In various countries epidemiologic studies show an association between human papillomavirus (HPV) and cancer of the uterine cervix. We determined the presence of HPV and the distribution of the different HPV genotypes in cervical carcinomas from Surinam, a high-incidence country. The results were compared to the Netherlands where the incidence is five times lower. One hundred thirty cervical carcinomas from patients in Surinam were randomly selected and compared to an unselected group of 128 cervical carcinomas from caucasoid Dutch patients. Presence of HPV and distribution of HPV genotypes was determined in DNA extracted from paraffin-embedded specimens by polymerase chain reaction and sequence analysis. HPV DNA was detected in 82% of the Surinamese cervical cancer patients and in 87% of the Dutch patients. Thirteen different HPV genotypes were detected in the Surinamese group, and nine different HPV genotypes were detected in the Dutch group. Among the HPV-positive samples, HPV 16 was present in 68% in the Netherlands compared to only 49% in Surinam, where less common genotypes such as HPV 35, 45, and 58 were more prevalent. The results show a strong association between HPV and cervical cancer in both groups. However, the observed significant variation in distribution of the genotypes in the two populations with a large difference in cervical carcinoma incidence is important to the general understanding of the etiology of cervical cancer and to the development of HPV vaccination strategies.