AUTHOR=Onywera Harris , Mabunda Sikhumbuzo A. , Williamson Anna-Lise , Mbulawa Zizipho Z. A. 

TITLE=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

JOURNAL=Frontiers in Reproductive Health

VOLUME=4

YEAR=2022

URL=https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2022.887736

DOI=10.3389/frph.2022.887736

ISSN=2673-3153

ABSTRACT=<sec><title>Background</title><p>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%).</p></sec><sec><title>Methods</title><p>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 <italic>t</italic>-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.</p></sec><sec><title>Results</title><p>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 (<italic>p</italic> = 0.005), infection with any and multiple <italic>Candida</italic> species (<italic>p</italic> = 0.011 and 0.006, respectively), <italic>Candida albicans</italic> infection (<italic>p</italic> = 0.010), <italic>Ureaplasma urealyticum</italic> pathobiont infection (<italic>p</italic> = 0.044), BV-associated bacteria (specifically <italic>Atopobium vaginae</italic>: <italic>p</italic> = 0.039, BV-associated bacteria 2: <italic>p</italic> = 0.021, <italic>Gardnerella vaginalis</italic>: <italic>p</italic> = 0.021, <italic>Megasphaera</italic> type 1: <italic>p</italic> = 0.037), and BV (<italic>p</italic> = 0.011).</p></sec><sec><title>Conclusions</title><p>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.</p></sec>