Journal of Research in Health Sciences

Prevalence of Human Papillomavirus (HPV) Infection and its Association With Pap Smear Findings Among Women Attending a Gynecology Clinic in Khorasan Razavi-Iran

Background: Human papillomavirus (HPV) infection is the most common sexual transmitted disease and Pap smears and HPV testing are crucial for early detection. Advancements in HPV testing improve accuracy, but optimal screening strategies are still debated. This cross-sectional study explores HPV genotypes and predictors of infection among Iranian women undergoing gynecological screening. Study Design: A retrospective cross-sectional study. Methods: Women undergoing their initial cervical screening enrolled in this study. Cervical cytology samples for Pap smear analysis were collected from women referred to the genetic laboratory of Academic Center for Education Culture and Research (ACECR), Khorasan Razavi, during gynecological visits, adhering to standardized liquid-based cytology protocols. These samples were obtained over a one-year period since January 2023. Statistical analyses were conducted using SPSS version 21.0, with a significance level set at P<0.05. Results: A total of 328 women enrolled in this study. The mean age of participants was 36±11 years and the overall HPV prevalence was 37.5% (n=123). Among HPV-positive women, nearly half (48.7%) had a single HPV genotype. Genotypes 6 (13%), 16 (12.3%), and 53 (6.7%) were the most prevalent types. Notably, high-risk HPV genotypes (16 and 18 among all) were identified in one-fourth of the study population. Women with endocervical/transformation zone cells had 25% higher odds of having HPV infection, and having mild, moderate, and severe inflammation increased the odds of having HPV infection by 14%, 11%, and 20%, respectively. Conclusion: The considerably high prevalence of HPV infection highlights the significance of HPV prevention programs in this population. Neither bacterial vaginosis nor candida infection showed a direct link to HPV positivity.

Evaluation of the Factors Affecting the Cure Rate of Cervical Intra-Epithelial Neoplasia Recurrence Using Defective Models

Background: Treatment of cervical intraepithelial neoplasia is very important since if it remains untreated, it may progress to cervical cancer. It is usually treated with excisional surgery. This study aimed to find the factors affecting the cure rate of cervical intraepithelial neoplasia recurrence after surgery using defective models. Study design: A retrospective cohort study. Methods: Excisional surgery was performed on 307 patients with high-grade cervical intraepithelial neoplasia, from 2009 to 2017. The patients were followed up until recurrence based on histopathology report. Hematologic factors were measured before surgery. The cure rates were estimated using defective models with a Gamma frailty term and the results were compared. Results: Neutrophil-to-lymphocyte ratio (NLR) (P<0.001) and excised mass size (P<0.001) had significant impacts on cure rates, and their cut-off values were 1.9 (P<0.001) and 15 mm2 (P<0.001), respectively. Patients with lower neutrophil-to-lymphocyte ratios and larger excised tissues had higher cure rates. Defective 3-parameter Gompertz distribution with gamma frailty term had the best fit to the data, and its estimated cure rates were 98% among patients with an excised mass size of >15 mm2 and NLR of <1.9, 84% among patients with an excised mass size of >15 mm2 and NLR of >1.9, 79% among patients with an excised mass size of <15 mm2 and NLR of <1.9, and 30% among patients with an excised mass size of <15 mm2 and NLR of >1.9. Conclusion: Cervical intraepithelial neoplasia must be identified and treated before its progress. Excision of more tissues during excisional surgery, especially when the NLR of the patient is high, can help to prevent cervical intraepithelial neoplasia recurrence.

Evaluation of Survival Rate and Associated Factors in Patients with Cervical Cancer: A Retrospective Cohort Study

Background: Cervical cancer, the most common gynecological cancer, is a matter of concern, especially in developing countries. The present study investigates survival rates, associated factors, and post-treatment follow-up status in cervical cancer patients. Study Design: A retrospective cohort study. Methods: This study was conducted on 187 patients referred to an academic referral cancer center in Iran from 2014-2020. Overall survival (OS) and event-free survival (EFS) were evaluated using Kaplan Meyer analysis. The event was defined as recurrence, metastasis, or death. Results: The patients came for post-treatment visits for a median of 36 months (interquartile range [IQR]: 18-51). The median OS and EFS were 24 and 18 months, respectively. The 1- and 3- year OS rates were 90% and 72%, respectively. The 1- and 3- year EFS rates were 76% and 61%, respectively. Stage≥III (hazard ratio [HR]: 3.1, 95% confidence interval [CI]: 1.5, 6.5, P<0.001) and tumor size>4 cm (HR: 2.5, 95% CI: 1.2, 4.9, P=0.006) predicted lower OS. The most common histopathology was squamous cell carcinoma (SCC) (71.1%) with non-significant higher 3- year OS (HR: 0.62, 95% CI: 0.33, 1.16, P=0.13). No significant difference in OS was found between adjuvant and definitive radiotherapy in both early and advance-staged patients (Log-rank=0.7 P=0.4, log-rank=1.6, P=0.2, respectively). Conclusion: As evidenced by the obtained results, the survival of patients was lower compared to that in developed countries. Higher stage and tumor size led to shorter survival. The histopathology and type of treatment in comparable stages did not have any significant impact on survival.

Prevalence of Human Papillomavirus Genotypes in Tehran, Iran

Background: Human papillomavirus (HPV) infection is a major cause of cervical cancer worldwide. Knowledge of the geographical distribution and epidemiology of the most common HPV genotypes is a crucial step in developing prevention strategies. Therefore, this study aimed to investigate HPV genotype distribution among HPV-positive women and men in Tehran, Iran. Study Design: A case series study. Methods: The study was performed on 219 HPV-positive individuals (160 females and 59 males) from Tehran, Iran. Samples were obtained from the cervix and vagina of female subjects and the genital warts of male subjects. DNA was extracted from samples, and a polymerase chain reaction (PCR)-reverse dot blot genotyping chip was used to examine HPV genotypes. Formalin-fixed, paraffin-embedded tissue samples of 51 patients from the study population were also included in this study. Results: The proportion of high-risk (HR)-HPV was 67.12%. The most common HR-HPV types were HR-HPV16 (17.4%), HR-HPV68 (11.4%), and HR-HPV51 (7.8%). The most common low-risk (LR)-HPV types included LR-HPV6 (31.1%), LR-HPV81 (11.9%), and LR-HPV62 (11.4%). The highest prevalence of HPV was in the age group of > 30 years (42.9%). Co-infection with multiple HR-HPV types was observed in 22.4% of specimens. Moreover, HR-HPV was found in 50% of women with normal cytology, 100% with a low-grade squamous intraepithelial lesion, and 84.61% with atypical squamous cells of undetermined significance. Conclusion: The results indicated the remarkable growth of HR-HPV68, which has rarely been reported in Iran. The findings add knowledge to HPV epidemiological investigation and emphasize the need for introducing educational programs in high schools and appropriate vaccination in Iran.