Microbiological and behavioral determinants of genital HPV infections among adolescent girls and young women warrant the need for targeted policy interventions to reduce HPV risk

Harris Onywera; Sikhumbuzo A Mabunda; Anna-Lise Williamson; Zizipho Z A Mbulawa

doi:10.3389/frph.2022.887736

Microbiological and behavioral determinants of genital HPV infections among adolescent girls and young women warrant the need for targeted policy interventions to reduce HPV risk

Front Reprod Health. 2022 Jul 28:4:887736. doi: 10.3389/frph.2022.887736. eCollection 2022.

Authors

Harris Onywera^{1

2

3

4

5}, Sikhumbuzo A Mabunda^{6

7

8}, Anna-Lise Williamson^{1

2

6}, Zizipho Z A Mbulawa^{2

6

9

10}

Affiliations

¹ Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
² Division of Medical Virology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
³ Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
⁴ Research, Innovations, and Academics Unit, Tunacare Services Health Providers Limited, Nairobi, Kenya.
⁵ Research and Innovation, Mount Kenya University, Thika, Kenya.
⁶ SAMRC/UCT Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa.
⁷ School of Population Health, University of New South Wales, Sydney, NSW, Australia.
⁸ The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
⁹ National Health Laboratory Service, Nelson Mandela Academic Hospital, Mthatha, South Africa.
¹⁰ Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha, South Africa.

Abstract

Background: Genital human papillomavirus (HPV) is the most common sexually transmitted virus in most populations globally. Adolescent girls and young women (AGYW) remain a key population group at risk for HPV infection. However, the risk factors of HPV infection among AGYW, especially in sub-Saharan Africa, are a subject of little investigation in published literature. Here, we investigated the factors associated with HPV infection among unvaccinated South African AGYW with a high HPV burden (prevalence: 76.1%).

Methods: We retrospectively recruited 213 AGYW learners (aged 15-25 years) from a previous cross-sectional study, the HPV Education Intervention Study, conducted in the Eastern Cape, South Africa. Sexually transmitted infections (STIs), bacterial pathobionts, genital ulcers (due to infectious causes), candidiasis, and bacterial vaginosis (BV) in the self-collected vaginal specimens were determined using the Allplex™ Panel Assays. Statistical analyses were performed using STATA v16.1. Continuous and categorical variables were computed by t-test /Wilcoxon rank-sum test and Chi-square/Fisher's exact tests, respectively. Logistic regression was used to determine the univariable predictors of HPV infection.

Results: The overall detection rate of any viral STI, bacterial STI, pathobiont, genital ulcer, candidiasis, and BV among the AGYW was 75.0, 34.4, 90.7, 14.4, 26.9, and 43.6%, respectively. The main factors associated with HPV infection were alcohol consumption (p = 0.005), infection with any and multiple Candida species (p = 0.011 and 0.006, respectively), Candida albicans infection (p = 0.010), Ureaplasma urealyticum pathobiont infection (p = 0.044), BV-associated bacteria (specifically Atopobium vaginae: p = 0.039, BV-associated bacteria 2: p = 0.021, Gardnerella vaginalis: p = 0.021, Megasphaera type 1: p = 0.037), and BV (p = 0.011).

Conclusions: Our study, albeit not necessarily generalizable, found social behavior as well as specific vaginal microbes as correlates of HPV infection among AGYW in South Africa. There is a need to investigate HPV epidemiology in other AGYW populations. The factors associated with genital HPV infection among AGYW burdened with HPV infection necessitate the need to formulate and implement population-specific public health strategies for creating HPV awareness and reducing its risk.

Keywords: HPV; South Africa; adolescent girls and young women (AGYW); determinants; risk factors.