Abstract
BackgroundThe incidence of cervical cancer in Paraguay is among the highest in the world, with the human papillomavirus (HPV) being a necessary factor for cervical cancer. Knowledge about HPV infection among indigenous women is limited. This cross-sectional study analyzed the frequency of HPV and other genital infections in indigenous Paraguayan women of the Department of Presidente Hayes.MethodsThis study included 181 sexually active women without cervical lesions. They belonged to the following ethnicities: Maká (n = 40); Nivaclé (n = 23); Sanapaná (n = 33); Enxet Sur (n = 51) and Toba-Qom (n = 34). The detection of HPV and other gynecological infectious microorganisms was performed by either molecular methods (for Mycoplasma hominis, Ureaplasma urealyticum, Chlamydia trachomatis), gram staining and/or culture (for Gardnerella vaginalis, Candida sp, Trichomonas vaginalis, Neisseria gonorrhoeae), serological methods (for Treponema pallidum, human immunodeficiency virus [HIV]) or cytology (cervical inflammation).ResultsA high prevalence (41.4%) of women positive for at least one sexually transmitted infection (STI) was found (23.2% any-type HPV, 11.6% T pallidum, 10.5% T vaginalis, 9.9% C trachomatis and 0.6% HIV) with 12.2% having more than one STI. HPV infection was the most frequent, with 16.1% of women positive for high-risk HPV types. There was a statistically significant association observed between any-type HPV and C trachomatis (p = 0.004), which indicates that the detection of one of these agents should suggest the presence of the other. There was no association between any-type HPV and other genital infections or cervical inflammation, suggesting that other mechanism could exist to favor infection with the virus.ConclusionThis multidisciplinary work suggests that STIs are frequent, making it necessary to implement control measures and improve diagnosis in order to increase the number of cases detected, especially in populations with poor access to health centers.
Highlights
The incidence of cervical cancer in Paraguay is among the highest in the world, with the human papillomavirus (HPV) being a necessary factor for cervical cancer
It was suggested that the increased risk of cervical cancer in women co-infected with C trachomatis is due, in part, to an inflammatory response associated with free radical generation and the development of genetic instability [6]
Of the 181 women enrolled, 40 women belonged to the Qemkuket community of ethnic Maká; 23 to the Novoctas community (15 Marcelo Cue, 8 Duarte Cue) of ethnic Nivacle; 33 to the Laguna Pato Complex (9 Lolaico”i, 13 Lolaico guasú, 3 Brillante, 7 Laguna Pato, 1 Salado) of ethnic Sanapaná; 28 to Maxhawaya (5 Monte Alto, 23 Maxhawaya) and 23 to Espinillo (13 Espinillo, 10 Pozo Colorado), both communities of ethnic Enxet South; and 16 women of Rio Verde and 18 women of TobaQom belonging to ethnic Toba-Qom
Summary
The incidence of cervical cancer in Paraguay is among the highest in the world, with the human papillomavirus (HPV) being a necessary factor for cervical cancer. It was suggested that the increased risk of cervical cancer in women co-infected with C trachomatis is due, in part, to an inflammatory response associated with free radical generation and the development of genetic instability [6]. Other organisms such as Gardnerella sp, Candida sp, Trichomonas sp, Mycoplasma hominis, Ureaplasma urealyticum and Treponema pallidum have been associated with cervical inflammatory processes, a situation that may facilitate the entrance of HPV [8,9]
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