Prevalence of HPV infection by cytologic diagnosis and HPV DNA extraction and prevalence of the HPV genotypes detected in urban Turkish women

Objective

To evaluate the prevalence of the different human papillomavirus (HPV) genotypes in women seen at 2 Marmara University Hospital gynecologic outpatient clinics in Istanbul, Turkey.

Methods

From May 1 through August 31, 2008, specimens were obtained from 500 women for cytologic evaluation by the split-sample method. HPV types were identified by PCR and hybridization using a microarray that identifies 35 types.

Results

The overall prevalence of HPV was 16.5%, multiple genotypes were found in 35.8% of the infected women, and 75% of the types were high risk; 79% of the infected women had negative cytologic results, 3.7% had ASCUS, 10% had LSIL, and 6% had HSIL; the highest infection rates were 36% for women aged 20 to 30 years and 35% for those aged 31 to 40 years; 65.2% of the infected women were university graduates; and 34% were single.

Conclusion

HPV infection involved numerous types, most of them high risk, even in women with negative cytology results. Further studies with larger groups will provide more information on HPV distribution in Turkey, which may guide the development of local vaccination programs.     

Prevalence of human papillomavirus genotypes among women in Hunan province,China

Objective

Human papillomavirus (HPV) infection has been implicated as a causative factor of cervical cancer. This study aimed to examine HPV genotype distribution and prevalence among women in Hunan province, mid-south China.

Study design

Cervical samples were collected from 3640 women for cervical cancer screening. Participants were screened by cytology, and HPV genotyping was performed by DNA chip.

Results

Of the 3640 cases, 22.6% (822/3640) were HPV DNA positive, of whom 19.0% (156/822) had multiple infections and 20.0% (726/3640) were confirmed to have high-risk HPV infection. The most common HPV genotype was HPV-16, followed by -52, -58, -18, -6 and -39. Cytological examination showed that the HPV positive rate was 59.3% (80/135) in women with atypical squamous cells of undetermined significance, 66.1% (111/168) in women with low-grade squamous intra-epithelial lesions, 72.6% (106/146) in women with high-grade squamous intra-epithelial lesions, and 87.2% (68/78) in women with invasive cervical cancer, all of which were significantly higher than the rate in women with normal squamous cells (14.3%, 451/3115).

Conclusion

This is the first study to report the prevalence and genotype distribution of HPV infection among women in Hunan province, China. The findings provide important guidance for a vaccination programme in this region aimed at immunizing women before they are infected with HPV.     

Study on the prevalence of human papillomavirus in the anal canal of women with cervical intraepithelial neoplasia grade III

Objective

The objective was to evaluate the prevalence of human papillomavirus (HPV) in the anal canal of women with cervical intraepithelial neoplasia (CIN) grade III.

Study design

Two groups were compared. In group I (study group), 40 women who had undergone cervical biopsy with a histopathological result indicating CIN III were evaluated. Group II (control) consisted of 40 women with normal results from colposcopic examination and colpocytological tests. The women in group I who presented high-grade neoplasia in colpocytological tests underwent collection of material from the uterine cervix and anal canal for investigating HPV DNA using the Hybrid Capture II^® technique. Colposcopy and cervical biopsy were then performed. If CIN III was confirmed, HPV DNA was investigated in the material collected. In group II, colpocytological tests and colposcopy were performed and, if normal, the procedure was similar to that followed for group I, except that no biopsy was performed.

Results

In group I, 39 women (97.5%) were positive for HPV in the uterine cervix and 14 women (35%) in the anal canal. In group II, only four women (10%) had a positive HPV test, for both the uterine cervix and the anal canal.

Conclusions

The prevalence of HPV in the anal canal of the women with CIN III was greater than in the women without CIN III.     

深圳市不同职业人群感染HPV的优势亚型

目的研究深圳市不同职业人群感染HPV的优势亚型。方法调查深圳市5种职业人群,共计2045名妇女,其中中小学教师130人、外来劳务工385人、服务业从业人员316人、特困下岗职工199人、医务人员420人,并以自然人群——某社区居民595人为对照。采用HPV基因芯片方法检测HPV亚型。结果在所研究的人群中HPV感染频度由高到低的前5位HPV亚型依次为HPV-16（27．2％）、18（14．7％）、58（13．8％）、33（6．25％）、11（6．25％）。高危型HPV在人群中所占的比例合计占95．36％,而低危型HPV仅占4．64％,二组相比,差异具有统计学意义（P〈0．05）;不同职业人群的HPV亚型分布有所不同;不同职业人群的HPV优势亚型有所不同,医务人员感染的最常见亚型是HPV-58型,而其他4种职业人群及社区居民的最常见亚型均为HPV-16型。结论不同职业人群的HPV优势亚型有所不同,医务人员感染的最常见亚型是HPV-58型,而其他4种职业人最常见亚型均为HPV-16型。     

Acceptability of self-collected versus provider-collected sampling for HPV DNA testing among women in rural El Salvador

Objective

To determine the acceptability of self-collected versus provider-collected sampling among women participating in public sector HPV-based cervical cancer screening in El Salvador.

Methods

Two thousand women aged 30–49 years underwent self-collected and provider-collected sampling with careHPV between October 2012 and March 2013 (Qiagen, Gaithersburg, MD, USA). After sample collection, a random sample of women (n = 518) were asked about their experience. Participants were questioned regarding sampling method preference, previous cervical cancer screening, HPV and cervical cancer knowledge, HPV risk factors, and demographic information.

Results

All 518 women approached to participate in this questionnaire study agreed and were enrolled, 27.8% (142 of 511 responding) of whom had not received cervical cancer screening within the past 3 years and were considered under-screened. Overall, 38.8% (n = 201) preferred self-collection and 31.9% (n = 165) preferred provider collection. Self-collection preference was associated with prior tubal ligation, HPV knowledge, future self-sampling preference, and future home-screening preference (P < 0.05). Reasons for self-collection preference included privacy/embarrassment, ease, and less pain; reasons cited for provider-collection preference were result accuracy and provider knowledge/experience.

Conclusion

Self-sampling was found to be acceptable, therefore screening programs could consider offering this option either in the clinic or at home. Self-sampling at home may increase coverage in low-resource countries and reduce the burden that screening places upon clinical infrastructure.     

“U” shape of age-specific prevalence of high-risk human papillomavirus infection in women attending hospitals in Shanghai,China

Objective

The purpose of the present study was to estimate the prevalence of high-risk human papillomavirus infection and the viral load in different age groups, to describe the distribution of human papillomavirus prevalence in women enrolled in two hospitals.

Study design

We retrospectively investigated 17,148 cases undergoing hybrid capture II between January 2005 and February 2007. The prevalence of human papillomavirus infection and the level of viral load were estimated in different age groups to describe the distribution in the cases.

Results

Human papillomavirus was detected in 5173 of 17,148 women (30.2%) aged 17–79 years. The highest prevalence appeared in the ≤20-year age group (45.2%). After age 20, the prevalence declined rapidly and then ascended slowly from 28.5% in the 21–30-year age group to 38.0% in the ≥61-year group. The mean viral load was 294.12 ± 511.66 relative light units/positive control in total human papillomavirus positive cases. The viral load of the 21–30-year age group was the lowest (271.99 ± 499.24 relative light units/positive control) and the highest was found in the ≥61-year interval (560.30 ± 672.87 relative light units/positive control). No significant correlation was found between viral load and the severity of cervical lesions.

Conclusions

Our study showed a “U” shape of age-specific prevalence of high-risk human papillomavirus infection occurring in women attending hospitals in Shanghai, China, similar to worldwide figures.     

Prevalence of genital human papillomavirus infection and genotypes among women from Fujian province, PR China

Objective

The prevalence and distribution of oncogenic human papillomavirus (HPV) genotypes in women who underwent screening for cervical cancer in Fujian province, China, were assessed and the correlation of genotypes with the histological results was evaluated.

Study design

Cervical samples were collected from 2338 women for cervical cancer screening. Participants were screened by liquid-based cytology and HPV genotyping using DNA Chip and referred to colposcopy and biopsy samples for further analyses if cytology results indicated undetermined significance (ASCUS) or higher.

Results

The prevalent types with cervical intraepithelial neoplasia 1 (CIN 1) were HPV-52 (22.5%), HPV-16 (11.6%) and HPV-CP8304 (10.1%). The prevalent types with cervical intraepithelial neoplasia 2 or 3 (CIN2/3) were HPV-16 (24.5%), HPV-33 (21.6%), and HPV-52 (19.6%). The prevalent types with carcinoma, including squamous cell carcinoma (SCC) and adenocarcinoma (ADCA), were HPV-16 (42.7%), HPV-18 (20.8%) and HPV-33 (12.5%). Analysis by odds ratio (OR) revealed that HPV-66, -68, and -CP8304 (HPV-CP8304: OR, 7.34; 95% confidence interval (CI) = 3.73-14.46) were associated with CIN 1; HPV-52 was CIN 2/3-associated type (OR, 7.25; 95%CI = 4.19-12.53); HPV-16, -18, -31, -33, -45, -53, -58, and -59 were associated with carcinoma (HPV-45: OR, 54.78; 95%CI = 10.49-286.16).

Conclusion

It was concluded that HPV infection in Chinese women in Fujian province showed higher frequencies of HPV-52 and HPV-33. However, HPV-16 was still the most common type in CIN2/3 and carcinoma. HPV-16, -18, -31, -33, -45, -53, -58 and -59 have more dominant oncogenic risk over other types in this area.     

HPV16 is associated with younger age in women with cervical intraepithelial neoplasia grade 2 and 3

Objective

To evaluate if women with HPV16 positive CIN2 and CIN3 are diagnosed at a younger age.

Methods

We conducted a population-based cohort study including more than 40,000 women having a liquid based cervical cytology sample taken as part of routine screening. HPV analysis was performed using Hybrid Capture 2 and LiPAv2. The study population was linked to the Danish Pathology Data Bank to retrieve information on subsequent cervical histology. We included HR HPV positive CIN2/3 samples, comprising 173 CIN2 and 467 CIN3 lesions. Due to a high number of multiple concurrent HPV infections, the causative HPV type was assigned to a hierarchically group.

Results

In CIN3, the estimated proportion of lesions positive for HPV16 was 68.1% among women aged 20 years and decreased to 38.9% among women aged 50 years. A decrease in HPV16 positivity with increasing age was also observed in CIN2. In a multinomial logistic regression analysis, young age was strongly associated with HPV16 positivity in CIN3 lesions (OR = 0.46 per 10 year increase in age, 95% CI: 0.32-0.65). The proportion of HPV16 and/or 18 positive lesions among women diagnosed with CIN2 and CIN3 below 30 years of age was 44% and 75%, respectively.

Conclusions

HPV16 positivity was significantly associated with younger age at diagnosis of CIN3. In a population vaccinated against HPV16 and 18, we will experience a shift to older ages in cervical precancerous lesions. These findings may imply that cervical cancer screening programs could start at an older age in HPV vaccinated populations.     

Genital human papillomavirus screening by gene chip in Chinese women of Guangdong province

BACKGROUND: Human papillomavirus (HPV) infections are associated with cervical cancer. There were only a few reports and detailed data about epidemiological research of HPV infection in general population of China. AIMS: To determine the prevalence of genital HPV infection in Chinese women of Guangdong province. METHODS: A total of 1705 women were screened by gene chip. All HPV-positive women were further examined by ThinPrep liquid-based cytology test (TCT), and the cervical biopsies of those women with positive HPV-DNA and abnormal TCT were collected for pathological diagnosis. RESULTS: The overall HPV prevalence was 9.03% (154 of 1705), and 72.3% (126 of 154) of total positive samples were high-risk types, with higher prevalence of types 52, 58, 16, 18 and CP8304. For women aged 51 years or older, the overall high-risk HPV prevalence was 12.2% (24 of 179), which was obviously higher than those of other age groups (P < 0.05). CONCLUSIONS: Our results showed that the HPV prevalence in Guangdong is very similar to the world level. Unlike most previous studies, our findings suggest that HPV prevalence increased with age, and that the predominant genotypes in this area were HPV 52 and 58.     

Oral and cervical HPV infection in HIV-positive and HIV-negative women attending a sexual health clinic in São Paulo,Brazil

Objective

To investigate the prevalence of HPV infections in the oral and cervical mucosa of HIV-positive and HIV-negative women attending a sexual health clinic.

Methods

One-hundred HIV-positive women and 100 HIV-negative women were recruited from a sexual health clinic in São Paulo, Brazil. All participants were given an oral and cervical examination. Cytologic samples were evaluated via HPV DNA test.

Results

In oral samples, HPV DNA was observed in 11 women from the HIV-positive group and 2 from the HIV-negative group. High-risk HPV subtypes were prevalent in both groups and no difference between groups was detected. HPV DNA was detected in cervical scrapings from 41 HIV-positive women and 45 HIV-negative women (P = 0.67). No participants showed oral lesions, whereas 15 HIV-positive and 17 HIV-negative women presented with macroscopic genital lesions.

Conclusion

HPV is detected more often in cervical scrapings than in oral samples. However, HPV oral shedding is more frequent in HIV-positive than in HIV-negative individuals. Concurrence of infection (high and low risk) was not observed in oral and cervical mucosa.     

Baseline characteristics and prevalence of HPV 6, 11, 16, 18 in young German women participating in phase III clinical trials of a quadrivalent HPV (6/11/16/18) vaccine

Introduction

As limited data among German women exist about HPV, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae, we report the prevalence of these genital infections and general baseline demographics of the young German women enrolled in the phase III trials of the quadrivalent HPV vaccine.

Materials and methods

German females (n = 437; 9–23 years) were recruited among 3 international phase 3 studies of an HPV-6/11/16/18 vaccine. We present baseline characteristics, prevalence of HPV-6/11/16/18 and, for women aged 16–23, abnormal cervical cytology and sexually transmitted diseases.

Results

Chlamydia trachomatis and Neisseria gonorrhoeae prevalence was 5 and 0.3%, respectively. Approximately 17% of participants had HPV-6, 11, 16, or 18 DNA or antibodies. All subjects <17 years were naïve to the four vaccine types.

Discussion

The results of the vaccine trials have demonstrated that it is worth administering prophylactic HPV vaccines before sexual debut; however, none of these sexually active German women were positive to all four types and most were positive to only one type. Thus, all women had the potential to benefit from vaccination with a quadrivalent HPV vaccine.     

Racial and Ethnic Differences in HPV Knowledge,Attitudes, and Vaccination Rates among Low-income African-American,Haitian, Latina,and Caucasian Young Adult Women

ObjectiveTo examine facilitators and barriers to HPV vaccine uptake in African-American, Haitian, Latina, and White women aged 18-22 and to determine vaccination completion rates among participants over 5 years.DesignUsing semi-structured interviews and medical record review, we assessed HPV knowledge and attitudes towards HPV vaccination among young women. We then determined their subsequent HPV vaccination initiation and completion rates. We used constructs from the Health Belief Model and methods based in grounded theory and content analysis to identify attitudes towards HPV vaccination cues to initiate vaccination, perception of HPV, and how communication about issues of sexuality may impact vaccine uptake.ParticipantsWe enrolled 132 African-American, Haitian, Latina, and White women aged 18-22 years who visited an urban academic medical center and 2 affiliated community health centers between the years 2007 and 2012.Main Outcome MeasuresIntent to vaccinate and actual vaccination rates.ResultsOf 132 participants, 116 (90%) stated that they were somewhat or very likely to accept HPV vaccination if offered by their physician, but only 51% initiated the vaccination over the next 5 years. Seventy-eight percent of those who initiated vaccination completed the 3 doses of the HPV vaccine series. Forty-five percent (45%, n = 50) of the adolescents who started the series completed 3 doses over a 5-year period: 42% of African-American (n = 16), 33% of Haitian (n = 13), 63% of Latina (n = 10), and 65% of White young women (n = 11) completed the 3-dose series. Despite low knowledge, they reported high levels of trust in physicians and were willing to vaccinate if recommended by their physicians.ConclusionDesire for HPV vaccination is high among older adolescents, physician recommendation, and use of every clinic visit opportunity may improve vaccine uptake in young women. More White young women completed the HPV vaccine series compared with other race and ethnic young women.     

Change in knowledge of women about cervix cancer,human papilloma virus (HPV) and HPV vaccination due to introduction of HPV vaccines

Objectives

Test knowledge of HPV, cervix cancer awareness and acceptance of HPV vaccination of women now and a year ago.

Study design

Questionnaires were filled out by 305 women visiting four gynaecologists of the Regional Hospital Heilig Hart, Tienen, Belgium during two subsequent weeks. Fisher T or Chi² were used as statistical methods to compare the data with the survey of 381 women exactly one year before.

Results

Knowledge about HPV as a cause of cervix cancer and the presence of a vaccine rose from roughly 50% in 2007 to over 80% in 2008 (p < 0.0001). Level of education and having daughters, sons or no children no longer influenced the level of knowledge or willingness to accept the vaccine. Most parents favor the age group 12–16 years as an ideal time for vaccination. In contrast with the 2007 survey, women below 26 years had now acquired almost equivalent knowledge to older women about the virus, cervix cancer and the vaccine, but they were far less likely to accept the vaccine due to its cost, unless it would be reimbursed (OR 4.2 (1.6–11) p = 0.0055).

Conclusion

One year after introduction of the first two HPV vaccines, over 75% of women attending an ambulatory gynaecology clinic know HPV causes cervix cancer and that you can get vaccinated against it. Compared with a year earlier, young and lower educated women had dramatically improved their knowledge. However, women below 26 years are less prepared to pay the cost for vaccination if it is not reimbursed.     

Hospital-based prevalence of polycystic ovarian syndrome among Omani women

BackgroundPolycystic ovarian syndrome (PCOS) is considered to be one of the most common endocrine disorders among women of reproductive age. It is known to be one of the main causes of infertility. The worldwide prevalence is estimated to be 6–7%; however, the country-specific prevalence estimates vary extensively. In Oman, the prevalence of PCOS is still unknown.ObjectiveThis study aimed to determine the hospital based prevalence of PCOS among Omani women of reproductive age group of 12–45 years who attended the gynecology clinic in a tertiary hospital in Oman.Materials and methodsThis is a retrospective cross-sectional study that included all cases of PCOS that presented at Sultan Qaboos University Hospital (SQUH) from July 2006 to December 2010. Data were collected from patients’ electronic health records available in SQUH. Diagnoses of PCOS were made according to the Rotterdam criteria. Prevalence estimates were standardized to the mid-year population of Omani women in year 2009.ResultsA total of 255 PCOS cases were enumerated among 3644 women who attended Gynecology outpatient department, indicating a hospital based frequency of 7.0%. The overall prevalence of PCOS per 1000 patients in 2010 was 2.8% [95% confidence intervals (95%CI) 0.7, 9.6]. Our study revealed a high prevalence of PCOS among women in the age group of 25–34 years. The highest prevalence was in the Muscat region (42%) followed by Dhakliya and Al Batinah regions.ConclusionsThis study shows the prevalence of diagnosed PCOS cases among women in Oman is similar to that of other countries. It highlights the need for future research to carry out a population-based assessment of PCOS prevalence.     

Methylation marker analysis and HPV16/18 genotyping in high-risk HPV positive self-sampled specimens to identify women with high grade CIN or cervical cancer

Objectives

Methylation marker analysis using bi-marker panel MAL/miR-124-2 is a promising triage test for identifying cervical (pre)cancer in high-risk human papillomavirus (hrHPV) positive women. Bi-marker panel MAL/miR-124-2 can be applied directly on self-sampled cervico-vaginal material and its sensitivity is non-inferior to that of cytology, yet at the cost of more colposcopy referrals. Our objective was to increase specificity of MAL/miR-124-2 methylation analysis by varying the assay thresholds and adding HPV16/18 genotyping.

Methods

1019 hrHPV-positive women were selected from a randomized controlled self-sampling trial (PROHTECT-3; 33–63 years, n = 46,001) and nine triage strategies with methylation testing of MAL/miR-124-2 and HPV16/18 genotyping were evaluated. The methylation assay threshold was set at four different predefined levels which correspond with clinical specificities for end-point cervical intra-epithelial grade 3 or worse (CIN3 +) of 50%, 60%, 70%, and 80%.

Results

The CIN3 + sensitivity of methylation analysis decreased (73.5 to 44.9%) while specificity increased (47.2 to 83.4%) when increasing the assay threshold. CIN3 + sensitivity and specificity of HPV16/18 genotyping were 68.0% and 65.6%, respectively. Combined methylation analysis at threshold-80 and HPV16/18 genotyping yielded similar CIN3 + sensitivity as that of methylation only at threshold-50 (77.6%) with an increased specificity (54.8%).

Conclusions

Combined triage by MAL/miR-124-2 methylation analysis with threshold-80 and HPV16/18 genotyping reaches high CIN3 + sensitivity with increased specificity to identify women with cervical (pre)cancer among HPV self-sample positive women. The combined strategy is attractive as it is fully molecular and identifies women at the highest risk of cervical (pre)cancer because of strongly elevated methylation levels and/or HPV16/18 positivity.     

HPV infection among women in a representative rural and suburban population of the USA

Objective

To study the prevalence of low-risk and high-risk HPV genotypes in a largely suburban, non-Hispanic, white female population of the USA, and to determine the positive predictive value of one-occasion HPV detection and genotyping using high-grade squamous intraepithelial lesion (HSIL) cytology as the endpoint for clinical evaluation.

Methods

HPV DNA present in liquid-based cytology specimens collected by gynecologists in private practice was amplified using nested polymerase chain reaction. HPV DNA was validated by signature DNA sequencing for accurate genotyping.

Results

Of 2633 specimens, 278 were positive for HPV DNA of any genotype. Among 255 single HPV infections, the most prevalent genotype was HPV-16 (n = 50; 19.6%), followed by HPV-52 (n = 24; 9.4%). Only 10 specimens, all positive for a high-risk HPV, were associated with an HSIL cytology result. Among them were 6 of the 50 specimens (12%) tested positive for HPV-16. One novel HPV-39 variant was detected in repeat testing in a patient with persistent HPV infection.

Conclusion

DNA sequencing is a useful method for increasing the specificity of HPV genotyping as an aid to follow persistent high-risk HPV infections to reduce excessive colposcopies in populations with low cancer prevalence.