The Journal of Infection in Developing Countries

The influence of parents' knowledge on HPV vaccine uptake — evidence from Albania

Introduction: Despite the HPV vaccine's efficacy in cervical cancer prevention, cervical cancer ranks second in prevalence among women, following breast cancer. Various factors negatively impact HPV vaccination uptake, with parents' knowledge and attitudes being particularly crucial in this regard. Methodology: A cross-sectional study was conducted between February and May 2023, targeting parents in northern Albania. The standardized Vaccination and HPV Knowledge (THinK) questionnaire was used, and a random sampling methodology was applied. Data were collected at primary healthcare centers, targeting parents who were seeking various healthcare services. Results: A total of 102 participants completed the questionnaire, yielding a response rate of 74%. The majority of parents were married (79.4%), female (82.4%), over 30 years of age, and residents of urban areas (67.6%). A low mean score was reported for both the vaccination rate of girls (1.79 ± 0.40) and the willingness to vaccinate them (1.31 ± 0.46). Of the participants, 15 (14.7%) parents expressed strong knowledge of vaccines, while only 6 (5.9%) had knowledge about HPV, and 52 (51%) expressed interest in receiving information about HPV vaccination. Three factors emerged, explaining 71.02% of the variance: knowledge about HPV and vaccination, side effects of the vaccines, and the impact of vaccinating girls on HPV vaccination uptake. Conclusions: The study found that the identified factors—knowledge, side effects of vaccines, and vaccination attitudes—significantly influence HPV vaccination uptake. Co-creation activities involving parents, girls, and healthcare professionals are the most effective strategies to build trust and improve awareness among the target population regarding the HPV vaccine.

Cervical HPV in central China: regional prevalence, subtypes and pathology

Introduction: This study investigated the epidemiological characteristics, subtype distribution, and clinical correlations of cervical human papillomavirus (HPV) infection in Jingmen, China. Methodology: A retrospective study of 5,155 women screened at Jingmen Central Hospital (2022–2024). The participants were categorized into 6 age groups: ≤ 20 years (n = 54), 21-30 years (n = 791), 31-40 years (n = 1,757), 41-50 years (n = 1,371), 51-60 years (n = 968), and ≥ 61 years (n = 214). HPV genotyping and histopathology were used to assess infection patterns and lesion correlations. Results The infection rates of high-risk HPV (HR-HPV), low-risk HPV (LR-HPV), and mixed infections were 18.10% (933/5,155), 3.38% (174/5,155), and 3.38% (174/5,155), respectively. HR-HPV infections exhibited a bimodal age distribution, with peak prevalence in women aged ≤ 20 years (33.33%) and ≥ 61 years (39.25%). This age-related difference was statistically significant (χ² = 81.430, p < 0.001). The dominant subtypes were HPV52 (23.5%), HPV16 (13.9%), and HPV58 (13.3%). Notably, HPV16 was significantly more prevalent in high-grade squamous intraepithelial lesions (HSIL; 44.3%) and cervical cancer (CC; 55.5%), compared with low-grade lesions (p < 0.01). Conclusions: This study identified both adolescent/young women (≤ 20 years) and older women (≥ 61 years) as high-risk populations for HR-HPV infection. Notably, HPV16 (55.5%) exhibited significantly higher detection rates in cervical cancer cases, emphasizing the importance of prioritizing this subtype in region-specific vaccine-based prevention strategies. These findings underscore the need for tailored clinical management approaches based on viral subtype distribution and lesion severity.

Induction of TLR5, IRAK1, and NF-κB expression by Trichomonas vaginalis in cervical cancer cell (HeLa) and normal human vaginal epithelial cell (HVECs) lines

Introduction: Trichomoniasis is the most common non-viral sexually transmitted infection that increases the risk of cervical cancer. Trichomonas vaginalis (T. vaginalis) can regulate the pro-inflammatory cytokine production in the host cells. Toll-like receptors (TLRs) are a family of the pattern recognition receptors (PRRs) of mammalian cells, expressed in various host cells and have an important role in recognizing pathogens, and pro-inflammatory responses. The aim of the present study is to investigate the role of TLR5 in cervical cancer cells (HeLa) and human vaginal epithelial cells (HVECs) exposed to T. vaginalis. Methodology: First, the cells and parasites were cultured in RPMI and trypticase yeast extract maltose (TYM), respectively. After adaption of parasite and epithelial cells by RPMI-TYM medium co-culture (9:1 vol/vol), HVECs and HeLa cells were stimulated with T. vaginalis trophozoites (24-hour incubation at 37 °C, 5% CO2). Following RNA extraction and cDNA synthesis, the gene expression levels of TLR5, IRAK1, and NF-κB were assessed using real-time PCR. Besides, the protein levels were measured using western blotting. All tests and controls were normalized using β-actin as a housekeeping control. Results: Real-time PCR results showed an increased gene expression of TLR5, IRAK1, and NF-κB in T. vaginalis exposed HVECs and HeLa cells compared to the control group (p < 0.05). Additionally, western blot analysis showed a statistically significant increase in TLR5, and NF-κB proteins in both groups after exposure to the parasite (p < 0.05). Conclusions: These findings provide insight into the host-parasite interaction, and the results indicated that T. vaginalis could stimulate TLR5 and activate related pathways.

Clinical comparison of two human papillomavirus detection assays: GenoFlow and reverse line blot

Introduction: Human papillomavirus (HPV) infection is typically critical in the oncogenesis of cervical cancer. However, available HPV detection kits differ in their ability and sensitivity to detect various types of HPV, and this variability has led to inconsistencies in the reporting of the geographic prevalence of HPV types, especially in developing countries. Here, we compared results of the recently developed GenoFlow HPV array test, which detects 33 HPV genotypes, to those of the well-established reverse line blot (RLB) assay, which detects 23 HPV types.
 Methodology: In total, 608 cervical specimens with cytology results ranging from normal to cancer were collected using an endocervical brush from women attending outpatient clinics in Riyadh, Saudi Arabia.
 Results: Sixty-nine specimens (11%) were positive for HPV. HPV genotype detection using the GenoFlow test had a sensitivity of 62% and a specificity of 100%. Overall agreement between the two HPV genotyping methods was 97%, with a concordance rate of 95%. Among the GenoFlow test results, 2% indicated additional HPV types that were not detected in the RLB assay, whereas the GenoFlow test missed 0.3% of the HPV types that were detected by the RLB; however, both tests were in agreement in detecting all major HPV types.
 Conclusion: The GenoFlow test was reliable, with results comparable to the RLB test. However, because the GenoFlow test is less labor-intensive and takes less total time (3 hours), it is a promising, affordable alternative to the RLB for HPV diagnosis and screening programs.

Prevalence of precancerous cervical lesions and high-risk human papillomavirus types in Yaounde, Cameroon

Introduction: Various Human papillomavirus (HPV) types cause cervical cancer, and represent the primary cause of cancer death in Africa and the second cause of most common cancers in Cameroon. Herein, we determined the prevalence of high-risk HPV types in women and associated cervical cytologic abnormalities in Yaounde, Cameroon. Methodology: A cross-sectional study targeting HPV-positive women aged 20 and over was conducted between March and June 2020 at the Saint Martin de Porres’ Health Centre in Yaounde. HPV tests were performed by PCR for detection of HPVs 16, 18, 33, and 45. The test was performed on 616 women using exfoliated cell specimens; then, we processed on cytological diagnosis with Pap smears on HPV positive specimens. Results: The HPV types tested were detected in 137 participants, of which 38.7% with multiple HPV infections, and the remaining part with single HPV infections of type HPV 16 (28.5%), HPV 18 (17.5%), HPV 33 (10.2%), and HPV 45 (5.1%). Cervical cytologic abnormalities were found in 69.34% of participants including: LSIL (49.63%), HSIL (15.32%), ASC-US (3.66%) and AGC (0.73%). Co-infections with HPV 16 and HPV 18 were significantly associated with HSIL (p = 0.001) lesions, while HPV 45 was more common in participants with normal cytology (p = 0.001). Cervical lesion occurrence was significantly associated with the number of sexual partners (p = 0.02) and history of oral contraceptive pill use (p = 0.001). Conclusions: Our results suggest that HPV 16 and 18 are predominant in Yaounde, and are associated with more severe precancerous lesions.

Human Papillomavirus Prevalence and Genotype Distribution in Cervical Swab Samples in Istanbul, Turkey

Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection agent worldwide and, with high-risk (HR) HPV genotypes, is the main factor for development of cervical cancer. This study aimed to assess the prevalence of HPV and distribution of HR-HPV genotypes in cervical swab samples and compare them with demographic and clinical data. Methodology: Cervical swab samples of 2,285 women between the age of 17 and 76 were assessed between January 2018 and October 2020 in order to obtain the data of Turkey. Fifteen different HR-HPV genotypes were determined using multiplex real-time polymerase chain reaction test. Results: HPV was positive in 36.3% (829/2,285) of DNA samples. Prevalence of multiple HR-HPV infection was 40.7%. Of the women, 30.9% (256/829) were infected with HPV16, 14.6% (121/829) with HPV39, and 14.2% (118/829) with HPV51. The most frequently detected genotypes with HPV16 were HPV31, HPV39 and HPV52, respectively. In women with cervical dysplasia, HPV16, 31, and 39 were the most common, and in women with genital warts, HPV16, 59 and 66 were most common, respectively. The highest HR-HPV prevalence was detected in the 17-34 age group (44.1%) (p < 0.001). Conclusions: The prevalence of HR-HPV was 36.3% in this study. High prevalence (44.1%) especially in young women was consistent with findings in literature. The most common HR-HPV genotypes were HPV16, 39 and 51, respectively. Determining the prevalence and genotypes of HR-HPV playing role in the etiology of cervical cancer will be guiding for measures on prevention of cervical cancer and research on preventive vaccines.

Association of abnormal vaginal microflora and HPV infection in cervical precancerous lesions: a retrospective study

Introduction: The aim of this study was to analyze the correlation between abnormal vaginal microflora and different types of human papillomavirus (HPV) infection and cervical precancerous lesions during the perimenopausal period.
 Methodology: This retrospective study included women patients who underwent liquid-based cytologic test (LBC), HPV test, leucorrhea routine test, or routine urine test at the China-Japan Friendship Hospital between October 2019 and January 2020. A cut-off of 45 years was used as the cut-off age for menopause. The positivity and subtypes of HPV were determined using a chip-based assay. Vaginal microflora was determined using an HB-2012a flow-through hybridization instrument.
 Results: A total of 132 patients were included in this study. 97 patients were younger than 45 years of age, with a median age of 35 (8.0), and 35 patients ≥ 45 years of age, with a median age of 55 (11.0). There were no significant differences in cytology, type of cervical lesion, HPV type, and common pathogens of the reproductive tract (all p > 0.05). The multivariable analysis showed that only HPV-16 infection lesions (OR: 2.825, 95% CI: 1.121-7.120, p = 0.028), Chlamydia trachomatis infection (OR: 0.142, 95% CI: 0.024-0.855, p =0.033), and Mycoplasma infection (OR: 7.750, 95% CI: 1.603-37.474, p = 0.011) were independent risk factors for cervical precancerous lesions. The menopausal status (with age < 45 or > 45 years as its surrogate) was not associated with cervical precancerous lesions.
 Conclusions: Menopause was not associated with cervical precancerous lesions. The results suggest that the prevention and treatment of HPV-16, Chlamydia trachomatis infection, and Mycoplasma infection could be significant to prevent the occurrence of cervical precancerous lesions.

Cerebral cystic echinococcosis reactivation during therapy for squamous tumor of the cervix: possible interactions?