Investigation of intravaginal practices as a factor associated with a high prevalence of genital human papillomavirus infection in adolescent girls.
Loading...
Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Background: Human papillomavirus (HPV) is a common sexually transmitted infection (STI)
in women which mainly infects the mucosal areas. Young women are disproportionately
infected by HPV, and factors that may render adolescents or younger women more vulnerable
to HPV acquisition than older women have not been fully elucidated. This study aimed to
investigate the associations between the prevalence of HPV, the use of intravaginal products,
the immune activation status of cervical T cells, and alterations of the composition and
concentrations of antimicrobial peptides (AMPs) in vaginal fluid among adolescent females
close to their sexual debut and older women in KwaZulu-Natal.
Methodology: Genital specimens (cervical cytobrush and cervicovaginal swabs) were
collected from 154 female participants aged 14-19 and 25-35 years. From cervicovaginal
swabs, HPV genotyping was done using a deoxyribonucleic acid (DNA) Flow hybridization
system. Flow cytometry was conducted from cervical cytobrush specimens (evaluating CD38+,
HLA-DR+, andCCR5+ expressions) to assess T-cell immune activation status. Enzyme-linked
Immunosorbent Assay (ELISA) kits were used to measure genital concentrations of human Ī²-
defensin (HBD-1, HBD-2), and psoriasin from cervicovaginal swabs. Statistical tests
conducted were Robust Poisson regression models (RPRM), the Tukey multiple comparison
adjustment, t-test, and Mann Whitney U test. š values of <0.05 were statistically significant.
Results: HPV prevalence was 85%, with high-risk genotypes being the most prevalent. The
majority of the cohort was infected with multiple genotypes (76.62%). Genotypes associated
with cancer and current GardasilĀ®9 HPV vaccine targets were more common (53.9%) than
those associated with genital warts (14.9%). The risk of HPV in adolescent females was 15.9%
higher than in adult females. The use of vaginal inserted products (VIPs) was associated with
a 40% higher risk of contracting genotypes related to cancer (p=0.0503) compared to nonusers.
The risk of HPV infection for adolescents using VIPs was 23% higher than that of adults
using VIPs. However, these differences were not statistically significant at a 5% level of
significance. Sexual debut after 18 years significantly reduced the risk of overall HPV infection
(p=0.0040) and infection with genotypes associated with cancer (p=0.0024). When comparing
HPV infected adolescents and adults, the proportion of activated CD4+ T cells was
significantly higher in adolescents, particularly in CD4+ HLA-DR+ cells (p=0.0008). CD8+ T
cells showed no difference. A significantly higher concentration of HBD-2 was observed in
HPV+ adults compared to HPV- adults (p=0.0215) and HPV+ adolescents (p=0.0189). Conclusion: The overall HPV prevalence is higher than the previously reported prevalence in
KwaZulu-Natal province. In addition, we demonstrate that the use of VIPs may be associated
with some HPV infection risk, particularly in adolescent females. This finding suggests that
young women should be warned about the potential risk of using VIPs. We also confirm that
the age-phase, delay in sexual debut, and the number of sexual life partners have significant
associations with HPV genotypes linked to cancer, highlighting the importance and the urgency
of vaccinating young girls with GardasilĀ®9 HPV vaccine. Adolescents with HPV have
significantly higher levels of activated CD4+ T cells in their cervical mucosa, suggesting the
presence of reactive activated cells that lack efficiency in the clearing of HPV infection in this
age group. HPV infection upregulates HBD-2 levels during HPV infection, notably
significantly higher in adult females than in adolescents. This investigation has generated new
insights into the risk factors for HPV acquisition in young women. These findings need to be
confirmed further by larger cohort size studies, essential for HPV prevention.
Description
Masters Degree. University of KwaZulu-Natal, Pietermaritzburg.