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.

Cervicovaginal COVID-19 Positivity: A Pilot Study

Purpose: ACE 2 RNA expression has been detected in organs of the female reproductive tract, suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could potentially infect female reproductive organs. In this study, we investigated the presence of SARS-CoV-2 virus in the cervicovaginal fluid.Materials and Methods: Our study included 31 female patients aged 18–65 years. The presence of SARS-COV-2 RNA was investigated by RT-PCR in two separate cervicovaginal swab samples collected from patients 14 days apart. Viral RNA was extracted using viral nucleic acid buffer (vNAT) solution, and SARS-COV-2 RNA was analyzed using Bio-speedy SARS-CoV-2 RT-qPCR kits in Bio-Rad CFX96 TouchTM device.Results: The first and second cervical swab samples were collected from 22 of 31 patients 14 days apart. The first cervical swab sample was collected from 9 patients; however, the second swab sample could not be collected after 14 days. SARS-COV-2 RNA result was negative in 100% of a total of 53 cervicovaginal swab samples collected. Moreover, the SARS-COV-2 RNA result was negative in the nasopharyngeal swab of babies after delivery in three pregnant women.Conclusion: Negative SARS-COV-2 RNA results in cervicovaginal swab samples suggest that there is no sexual transmission of COVID-19 and no vertical transmission during pregnancy. However, the number of studies conducted on this subject and the sample size examined are still insufficient.

Evaluation of the potential of Pap test fluid and cervical swabs to serve as clinical diagnostic biospecimens for the detection of ovarian cancer by mass spectrometry-based proteomics

Background The purpose of this study was to determine whether the residual fixative from a liquid-based Pap test or a swab of the cervix contained proteins that were also found in the primary tumor of a woman with high grade serous ovarian cancer. This study is the first step in determining the feasibility of using the liquid-based Pap test or a cervical swab for the detection of ovarian cancer protein biomarkers. Methods Proteins were concentrated by acetone precipitation from the cell-free supernatant of the liquid-based Pap test fixative or eluted from the cervical swab. Protein was also extracted from the patient’s tumor tissue. The protein samples were digested into peptides with trypsin, then the peptides were run on 2D-liquid chromatography mass spectrometry (2D-LCMS). The data was searched against a human protein database for the identification of peptides and proteins in each biospecimen. The proteins that were identified were classified for cellular localization and molecular function by bioinformatics integration. Results We identified almost 5000 proteins total in the three matched biospecimens. More than 2000 proteins were expressed in each of the three biospecimens, including several known ovarian cancer biomarkers such as CA125, HE4, and mesothelin. By Scaffold analysis of the protein Gene Ontology categories and functional analysis using PANTHER, the proteins were classified by cellular localization and molecular function, demonstrating that the Pap test fluid and cervical swab proteins are similar to each other, and also to the tumor extract. Conclusions Our results suggest that Pap test fixatives and cervical swabs are a rich source of tumor-specific biomarkers for ovarian cancer, which could be developed as a test for ovarian cancer detection.

The role of Chlamydia trachomatis in preterm delivery: a case-control study in Besat Hospital, Sanandaj, Iran (2018-2019)

Background and Objectives: Preterm delivery is an important subject in gynecology, obstetrics and pediatrics. It is defined as regular uterine contractions every five to eight minutes or less, lasting for 30 seconds. It is associated with progressive changes in the cervix, resulting in delivery after 22 weeks and before 37 weeks of gestation. This study aimed to evaluate the role of Chlamydia trachomatis infection in women with preterm delivery. Materials and Methods: This case-control study was performed on 75 women with preterm delivery (case group) and 75 women with term delivery (control group). The research tools included a questionnaire, polymerase chain reaction (PCR) assay of cervical swab samples and ELISA assay of umbilical cord blood samples. Fisher’s exact test and t test were also performed to compare qualitative variables between the two groups. Results: In this study, the mean age of subjects was 26.55 ± 0.53 years in the control group and 26.76 ± 0.56 years in the case group. The prevalence of C. trachomatis in the cervical swab samples was 7 (9.33%) in the control group and 2 (2.67%) in the case group. There was no C. trachomatis IgM antibody in either of the groups, while there was 1 (1.33%) C. trachomatis IgG antibody in both groups. Conclusion: The results of the present study showed that there was no significant relationship between C. trachomatis infection and preterm delivery.

The Prevalence of Human Papillomavirus Among the Indigenous Population in Serian, Sarawak, Malaysian Borneo

Introduction: Cervical cancer remains a significant problem worldwide, particularly in resource-limited countries, and having persistent HRHPV infection is a necessary risk factor. HPV16/18 are generally regarded as the cause of 70% cervical cancer incidences worldwide, and effective vaccines have been developed against these two HPVs. Although Malaysia has officially adopted an HPV vaccination strategy into the National Vaccination Program, the comprehensive prevalence data on each endemic HPV genotypes was absent in East Malaysia and most parts of the country except for major cities in Peninsular Malaysia.Objective: The objective of this study is to elucidate the endemic HPV genotypes that are circulating in the suburban population in Serian Division, Sarawak, Malaysia.Methods:Non-virgin women who were attending the Women's health campaign on the 5th and 23rd October 2018 were recruited. Informed consent was obtained, and a cervical swab was clinician-collected. The presence of HPV in the cervical swab was detected using MY09/MY11 followed by GP5+/GP6+ nested-PCR and its corresponding genotypes identified via sequencing. HRHPV positive women were screened using Results: We have recruited 43 sexually active women with median age of 51-year-old. HPV18, 39, 52, 56, and 84 were detected at an equal ratio. The overall prevalence rate of HPV, HRHPV and URHPV were 11.62% (5/43), 9.3% (4/43) and 2.3% respectively. Only 20% (n=1/5) of the HRHPV positive women were positive by VIA.Conclusion: HPV18, 39, 52, 56, and 84 were detected in Serian at an equal ratio. HPV16 was absent, and HPV18 was the only vaccine-genotype detected. HPV 39, 52, 56, and 84 were not covered by the bivalent and tetravalent HPV vaccines.

The prevalence of hrHPV among the isolated community in the Highland of Bario, Sarawak, East Malaysia

Background Malaysia has introduced the free Pap smear as the primary cervical cancer screening program since the 1960s but has only achieved the national coverage of 22%. The coverage would be much lower in the rural communities especially in Sarawak where many villages are still inaccessible by road, and communities are living in low resource settings. In this study, we have evaluated Qiagen’s careHPV system as a point-of-care HPV diagnostic test together with the visualization using acetic acid (VIA) in the isolated community in the Highland of Bario which are predominantly from the Kelabit ethnicity. Methods Women attending the cervical cancer outreach program were recruited. Consent was obtained and a cervical swab was clinician-collected and screened for High-risk HPV DNA using the careHPV system. Cervical examination using VIA was offered to all women age <50-year. hrHPV positive women were recruited during their follow-up session and the second cervical swab was collected for HPV genotyping using consensus primer-nested PCR to elucidate the infecting HPV genotypes. Results Seventy-five women from the age of 27-83 (mean age 55) attended the cervical cancer screening clinic and 8% (n=6/75) of them were positive for hrHPV. Only 33 women were screened using VIA and 21.2% (n=7/33) were found to be positive. A majority of the women (58.6%) were above the age of 50-year and not recommended for VIA to be performed. Thus, it was not feasible to correlate the results obtained from the HPV DNA test and VIA. Only four hrHPV positive women returned for follow-up and genotyping revealed HPV52 in 2 of four women tested suggesting that HPV52 may be the predominant genotype in Bario. Conclusions The careHPV system is portable and can be used in low resource settings as long as reliable electricity is available. We found that careHPV DNA test is more objective compared to VIA and can be used to screen women outside the recommended eligible age. This is especially true for older women in the rural who have never had any form of cervical cancer screening before.