Sexually transmitted infections (STIs)/HIV linked to human papillomavirus (HPV) in precancerous lesions in Cameroonian women

Abstract

Cervical precancerous lesions signify cellular changes in the cervix linked to an escalated risk of cancer. These lesions often evolve towards malignancy influenced by various factors, including sexually transmitted infections (STIs), irrespective of human papillomavirus (HPV) presence. STIs represent a substantial global public health concern, affecting both sexes, with over 30 pathogens, comprising bacteria, viruses, and parasites, capable of causing STIs. The clinical presentation of these pathogens varies significantly. This study aimed to delineate the microbial profile within HPV-containing precancerous lesions. A prospective cross-sectional descriptive study was conducted in Cameroon's central region, particularly in the Endom district. Among 343 patients screened, 225 women were enrolled based on positive HPV cervical smear results. Cervical cell lesions were analyzed using the Papanicolaou technique, while parasitological and microbiological methods were utilized to identify other microbes. HPV genotypes were determined via multiplex PCR. The study revealed 65 HIV-positive and HPV-positive individuals (18.96%); 40 HIV-negative and HPV-positive individuals (11.65%); 25 HIV-positive and HPV-negative individuals (7.29%); and 213 HIV-negative and HPV-negative individuals (62.10%). Various cervical lesions were identified, including Low-grade Lesions (LSILs) (21%) and High-grade lesions (HSILs) (16%). Trichomonas vaginalis (TV) (51%), Candida albicans (CA) (28%), Herpes simplex (HS) (2%), Gardnerella vaginalis (GV) (17%), Aspergillus (A) (2%), and HIV were the primary infectious agents identified in these precancerous lesions, with significant distribution (P<0.005), suggesting their role as risk factors for precancerous lesions (OR=13.89, 95% CI 6.87-21.60). Multiple HPV genotypes were characterized in the same precancerous lesions, with approximately 25% (85) of women harboring either Low_Risk (LR) (6, 11) or High_Risk (HR) (16, 18, 45, 58) HPV genotypes (P<0.001). Coinfections such as HPV/TV/CA and HPV/HIV/TV were prevalent, indicating their potential as associated risk factors for precancerous lesions. Coinfections with other microbes, typically associated with cervicitis, appear to facilitate HPV infection. These findings contribute to understanding the microbial landscape of cervical samples and underscore the importance of integrated care approaches for HIV-positive individuals with HPV-related lesions.

Keywords

• Precancerous lesions
• HPV
• Coinfections
• Cervical cytology
• Microbial composition

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