis of the IARC multicentric case-control study. Int J Cancer. 2004, 111 (3): 431-439. 10.1002/ijc.20257.CrossRefPubMed
35.
go back to reference Gillet E, Meys JF, Verstraelen H, Bosire C, De Sutter P, Temmerman M, Broeck DV: Bacterial vaginosis is associated with uterine cervical human papillomavirus infection: a meta-analysis. BMC Infect Dis. 2011, 11: 10-10.1186/1471-2334-11-10.CrossRefPubMedPubMedCentral Gillet E, Meys JF, Verstraelen H, Bosire C, De Sutter P, Temmerman M, Broeck DV: Bacterial vaginosis is associated with uterine cervical human papillomavirus infection: a meta-analysis. BMC Infect Dis. 2011, 11: 10-10.1186/1471-2334-11-10.CrossRefPubMedPubMedCentral
36.
go back to reference Koumans EH, Johnson RE, Knapp JS, St Louis ME: Laboratory testing for Neisseria gonorrhoeae by recently introduced nonculture tests: a performance review with clinical and public health. Clin Infect Dis. 1998, 27: 1171-1180. 10.1086/514994.CrossRefPubMed Koumans EH, Johnson RE, Knapp JS, St Louis ME: Laboratory testing for Neisseria gonorrhoeae by recently introduced nonculture tests: a performance review with clinical and public health. Clin Infect Dis. 1998, 27: 1171-1180. 10.1086/514994.CrossRefPubMed
Metadata
Title
Human papillomavirus and other genital infections in indigenous women from Paraguay: a cross-sectional analytical study
Authors
Laura Mendoza
Pamela Mongelos
Malvina Paez
Amalia Castro
Isabel Rodriguez-Riveros
Graciela Gimenez
Patricia Araujo
Gloria Echagüe
Valentina Diaz
Florentina Laspina
Wilberto Castro
Rosa Jimenez
Ramón Marecos
Santiago Ever
Gerardo Deluca
María Alejandra Picconi
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2013
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-13-531

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