Abstract
As part of the human papillomavirus (HPV) vaccination strategy in South Africa, it is essential to have information on HPV prevalence, and HPV types distribution among the unvaccinated population. Information on the prevalence of HPV and the distribution of HPV types in adolescents and young women in South Africa’s Eastern Cape Province is minimal. Therefore, this study investigates the prevalence, distribution of HPV types, and factors associated with HPV infection amongst unvaccinated female learners. A sample composed of 213 sexually active female learners attending high schools in the Eastern Cape Province of South Africa; median age 18 years, who provided self-collected vaginal specimens. Roche Linear Array HPV genotyping assay that detects 37 HPV genotypes was used to detect HPV infection. HPV infection was detected in 76.06% (162/213) of participants. Of these 14.55% (31/213) were positive for HPV types targeted by the Cervarix® HPV vaccine (HPV-16 and/or 18), 20.66% (44/213) by Gardasil®4 (HPV-6, -11, -16 and/or -18) and 37.09% (79/213) by Gardasil®9 (HPV-6, -11, -16, -18, -31, -33, -45, -52 and/or -58). HPV-35, commonly detected in cervical cancer cases among women of African ancestry, was frequently detected (9.40%). Participants who reported to have ever consumed alcohol had a significantly higher risk of HPV infection (OR: 2.91, 95% CI: 1.38–6.11, p = 0.005). High HPV prevalence was observed among participants. The high prevalence of HPV types targeted by the Gardasil®9 vaccine encourages the introduction of the Gardasil®9 vaccine. Data from this study will inform both vaccination campaigns and monitor the impact on HPV types after vaccination.
Highlights
Transmitted infection (STI) prevalence is very high in developing countries where routine Sexually transmitted infection (STI) screening and treatment have inadequate coverage
A proportion of 32.39% study participants reported a sexual debut of age 16 years, 53.99% had 2–3 current sexual partners, 35.68% used condoms during last sexual intercourse, 79.44% had vaginal sex in the past month, 20.66% had anal sex in the past month, 16.43% had oral sex in the past month, 62.91% were on contraceptives, 22.07% had been pregnant, 65.73% had experienced vaginal discharge, and 21.13% had experienced genital warts/blisters/ulcers (Table 2)
human papillomavirus (HPV) prevalence was not found to differ between human immunodeficiency virus (HIV)-negative (74.10%, 103/139), and HIV-positive (75.00, 6/8; p = 0.955) or the female learners that were not tested for HIV (80.30%, 53/66; p = 0.332, Table 4)
Summary
Transmitted infection (STI) prevalence is very high in developing countries where routine STI screening and treatment have inadequate coverage. Self-sampling for STIs, including human papillomavirus (HPV) testing, is a promising method to increase the STI screening coverage [1,2]. HPV prevalence (low and high-risk) ranges between 44% and 85% among South African adolescents and young women (15–25 years) [14,15,16,17,18,19,20]. Both cervical cancer and human immunodeficiency virus (HIV) burden is high in Africa [21,22,23]. Compared to HIV-negative individuals, HIV-infected individuals are more likely to be infected by HPV, co-infected with multiple HPV types, persistent infection, reactivation, and develop HPV-associated cancers on different anatomical sites [23,24,25,26]
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