Introduction: Human Papilloma Virus (HPV) which is a major health concern around the world can cause serious diseases in both men and women. The topic of HPV continuous to be an important, as its infection speared rapidly (1). Papillomaviruses are specific for each individual and they are ubiquitous which are detectable in wide variety of animals as well as humans. Basal epithelial cell of the skin or inner lining of the tissue are divided into two sections, first is the cutaneous types and the second one is mucosal types. These sections are the target tissue of the HPVs which can infect them. Those types of HPV that infect the cutaneous part are epidermitrophic and target the skin of the hands and feet, while, the second group which are mucosal infect the lining of the mouth, respiratory tract, throat and anogenital epithelium (1,2). According to the World Health Organization, the prevalence of HPV infection is approximately between 9 to 13 percentages or on the other hand, is 630 million people around the world (1). Moreover, the infection with anogenital HPVs is the most common viral sexually transmitted infection. HPV is categorized into two groups based on their partnership with cervical cancer and precursor lesion. These two groups are included High-risk and Low-risk HPV types (2). Cervical cancer is the second type of the cancer among women around the world especially developing countries. Late detection of this infection can have negative consequences such as death for women (3). Furthermore, if the infection with high-risk groups persists in the cervix for a long time, it can produce precancerous lesion and lead to cervical cancer (4). The cervical cytology program in developed or high-income salaries countries, reduce the rate of mortality of the cervical cancer; however, in middle- and low-income countries the incidence is increased due to the lack of effectiveness in screening program (5). The important factor which can weaken the screening program is the unavailability of adequate resources and infrastructure in these countries.
Harold zur Hausen was a German virologist who demonstrated the connection between genital infection and cervical cancer in the early 1980s (2). According to the statistics, 99.7% of cervical squamous cell cancer is related to the HPV. Moreover, adenocarcinomas of the cervix are HPV association, while, the correlation is completely age dependent, for instance in women who are younger than 40 the percentage of adenocarcinomas reach to the 89%, and in women in the age of 60 years and older, HPV can observe in only 43% (2). Infection with multiple types of HPV can be a risk factor to increase cervical cancer, but there is still debate that whether this infection is due to the relationship among certain types of HPV or it occurs randomly (3). Furthermore, there are between 12 and 15 types among 200 HPV types which are classified as HR-HPV. These groups are able to infect cervix and they are a risk factor leading to the development of cervical cancer. Coinfection of HPV genotype is common in 20-50% of infected women, especially among young women. There is still a lot of question about the relationship between HPV infection and cervical cancer. Despite several contradictions, study about this relationship is very few (3).
In this study, we analyzed 50 women who infected with HPV genotypes and referred to the Mad Pathology Laboratory, Tehran, Iran and consider the association between their infection with cervical cancer.
Methods: The study was conducted according to the documents which we had during two months from September 2022 to November 2022. We collected patient’s histories who referred to the Mad Pathology Laboratory. The data from their histories revealed that they have been infected with one or multiple HPV types. Their pathology reports were also analyzed and the relationship between Cervical cancer and HPV coinfection types were discussed. This infection caused some of patients became at risk of cervical cancer and the lesion around cervix influenced by HPV types. Women with positive HPV were dispatched for colposcopy with biopsies. Expert colposcopies performed all examinations and the reports were classified according to the patient’s histories. The ranges of participant’s age were between 23 to 48 years. All biopsies with or without morphological changes for a total of 50 samples were analyzed. A woman who infected with more than one genotypes was considered to have coinfection. To prove this hypothesis, required information was obtained from patients and the data were analyzed by SPSS (ver.23).
Results: A total of 50 patients were analyzed in this study, of whom 33 patients (66%) was HPV positive with single type, while 17 patients (34%) had coinfection with multiple HPV types (both HR and LR HPV). Moreover, 23 out of 50 patients being infected by LSIL/CIN I; however, only 5 participants suffered from HSIL/ CIN II. There were 26 patients who not only were infected by HPV 16 and 18 types, but also had coinfection with other types. The pathology report of these participants reveals that they had chronic Endo cervicitis with metaplasia and hyperplasia. According to the results, majority of them had the problem of LSIL/CIN I. Reactive squamous with koilocytic changes (Nuclear Enlargement), was seen in patients who had coinfection of other types such as 62/68, 55/66, 35/39/31 HR-HPV and 6/11/54 LR-HPV. The significant point of this study was the young generation of participants. There were 10 patients who the mean age of them was 25 (From 21 to 29), and the majority of them were positive for 16 and 18 HR- HPV. These patients had the pathology reports of chronic inflammation, or chronic Endo cervicitis with metaplasia and hyperplasia, LSIL/CIN I and HSIL/CIN II. On the other hand, they showed the same symptoms due to the same HPV types. These results demonstrate that the young generations are more at risk of cervical cancer rather than other groups. Furthermore, benign squamous epithelium was seen in approximately 10 patients.
Conclusion: In this study, the dominant types of HPV genotypes were 16, 18 and 56/66 which most patients suffered from them. Moreover, LSIL/CIN I was the main symptoms among women. This study wanted to indicate the significance of the results of HPV PCR beside the colposcopy. However, the Pap smear results cannot be denied and can help doctor to screen better. It should be mentioned that, as the sensitivity of the women’s genital tract is so high, any symptoms should be given importance. Furthermore, further study is required in order to increase public awareness about the importance of HPV screening as well as vaccination.
Keywords: Human Papillomavirus, Genital Lesion, Cervical Cancer, Co-infection, Pap smear