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Prevalence of High-Risk Human Papillomavirus in Women with Normal and Abnormal Pap Smear: A Cross Sectional Study from a Tertiary Hospital in South India



Human Papillomavirus (HPV) has been identified as an important risk factor that predisposes to cervical cancer. Traditionally the Papanicolaou (Pap) smear test has been routinely used for the detection of premalignant lesions in the uterine cervix. However, due to the rise in false positive and negative results, advanced molecular techniques like PCR are more sensitive and reliable. This study aimed to assess the burden of HPV infection in women with normal and abnormal Pap testing attending a tertiary care hospital. Methods A total of 126 sexually active women were recruited for cervical examination in this cross sectional study. Cervical exfoliated cells were collected for cytology and HPV analysis. DNA was extracted and HPV detection was performed using nested PCR technique. Results HPV prevalence was higher in women with abnormal cytology infection (12.5%) compared with those who had normal Pap smear(3.8%); HPV 16 was found to be the most common subtype. Younger age at marriage, multiple sexual partners, and multiparity were found to be the most important confounding factors in the acquisition of HPV. Conclusion The current study demonstrated the presence of high-risk HPV in cervical smear specimens irrespective of normal and abnormal cytology, and hence emphasizes the need for implementation of effective national cervical cancer screening programs that could decrease the burden of cervical cancer in India.

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  1. 1.

    Pilleron S, Soto-Perez-de-Celis E, Vignat J, Ferlay J, Soerjomataram I, Bray F, Sarfati D. Estimated global cancer incidence in the oldest adults in 2018 and projections to 2050. Int J Cancer. 2021;148(3):601–8.

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Bruni L, Barrionuevo-Rosas L, Albero G, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, De Sanjosé S. ICO information centre on HPV and cancer (HPV information centre). Human papillomavirus and related diseases in the world. Summary Report. 2015;4(08).

  3. 3.

    Vu M, Yu J, Awolude OA, Chuang L. Cervical cancer worldwide. Curr Probl Cancer. 2018;42(5):457–65.

    Article  PubMed  Google Scholar 

  4. 4.

    Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191-203.

    Article  Google Scholar 

  5. 5.

    Sarma U, Mahanta J, Borkakoty BJ, Talukdar KL, Gogoi R, Yadav K. Demographic Characteristic of HPV infection in women-A hospital based study from Guwahati, India. National J Med Res. 2013;3(1):1–4.

  6. 6.

    Bharti AC, Shukla S, Mahata S, Hedau S, Das BC. Human papillomavirus and control of cervical cancer in India. Expert Rev Obstetric Gynecol. 2010;5(3):329–46.

    Article  Google Scholar 

  7. 7.

    Kulkarni SS, Kulkarni SS, Vastrad PP, Kulkarni BB, Markande AR, Kadakol GS, Hiremath SV, Kaliwal S, Patil BR, Gai PB. Prevalence and distribution of high risk human papillomavirus (HPV) types 16 and 18 in carcinoma of cervix, saliva of patients with oral squamous cell carcinoma and in the general population in Karnataka. India Asian Pac J Cancer Prev. 2011;12(3):645–8.

    PubMed  Google Scholar 

  8. 8.

    Rozendaal L, Walboomers JM, Van Der Linden JC, Voorhorst FJ, Kenemans P, Helmerhosrt TJ, Van Ballegooijen M, Meijer CJ. PCR-based high-risk HPV test in cervical cancer screening gives objective risk assessment of women with cytomorphologically normal cervical smears. Int J Cancer. 1996;68(6):766–9.;2-Z.

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Lörincz AT, Richart RM. Human papillomavirus DNA testing as an adjunct to cytology in cervical screening programs. Arch Pathol Lab Med. 2003;127(8):959–68.;2.

    Article  PubMed  Google Scholar 

  10. 10.

    Haws AL, He Q, Rady PL, Zhang L, Grady J, Hughes TK, Stisser K, Konig R, Tyring SK. Nested PCR with the PGMY09/11 and GP5+/6+ primer sets improves detection of HPV DNA in cervical samples. J Virol Methods. 2004;122(1):87–93.

    CAS  Article  Google Scholar 

  11. 11.

    Ramesh PS, Devegowda DE, Naik PR, Doddamani PA, Nataraj SM. Evaluating the feasibility of nested PCR as a screening tool to detect HPV infection in saliva of oral squamous cell carcinoma subjects. J Clin Diagnostic Res. 2018;1:12.

    Article  Google Scholar 

  12. 12.

    Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015;136(5):E359–86.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Vaccarella S, Lortet-Tieulent J, Plummer M, Franceschi S, Bray F. Worldwide trends in cervical cancer incidence: impact of screening against changes in disease risk factors. Eur J Cancer. 2013;49(15):3262–73.

    Article  PubMed  Google Scholar 

  14. 14.

    Sowjanya AP, Jain M, Poli UR, Padma S, Das M, Shah KV, Rao BN, Devi RR, Gravitt PE, Ramakrishna G. Prevalence and distribution of high-risk human papilloma virus (HPV) types in invasive squamous cell carcinoma of the cervix and in normal women in Andhra Pradesh, India. BMC Infect Dis. 2005;5(1):1–7.

    Article  Google Scholar 

  15. 15.

    De Sanjosé S, Diaz M, Castellsagué X, Clifford G, Bruni L, Muñoz N, Bosch FX. Worldwide prevalence and genotype distribution of cervical human papillomavirus DNA in women with normal cytology: a meta-analysis. Lancet Infect Dis. 2007;7(7):453–9.

    Article  PubMed  Google Scholar 

  16. 16.

    Sharma K, Kathait A, Jain A, Kujur K, Raghuwanshi S, Bharti AC, Saklani AC, Das BC. Higher prevalence of human papillomavirus infection in adolescent and young adult girls belonging to different Indian tribes with varied socio-sexual lifestyle. PLoS ONE. 2015;10(5): e0125693.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Singh K, Oberoi L, Devi P. Prevalence of Human Papillomavirus and its associated risk factors in women with abnormal cytology at a tertiary care hospital of North India. J Evol Med Dent Sci. 2017;6(89):6172–5.

    Article  Google Scholar 

  18. 18.

    De Villiers EM, Schneider A, Miklaw H, Papendick U, Wagner D, Wesch H, Wahrendorf J, Zur HH. Human papillomavirus infections in women with and without abnormal cervical cytology. The Lancet. 1987;330(8561):703–6.

    Article  Google Scholar 

  19. 19.

    Rassu M, Bertoloni G, Mengoli C, Peron A, Benedetti P, Palu’ G. HPV genotype prevalence in cervical specimens with abnormal cytology: a report from north-east Italy. Scandinavian journal of infectious diseases. 2005;37(6–7):476–81.

  20. 20.

    Nielsen A, Kjaer SK, Munk C, Iftner T. Type-specific HPV infection and multiple HPV types: prevalence and risk factor profile in nearly 12,000 younger and older Danish women. Sex Transm Dis. 2008;35(3):276–82.

    Article  PubMed  Google Scholar 

  21. 21.

    Molden T, Kraus I, Karlsen F, Skomedal H, Hagmar B. Human papillomavirus E6/E7 mRNA expression in women younger than 30 years of age. Gynecol Oncol. 2006;100(1):95–100.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Bauer HM, Hildesheim AL, Schiffman MH, Glass AG, Rush BB, Scott DR, Cadell DM, Kurman RJ, Manos MM. Determinants of genital human papillomavirus infection in low-risk women in Portland. Oregon Sex Trans Dis. 1993;20(5):274–8.

    CAS  Article  Google Scholar 

  23. 23.

    Chouhan S, Malik R, Nigam RK, Jain P. Immunohistochemical and polymerase chain reaction study on expression of HPV and HSV and its histopathological pattern correlation in cervical lesions. J Evol Med Dent Sci. 2016;5(71):5190–6.

    Article  Google Scholar 

  24. 24.

    Asiaf A, Ahmad ST, Zargar MA, Mufti SM, Mir SH. Prevalence of human papillomavirus infection in a Kashmiri ethnic female population. Genet Test Mol Biomarkers. 2012;16(8):904–9.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Vinodhini K, Shanmughapriya S, Das BC, Natarajaseenivasan K. Prevalence and risk factors of HPV infection among women from various provinces of the world. Arch Gynecol Obstet. 2012;285(3):771–7.

    Article  PubMed  Google Scholar 

  26. 26.

    Aggarwal R, Gupta S, Nijhawan R, Suri V, Kaur A, Bhasin V, Arora SK. Prevalence of high-risk human papillomavirus infections in women with benign cervical cytology: a hospital based study from North India. Indian J Cancer. 2006;43(3):110.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Autier P, Coibion M, Huet F, Grivegnee AR. Transformation zone location and intraepithelial neoplasia of the cervix uteri. Br J Cancer. 1996;74(3):488–90.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Remschmidt C, Kaufmann AM, Hagemann I, Vartazarova E, Wichmann O, Deleré Y. Risk factors for cervical human papillomavirus infection and high-grade intraepithelial lesion in women aged 20 to 31 years in Germany. Int J Gynecol Cancer. 2013;23(3).

  29. 29.

    Antić L, Vuković D, Ðikanović B, Antić D, Janković S, Naumović T. Implementation of secondary preventive practice important for cervical cancer among women who use oral contraception. Arch Oncol. 2013;21(3–4):91–6.

    Article  Google Scholar 

  30. 30.

    Srivastava S, Gupta S, Roy JK. High prevalence of oncogenic HPV-16 in cervical smears of asymptomatic women of eastern Uttar Pradesh, India: a population-based study. J Biosci. 2012;37(1):63–72.

    Article  PubMed  Google Scholar 

  31. 31.

    Chakravarty J, Chourasia A, Thakur M, Singh AK, Sundar S, Agrawal NR. Prevalence of human papillomavirus infection and cervical abnormalities in HIV-positive women in eastern India. Indian J Med Res. 2016;143(1):79.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Veena Shetty.

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Shashidhar, S.C., Sonkusare, S., Ramesh, P.S. et al. Prevalence of High-Risk Human Papillomavirus in Women with Normal and Abnormal Pap Smear: A Cross Sectional Study from a Tertiary Hospital in South India. Indian J Gynecol Oncolog 19, 97 (2021).

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  • Human Papillomavirus
  • Papanicolaou test
  • Cytology
  • PCR
  • Cervical cancer