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ORIGINAL RESEARCH article

Front. Glob. Womens Health
Sec. Infectious Diseases in Women
Volume 5 - 2024 | doi: 10.3389/fgwh.2024.1436064

Urinary Human papillomavirus DNA as an indicator of gynaecological infection in young women in Schistosoma and HIV endemic South Africa

Provisionally accepted
Pavitra Pillay Pavitra Pillay 1*Hashini Nilushka Galappaththi-Arachchige Hashini Nilushka Galappaththi-Arachchige 2Myra Taylor Myra Taylor 3Borghild Roald Borghild Roald 2,4Eyrun Floerecke Kjetland Eyrun Floerecke Kjetland 2,3
  • 1 Durban University of Technology, Durban, South Africa
  • 2 Faculty of Medicine, University of Oslo, Oslo, Oslo, Norway
  • 3 University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
  • 4 Oslo University Hospital, Oslo, Nordland, Norway

The final, formatted version of the article will be published soon.

    Globally, Africa has the highest HIV, cervical cancer and schistosomiasis prevalence. Female Genital Schistosomiasis (FGS) is hypothesized to be associated with HIV and cervical atypia. Young women aged 15 and above, constituting almost 3 million of the South African population, have limited health care access are at risk for these diseases. Urinary HPV DNA analysis is a non-invasive sampling method that can be used in risk assessment. This study compared HPV DNA in urine and cervicovaginal lavage (CVL) samples to cytology Pap smears, Schistosoma microscopy and HIV results. In this cross-sectional study, 235 young women aged 16 years and older from rural high schools in KwaZulu-Natal participated. HPV DNA analysis was done in urine and CVL samples. Cytology pap smears analysis and urine Schistosoma microscopy was done. Urinary schistosomiasis was reported in 49 (20.9%) and HIV detected in 49 (20.4%). Urinary and CVL HPV DNA was found in 147 (62.6%) and 177 (75.3%) respectively. Any atypia was detected cytologically among 173 (73.6%). The following associations were found using the Pearson Chi-Square and a Likelihood Ratio test: a) between HIV positive status and urinary HPV DNA positive cases on both the urine (X 2 = 5.007; p-value = 0.025) and (X 2 = 4.264; p-value = 0.039) and between HIV positive status and CVL HPV DNA tests respectively (X 2 = 5.165; p-value = 0.023) and (X 2 = 4.321; p-value = 0.015), and b) among urine HPV DNA and the CVL HPV DNA tests, where (X 2 = 52.966; p-value = 0.001) and (X 2 = 50.716; p-value = 0.001). Urine HPV DNA showed a sensitivity of 75.7% and specificity of 77.6% relative to the CVL HPV DNA. There was no statistical association between urinary schistosomiasis and HPV or with any atypia. Urine can be potentially optimized as an alternative and more acceptable sample for HPV detection among young adolescent populations at risk in comparison to CVL samples. An integrated targeted intervention incorporating Schistosoma in addition to HPV and HIV testing needs consideration among young women in this age group from endemic areas.

    Keywords: Urine, Human papillomavirus, DNA, Cervico-vaginal lavage, female genital schistosomiasis

    Received: 21 May 2024; Accepted: 20 Dec 2024.

    Copyright: © 2024 Pillay, Galappaththi-Arachchige, Taylor, Roald and Kjetland. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Pavitra Pillay, Durban University of Technology, Durban, South Africa

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