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Introduction
Cervical cancer represents the fourth most frequently
diagnosed malignancy in women and the fourth leading
cause of cancer-related demise worldwide (1-3). In
addition, human papillomavirus (HPV) infection is the
leading sexually-transmitted infection (STI) globally (4).
Multiple clinical and epidemiological reports have clearly
established the role of HPV infection as the primary
etiologic factor of cervical cancer (5-7). According to
their oncogenicity, HPVs are classified into high-risk
(HR), potential high-risk (pHR), and low-risk (LR)
groups. The oncogenic HR-HPV genotypes 16 and 18
are the most prevalent types in individuals with cervical
carcinoma or cervical intraepithelial neoplasia and are
implicated in more than 70% of cervical carcinoma cases
(8, 9). Conversely, the LR group genotypes 6 and 11 are
implicated in most cases of condylomata and genital warts
(10, 11). Given that HPV prevalence and distribution
differ geographically and within different populations,
there is a constant need for conducting HPV genotype
screening routinely.
In Jordan, the annual incidence of cervical cancer
is estimated at 50-60 cases with a 50% mortality rate
(12). These low figures could be largely attributed to
predominant conservative sexual practices in Jordan.
However, in recent years, globalization has tremendously
affected several aspects of social life. Unfortunately, no
recent report has examined whether this change has
affected HPV infection rates. Furthermore, these changes
in sexual practices might still be accompanied by the
underutilization of mechanical protection (condoms),
which significantly decreases the risk of STIs, which is
still a main concern in the Middle East region (13). In this
pilot study, Jordanian women attending the Gynecology
Clinic at Prince Hamza Hospital were screened to identify
the frequency of the HPV infection in this population.
Moreover, the distribution of HPV genotypes and the
extent of multiple HPV infections were studied in
Abstract
Objectives: Human papillomavirus (HPV) infection is the leading sexually-transmitted infection (STI) worldwide and the main
etiology of cervical cancer. HPV infection rates are important in directing vaccination policies and screening for cervical
cancer. Unfortunately, no recent reports have evaluated the prevalence of this infection among Jordanian women despite major
globalization-driven changes in sexual behavior. Accordingly, this study aimed to determine the prevalence of HPV infection and
its genotypic distribution in the cervical samples of Jordanian women.
Materials and Methods: The study was carried out at Prince Hamza Hospital (Amman, Jordan) during 2016-2017. Women (15-
75 years old) were randomly selected for cervical cell collection. DNA was extracted and then amplified using MY09/11 and
GP5+/6+ consensus primers. Finally, positive samples were genotyped by applying real-time- polymerase chain reaction and
reverse line blotting.
Results: Fourteen out of 348 women tested positive for HPV with a prevalence rate of 4%. In addition, multiple HPV genotypes
were observed in 36% (5/14) of infected women while single HPV genotype infection was found in 64% (9/14) of infected women.
Further, high-risk (HR), potential high-risk (pHR), and low-risk (LR) HPV genotypes were detected in most cases with a 78.6%
(11/14) infection rate, 42.9% (6/14), and 7.1% (1/14) of infected women, respectively. Eventually, 10 different genotypes were
detected in infected women and HPV 16 was the most common type (42.9%, 6/14).
Conclusions: Our data suggest that the prevalence of HPV infection among Jordanian women is below the global and regional
rates. It is hoped that these data should facilitate the implementation of appropriate cervical cancer screening and future HPV
vaccination programs.
Keywords: Human papillomavirus, Real-time PCR, HPV 16, Prevalence, Jordan, Cervical cancer
Prevalence and Genotype Distribution of Human
Papillomavirus Among a Subpopulation of Jordanian
Women
Ashraf I. Khasawneh1*
ID
, Fida F. Asali2
ID
, Rami M. Kilani2
ID
, Jumana A. Abu-Raideh1
ID
, Nisreen M.
Himsawi1
ID
, Muna A. Salameh3
ID
, Ghadeer H. Al Ghabbiesh4
ID
, Tareq Saleh1
ID
Open Access Original Article
International Journal of Women’s Health and Reproduction Sciences
Vol. 9, No. 1, January 2021, x–x
http://www.ijwhr.net doi 10.15296/ijwhr.2021.xx
ISSN 2330- 4456
Received 7 November 2019, Accepted 20 January 2020, Available online 14 February 2020
1Department of Basic Medical Sciences, Faculty of Medicine, the Hashemite University, Zarqa, Jordan. 2Department of Obstetrics and Gynecology,
Faculty of Medicine, the Hashemite University, Zarqa, Jordan. 3Department of Basic Medical Sciences, College of Medicine, Al-Balqa’ Applied
University, Al-Salt, Jordan. 4Molecular Biology Department, MedLabs Consultancy Group, Amman, Jordan
*Corresponding Author: Ashraf I. Khasawneh, Tel: +962 (5) 3903333(5562), E-mail: ashrafkh@hu.edu.jo
Khasawneh et al
International Journal of Women’s Health and Reproduction Sciences, Vol. 9, No. 1, January 2021
2
women from the region of Amman, Jordan. To the best
of our knowledge, this is the first report that provides
epidemiologic data on HPV infection and highlights its
prevalence and genotype distribution in a general female
subpopulation from a local area in Jordan.
The identification of specific HPV genotypes in the
clinical setting is critical for accurate diagnostic workup,
treatment planning, and prediction of the prognosis of
HPV infection-related pathologies in certain populations.
Accordingly, our results provide essential information to
guide the future planning of public prevention programs
and the potential use of HPV type-specific vaccines,
ultimately, leading to an overall reduction in the incidence
of cervical cancer in Jordan.
Materials and Methods
Specimen Collection
Cervical samples were collected from 380 healthy, married
Jordanian females aged 18-70 years. Women attending
the Gynecology Clinic at Prince Hamza Hospital as part
of a routine gynecological exam were recruited during
2016-17. Single unmarried women, pregnant women, and
those with previous hysterectomy or previously diagnosed
with cervical cancer were excluded from this study. The
samples were obtained using a Digene cervical brush,
and then transferred into sterile tubes containing 2 mL
of phosphate buffer saline, and finally, stored at 4ºC for
DNA extraction (14). The Institutional Review Board
approvals of this study were obtained from the Hashemite
University and Prince Hamzah Hospital according to
the established guidelines. All participating individuals
signed an informed consent form, along with a structured
questionnaire.
Nucleic Acid Extraction
Cervical samples were vortexed to dissociate the cells
and centrifuged at 10 000 rpm for 5 minutes. Then the
supernatant was discarded and DNA was extracted from
cervical samples using the DNeasy Blood and Tissue Kit
(Qiagen, USA) according to the manufacturer’s protocol.
Next, DNA was eluted in 200 µL of the Adams–Evans
buffer and stored at -20ºC for subsequent processing.
Eventually, DNA concentration was measured using the
Qubit 3.0 Fluorometer (Thermo Fisher Scientific, USA) as
detailed by the manufacturer.
HPV Detection Through Conventional Polymerase Chain
Reaction
A touchdown Polymerase Chain Reaction (PCR) was
used to amplify the conserved sequences of the HPV L1
gene by employing the consensus GP5+/GP6+ primer
set. As previously mentioned, touchdown PCR enhances
the detection of HPV-positive samples compared to the
conventional PCR (15). The applied primer sets in this
study are listed in Table 1. The PCR for the GP5+/GP6+
primer set was carried out in a 25 µL final volume using
the HotStarTaq Master Mix (Qiagen, USA) as reported
previously (15). To increase the yield of HPV-positive
sample detection, the MY09/MY11 primer set was also
used to screen cervical samples for HPV infection (16).
Moreover, PCR for the MY09/MY11 primer set was
conducted in a 25 µL final volume by utilizing HotStarTaq
Master Mix (Qiagen, USA) under the conditions of initial
denaturation at 95ºC for 15 minutes, followed by 40 cycles
at 94, 55, and 72ºC for 45, 45, and 45 seconds, respectively,
with a final extension step of 72ºC for 5 minutes. All PCR
runs included a negative control (no DNA template) and
a positive control (HPV 16 or 18) thankfully provided
by MedLabs Consultancy Group (Amman, Jordan).
Additionally, the human Beta-globin gene was employed
as an internal control to check for the quality and adequacy
of the extracted DNA. Then, the electrophoresis of PCR
products was conducted using a 2% agarose gel stained
with ethidium bromide, and finally, visualized using UV
transillumination (Alpha Innotech, USA).
►HPV prevalence among women in Jordan is 4%.
►HPV 16 is the most common subtype identified in 43%
of infected Jordanian women.
►The introduction of the HPV bivalent vaccine as part
of the national vaccination program is recommended.
Key Messages
Table 1. Primer Sequences Used for HPV Amplification
Primer Name Target Gene Primer Sequence Band Size
MY09 HPV L1 5’-CGTCCMARRGGAWACTGATC-3’ 450 bp
MY11 5’-GCMCAGGGWCATAAYAATGG-3’
GP5+ HPV L1 5’-TTTGTTACTGTGGTAGATACTAC-3’ 150 bp
GP6+ 5’-GAAAAATAAACTGTAAATCATATTC-3’
BG-F β-globin 5’-GAAGAGCCAAGGACAGGTAC-3’ 268 bp
BG-R 5’-CAACTTCATCCACGTTCACC-3’
The table includes a detailed illustration of all the applied primer sequences for detecting positive HPV samples. Consensus HPV primers were used to detect
the HPV L1 gene sequence.
Note. HPV: Human papillomavirus.
Khasawneh et al
International Journal of Women’s Health and Reproduction Sciences, Vol. 8, No. 4, October 2020 3
HPV Genotyping
Two methods were used for HPV genotype identification,
including the real-time PCR (RT-PCR) kit and a reverse
line blot kit (AB ANALITICA, Italy). REALQUALITY
RQ-Multi HPV detection is an in vitro diagnostic kit
which is capable of identifying 28 HPV types including
14 HR (16,18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and
68), 6 pHR (26, 53, 67, 70, 73, and 82), and 8 LR (6, 11, 40,
42, 43, 44, 55, and 83) genotypes (17). This kit amplifies a
fragment in the regions of E6 and E7 in the HPV genome
and detects different genotypes as a pool except for
HPV 16 and HPV 18 which are detected individually. In
addition, the kit includes an internal control (human beta-
globin) to monitor for the quality of DNA extraction and
the amplification process. Further, it provides a negative
control (nuclease-free water) and a positive control
(plasmid DNA contains the fragments of HPV 16, 18, and
33 for HR-HPV, along with the fragments of HPV 6, 11,
and 26 genotypes for LR-HPV).
The inconclusive results of a single genotype were further
analyzed with AMPLIQUALITY HPV-TYPE EXPRESS
(version 3.0, AB ANALITICA, Italy) according to the
manufacturer
’
s instructions (18). This kit can identify 40
HPV individual genotypes based on the amplification of
a 145-bp fragment in the L1 region of the HPV genome,
followed by a reverse line blot assay. Furthermore, the
kit includes a housekeeping gene control and a plasmid
DNA with fragments of the HPV 61 genotype as a positive
control.
Statistical Analysis
All statistical calculations were performed using SPSS
software, version 22 (IBM, USA), and the chi-square test
was the main tool for testing differences in proportions.
In this study, a P < 0.05 was used as the point of statistical
significance.
Results
This cross-sectional study recruited 380 females attending
the Gynecology Clinic at Prince Hamza Hospital as part
of a routine gynecological exam. Of 380 collected samples
collected, a few had no cells, looked turbid, or were
extremely bloody, and thus were excluded from the study.
Some cervical samples yielded no housekeeping gene
(β-globin) and thus were not further processed. However,
most samples tested positive for internal control (Figure
1A). The remaining 348 samples were further analyzed by
the PCR using MY09/11 and the GP5+/6+ primers (Figure
1B-C). MY09/11 and the GP5+/6+ are L1 consensus
primer sets that are routinely used for detecting HPV
DNA using the PCR (16). Samples that demonstrated a
strong positive (a sharp band) or a possibly positive (a faint
band) were further analyzed by the RT-PCR in order to
confirm or rule out the presence of HPV infection (Figure
2A). Moreover, the indeterminate HPV genotype in the
RT-PCR was further tested for using the reverse line blot
assay (Figure 2B), and the prevalence of HPV infection in
the studied population was 4%.
Table 2 summarizes the demographic data and risk
factors for the studied group. Based on the data, the mean
age of women in the studied population was 42.61 ± 10.95,
and there was no difference in the mean age between
HPV positive and negative women. Furthermore, other
demographic data such as educational level, marital status,
and body mass index revealed no significant differences
between the two populations. Finally, risk factors such as
the onset of sexual activity, pregnancy, abortion, alcohol,
and tobacco use also demonstrated an insignificant
variability between HPV positive and negative groups.
As mentioned earlier in Table 3, 14 women were infected
with HPV with a prevalence of 4%. Additionally, 36%
(5/14) of women were found to be infected with multiple
HPV genotypes while 64% (9/14) of them showed single
HPV genotype infection. Based on the results, HPV low-
risk infection was detected in 7.1% (1/14) of women
whereas the pHR HPV infection was observed in 42.9%
(6/14) of women. Similarly, infection with high-risk HPV
was detected in the majority of cases with a 78.6% (11/14)
infection rate. A total of 10 different HPV genotypes were
detected as well (Table 3). HPV type 16 was the most
common type (42.9%, 6/14), followed by HPV 53 and 73
Figure 1. PCR of β-globin and HPV consensus primers MY09/11 and
GP5+/6+. A. A 268 bp band representing the presence of β-globin genes
in all six cervical samples is shown, samples with negative β-globin were
excluded from the study. B. PCR amplification with the MY09/11 primer
yielded a 450 bp band. C. GP5+/6+ primer amplified a 150 bp band. Arrows
represent HPV positive samples, while stars represent a possible positive
HPV sample that needs further testing, unmarked samples represent an HPV
negative sample. M: DNA ladder, NC: Negative control, PC: Positive control.
Khasawneh et al
International Journal of Women’s Health and Reproduction Sciences, Vol. 9, No. 1, January 2021
4
(21.4%, 3/14), HPV 18, 68, 70, and 82 (14.3%, 2/14), and
HPV 6, 35, and 53 (7.1%, 1/14).
Based on data in Table 3, 14 women were infected
with HPV with a prevalence of 4%. The results revealed
that 36% (5/14) of women were infected with multiple
HPV genotypes while 64% (9/14) of them demonstrated
single HPV genotype infection. In addition, HPV low-
risk infection was detected in 7.1% (1/14) of women
whereas the pHR HPV infection was observed in 42.9%
(6/14) women. Eventually, infection with high-risk HPV
was found in the majority of cases with a 78.6% (11/14)
infection rate. In general, 10 different HPV genotypes
were detectable (Table 3). Accordingly, HPV type 16 was
the most common type (42.9%, 6/14), followed by HPV
53 and 73 (21.4%; 3/14), HPV 18, 68, 70, and 82 (14.3%,
2/14), and HPV 6, 35, and 53 (7.1%, 1/14).
Discussion
The pathogenic role of HPV infection in cervical cancer
is well identified. It is expected that sexually active men
and women eventually acquire an infection with a strain
of HPV during their lifetimes with an associated increased Table 2. Demographic Data and the Risk Factors of Women Included in the
Study
Variable HPV (-) HPV (+) P Value
Age (y)
-
(n=348)
42.61 ± 10.89
(334)
42.73 ± 10.95
(14)
39.71 ± 9.38
Marital status
0.689
Married (n=331) 91.4% (318) 3.7% (13)
Separated (n=17) 4.6% (16) 0.3% (1)
Education
0.976≤ 9 years (n=123) 33.9% (118) 1.4% (5)
≥ 9 years (n=225) 62.1% (216) 2.6% (9)
Onset of sexual activity
0.471≤ 18 years (n=77) 21.6% (75) 0.6% (2)
≥ 18 years (n=271) 74.4% (259) 3.4% (12)
Pregnancy
0.819None (n=20) 5.5% (19) 0.3% (1)
One or more (n=328) 90.5% (315) 3.7% (13)
Abortions
0.619No (n=227) 62.4% (217) 2.9% (10)
Yes (n=121) 33.6% (117) 1.1% (4)
Body mass index
0.727
≤ 29 (n=183) 50.3% (175) 2.3% (8)
≥ 30 (n=165) 45.7% (159) 1.7% (6)
Tobacco
0.887Yes (n=80) 22.1% (77) 0.9% (3)
No (n=268) 73.9% (257) 3.1% (11)
Alcohol
0.680
Yes (n=4) 1.1% (4) 0% (0)
No (n=344) 94.8% (330) 4% (14)
The table describes several demographic parameters of the participating
subjects, including age, marital status, education, and the onset of sexual
activity. It also provides the quantification of several risk factors associated
with cervical cancer.
Note. HPV: Human papillomavirus.
risk of cancer development in both populations (19).
The increasing rates of HPV-associated malignancies
have guided the implementation of rigorous vaccination
protocols against HPV and the development of screening
protocols for cervical cancer (20). On the contrary,
cultural and religious conservatism in the Middle East is
expectedly a major contributor to the lower prevalence
of HPV infection in comparison to Western societies,
particularly among females (21). However, certain sexual
behaviors are gradually being adopted in Arab countries
due to globalization, suggesting the possibility of changes
in HPV infection rates, especially in the last few years.
These changes would certainly require the reassessment
of the currently implemented strategies to lower the risk
of cervical cancer among women living in the Middle
East, including Jordan. Unfortunately, there are no recent
reports estimating the prevalence of HPV infection, and so
far, this has been the first study that has directly reported
this issue among Jordanian women.
Figure 2. A Representative RT-PCR and Reverse Line Blot Strip Analysis
(A) A RT-PCR run using REALQUALITY RQ-Multi HPV detection kit. A single
demonstrative run for 20 samples using the cy5 channel is shown which
detects an individual genotype (HPV 18). The 3S-shaped curves represent
the positive control (PC) and two positive samples (S1 and S2) while the
remaining samples and the negative control (NC) run along the baseline.
(B) A reverse line blot HPV genotyping test strip showing colored bands
corresponding to HPV68 73 and 82. The strip is coated with a staining
control, an amplification control, and a universal HPV band. Note. RT-PCR:
Real-time polymerase chain reaction; HPV: Human papillomavirus.
Khasawneh et al
International Journal of Women’s Health and Reproduction Sciences, Vol. 8, No. 4, October 2020 5
In our study, the prevalence of HPV infection was 4%
(14/348) in women attending the Gynecology Clinic at
Prince Hamza Hospital (Amman, Jordan). This prevalence
rate was in accordance with that of a recent study done at
King Hussein Cancer Center in Amman, showing a 3.8%
abnormal Pap smear rate among a total of 5,529 routine
tested smears (22). Our results showed slightly higher
HPV infection rates when compared to other local studies
that demonstrated a low prevalence of cervical epithelial
cell abnormality as an indicator of HPV infection (23).
This favors the expectation that the number of HPV-
positive and thus individuals at the risk of cervical cancer
is increasing.
It should be noted that the HPV infection rate varies in
different countries, with a global prevalence of 11.7% (24).
The highest infection rates were recorded in Africa (21%),
followed by Central America and Mexico (13%), and
then North America, Europe, and Asia with 4.7%, 14.2%,
and 9.4%, respectively (24). In the Middle East, HPV
prevalence studies are scarce. However, in recent years, a
number of studies have emerged in Iran, Kuwait, Qatar,
Iraq, Saudi Arabia, Bahrain, and Palestine, reporting
10.3%, 9.3%, 7.6%, 12.5%, 9.8%, 9.8%, 13%, and 4.9%
prevalence rate of HPV infection, respectively (25-31). In
comparison with these numbers, the infection rate in this
study is the lowest in the region. Several reasons might
account for this difference and are mainly attributed to
cervical sample collection bias. This is because these
samples were collected only from women attending one
gynecology clinic. Furthermore, HPV infections might be
transient, and thus the infection rate might change with
time and reflects only the current time-point.
Our results further showed that 36% and 64% of infected
women had mixed or single HPV infection, respectively,
which is in agreement with the findings of Martins et
al (32) representing mixed infection in 113 cases (35%)
compared to 210 cases (65%) of single genotype infection
(Table 4). Moreover, 71% (10/14) of HPV infections were
reported in women with a mean age of 34 years while
the prevalence reduced to 4 cases only with a mean age
of 54 years (the data are not presented). Our findings are
consistent with those of other studies which demonstrated
that the frequency of HPV infection decreases with age
(31-33). On the other hand, AlObaid et al reported an
increase in the frequency of HPV infection with age,
suggesting community-specific differences (27).
The most prevalent HPV in this study was genotype 16
at 42.9%, which is in line with the findings of most studies
conducted in the region (28,31,33,34), and other areas of
the world where the HPV vaccine was not implemented
effectively (32,35). Other results in this study might
deviate from the findings reported elsewhere due to a
difference in the age group compared to other studies.
In the present study, the mean age was almost 43 years,
which is 20-25 years more than the peak age incidence
of HPV infection (36). Another reason might be sexual
and socio-behavioral differences governed by cultural and
religious values in a conservative community.
Finally, factors such as women’s immune status, parity,
smoking, and alcohol play a role in the progression of
Table 3. HPV Genotypes Distribution Among HPV Positive Women (n=14)
Sample Number HPV Genotype
HR pHR LR
1 16, 35, 56 70, 73
2 18, 68
3 73
4 70
5 53
6 18
7 16
8 16
9 16
10 68 73, 82
11 16 6
12 56
13 56 82
14 16
Samples numbered 1-14 represent HPV positive women. In addition, samples
1, 2 10, 11, and 13 show mixed HPV infection while the others demonstrate
single HPV genotype infection. Further, genotypes 16, 18, 35, 56, and 68
represent high-risk HPV while 53, 70, 73, and 82 are considered as pHR
genotypes. Finally, HPV 6 is a low-risk genotype.
Note. HPV: Human papillomavirus; HR: High-risk; pHR: Potential high-risk;
LR: Low-risk.
Table 4. HPV Genotypes in Infected Women
HPV Prevalence/Genotype n %
Single infection 9 64.3
Multiple infection 5 35.7
Any LR-HPV 1 7.1
6 1 7.1
Any pHR-HPV 6 42.9
53 1 7.1
70 2 14.3
73 3 21.4
82 2 14.3
Any HR-HPV 11 78.6
16 6 42.9
18 2 14.3
35 1 7.1
56 3 21.4
68 2 14.3
Single HPV genotype infection was noticed in 64.3% of HPV positive women
while 35.7% of them had mixed HPV infection. The frequency of infection
for each genotype is displayed as the number of HPV positive cases (n) and
percentage (%).
Note. HPV: Human papillomavirus; HR: High-risk; pHR: Potential high-risk;
LR: Low-risk.
Khasawneh et al
International Journal of Women’s Health and Reproduction Sciences, Vol. 9, No. 1, January 2021
6
HPV infection into pre-cancerous or cancerous lesions
(37). Nonetheless, the above-mentioned factors had no
significant association with HPV infection in the current
study.
Bivalent and quadrivalent vaccines provide coverage
against the HR HPV 16 and 18. Moreover, some recent
studies have reported cross-protection against HR non-
vaccine genotypes (37,38). Considering that most HPV
infections in Jordan are caused by HPV 16, Jordanian
women might benefit from the introduction of the bivalent
vaccine to provide protection against cervical cancer.
Eventually, this study had some limitations. First, the
samples were taken from women visiting a gynecology
clinic in a single hospital in Jordan, and this renders our
samples non-representative of the Jordanian population.
In addition, the interpretation of the genotyping data
might be affected by the limited sample size and the low
number of HPV positive women (n=14). Finally, single
women with no previous history of sexual intercourse
were excluded from sample collection due to the
inability to perform Pap smears on patients with intact
hymens. Unfortunately, the current screening practice
in the country excludes the inclusion of single women
from routine cervical swab collection. Thus, these data
represent HPV prevalence in married or separated
Jordanian women. Accordingly, future studies are directed
toward estimating the prevalence of the HPV of a larger,
more representative population of Jordanian women. This
includes collecting cervical samples from several health
institutions providing gynecological care spread over all
Jordanian governorates of both private and public sectors.
We also believe that it is important to investigate the use
of new tools that allow the detection of HPV infection
in single women since their exclusion continues to be a
major drawback for a more accurate estimation of the
HPV infection prevalence rate in Jordan.
Conclusions
To the best of our knowledge, this study is the first one
to evaluate the prevalence of HPV infection in Jordan.
It has been also shown that the HPV infection rate in
Jordan is considered the lowest in the Middle East and
Gulf countries. However, the current numbers suggest a
potential increase in infection rates when compared to
previous reports on the prevalence of cervical dysplasia.
This study has enabled us to obtain a rough estimation of
the HPV prevalence in Jordan and to realize circulating
genotypes in the local community. Finally, the finding
suggests that future vaccination programs should include
HPV bivalent vaccine since HPV 16 is the most common
subtype among infected Jordanian women.
Authors’ Contribution
Conceptualization, validation, formal analysis, original draft preparation,
supervision, funding acquisition: AIK. Methodology: JAAR, NMH, MAS,
and GHAG. Investigation, and sample collection: RMK and FFA. Review
and editing: TS.
Conflict of Interests
Authors declare that they have no conflict of interests.
Ethical Issues
The research project was approved by the institutional review boards of
The Hashemite University (ethics no. 7/2.2015/2016) and Prince Hamza
Hospital (ethics no. MH/32/112).
Financial Support
This project was funded by a grant provided by the Scientific Research
Deanship, Hashemite University, Jordan.
Acknowledgments
The authors would like to thank Noor Bondoqgi for her contribution
at the clinic, Prince Hamzah Hospital. Special thanks also go to Dr.
George Sahyoun from the MedLabs Consultancy Group for providing
HPV positive controls.
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