| Abstrakt: |
Objective: To study the occurrence of high-risk Human Papillomavirus (HR-HPV) infection among women aged 18–45 years with chronic vaginal discharge and to determine the role of cervicovaginal microbiota in the persistence of HR-HPV infection. Methods: A prospective cohort study was conducted between January 2018 and December 2020. Four hundred women aged 18–45 years with chronic vaginal discharge were included after obtaining consent. The socioeconomic and demographic details were recorded. Vaginal and endocervical swabs were processed for aerobic bacterial, fungal, and Trichomonas vaginalisculture. The HR-HPV detection was done using HC2 HPV DNA hybridization capture assay. The women who tested positive for HR-HPV were followed-up for 12 months, and repeat HR-HPV screening was done to assess the persistence. Results: The mean age of women was 35 years, and most belonged to the lower-income group, and 68% had educational levels above middle school. Lactobacilli were absent in 62.8% of women, and abnormal cervicovaginal microbiota was found among 32.7% of women. Escherichia coli(9.5%), Candida albicans(8%), and non-albicans Candida spp(5.8%) were the most common organisms. HR-HPV was found in 13.25% of women. After 12-month follow-up, 33 cleared HPV, while 20 had a persistent infection. Those who cleared HR-HPV had resolved symptoms and re-established lactobacilli. Extra-marital affair among the spouse, post-coital, and intermenstrual bleeding was more often associated with HR-HPV infection (p< 0.001). Trichomonas vaginalisinfection was often associated with HR-HPV infection (p< 0.05). Non-albicans Candida sppwas significantly associated with HR-HPV persistence which is a new finding. Conclusion: The altered cervicovaginal microbiota and decreased lactobacillus count were significantly associated with HR-HPV. The clearance of abnormal microbiota with the re-establishment of lactobacilli resulted in HR-HPV eradication. The infection with non-albicans Candida spp. and Trichomonas vaginalis infections had persistent HR-HPV infection. |
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