Prevalence of human papilloma virus genotypes 16, 18 in women with abnormal cervical cytology smears (abnormal Pap smear) attending Erbil Maternity Teaching Hospital

Abstract

Cervical cancer is the fourth most common cancer among women, after breast, colorectal, and lung cancer. 1 About 80% of new cases of cervical cancer occur in developing countries. 2 Oncogenic HPV infection is the major etiological agent of cervical cancer, of which 70% are caused by HPV-16 and HPV-18 type. 2,3 It may take up to 5-10 years for the infection to progress to the precancerous lesion. 3 HPV genotype distribution varies with the severity of the cervical disease, patient demographics such as age, as well as geographical location. 4,5 There has been a large decline in cervical cancer incidence and death rate in countries with regular cervical screening program during the past few decades. Unfortunately, there is no such decline in countries without such a screening program. The disproportionate burden of cervical cancer in developing countries with poor health systems is mainly due to a lack of effective screening program. 2 In developing countries, limited access to effective screening means that the disease is often not identified until it is further advanced and symptoms develop. In addition, prospects for the treatment of such late-stage disease may be poor, resulting in a higher rate of death from cervical cancer in these countries. 6 Background and objective: Cervical cancer is the fourth most common cancer among women. Carcinogenic Human Papilloma Virus (HPV) infection is the major etiological agent for cervical cancer, of which70% are caused by HPV-16 and HPV-18 genotype infection. This study aimed to detect high risk HPV (16,18) in women with different abnormalities in pap smear to allow subsequent more accurate management of the cases and provide information that assists in future development of guidelines in our hospital. Methods: We performed a cross-sectional study on 100 ladies with an abnormal pap smear. Subjects were interviewed and underwent cervical testing with broom using liquid based samples to confirm the cytological abnormality and test for HPV genotypes 16 and 18 using Polymerase Chain Reaction (PCR). Then, colposcopy referral was done according to local protocols. Results: The median age of the subjects was 34. The prevalence of HPV genotypes 16,18 in the whole studied sample was 36%. Various studied risk factors showed significant association with abnormal pap smear and positive HPV genotypes 16,18, including the number of partners, increasing parity, age at first pregnancy, and smoking. Data were analyzed by the statistical package for the social sciences (version 23). Conclusion: The prevalence of HPV 16,18 was 36% in the sample, with the highest proportion being among those with high-grade lesions. Those using natural methods of contraception had higher rates of infection in comparison with other methods.