Human papillomavirus genotypes and clinical management of genital warts in women attending a colposcopy clinic in Cape Town, South Africa

Abstract

Background. Genital human papillomavirus (HPV) infection is the most common sexually transmitted viral disease in the world. HPV infection of the genital epithelium is associated with genital warts and malignancies of the lower genital tract. Objectives. To describe the distribution, phenotypic appearance and HPV type associated with genital warts in women.Methods. This was a prospective observational study of all women with genital warts who attended the Colposcopy Clinic, Groote Schuur Hospital, Cape Town, South Africa, during 2010 and fulfilled the inclusion and exclusion criteria. One hundred and thirteen women were tested for HPV using the Roche Linear Array HPV genotyping kit to determine the HPV genotypes causing genital warts. Results. The median age of the women was 27 years (range 15 -53); 90 (79.6%) were HIV-positive, and two-thirds were on antiretroviral treatment. Treatment involved ablation with topical agents, cauterisation or carbon dioxide laser. At 3 months' follow-up after treatment, 56.6% of the women, the majority of whom were HIV-positive, had recurrent/persistent disease. In both HIV-positive and HIV-negative women, HPV was detected in over 90% of cases. However, over half the HIV-positive women as opposed to 2/18 of the HIV-negative women were infected with multiple HPV genotypes. The commonest HPV genotypes in HIV-positive and HIV-negative women were types 11, 6, 89, 61, 55 and 62 and types 11 and 6, respectively. Conclusions. The majority of the patients were HIV-positive and had multiple HPV infections. While this did not alter the phenotypic appearance of the warts, recurrence/persistence after treatment was more common.

Abnormal cervical cytology amongst women infected with human immunodeficiency virus in Limpopo province, South Africa

“…11 The reasons for various prevalence rates reported in these studies are unclear; however, it could be because of various methods used for CC screening 20,21,22,23 and sexual practices of women, 7,8,12,24,25 which is explained by higher burden of HPV infection. 26,27,28,29 Despite the effectiveness of highly active retroviral therapy (ART) in preventing the development of cervical lesions, 7,8 interestingly in our study, prevalence of abnormal cervical http://www.phcfm.org Open Access cytology was significantly higher in women with HIV than in women without HIV. Vafaei et al, in their study, reported a greater proportion of women with abnormal cervical cytology amongst HIV-positive women than in the general population.…”

“… 11 The reasons for various prevalence rates reported in these studies are unclear; however, it could be because of various methods used for CC screening 20 , 21 , 22 , 23 and sexual practices of women, 7 , 8 , 12 , 24 , 25 which is explained by higher burden of HPV infection. 26 , 27 , 28 , 29 …”

Incidence, Persistence, Clearance, and Correlates of Genital Human Papillomavirus Infection and Anogenital Warts in a Cohort of Men Living With Human Immunodeficiency Virus in South Africa

“…This is less than 44% clearance at 3 month follow-up among women (not living with HIV) reported in a study in Cape Town. 30 The long time to AGW clearance among MLHIV supports the idea of introducing quadrivalent HPV vaccines which also prevent AGW. Cost implications of extending the vaccine to boys might generate reluctance by national Ministries of Health.…”

Editor's choice

“…HIV infection is an important risk factor for HPV infection and persistence. In their Cape Town study, Tayib et al [9] found that almost 80% of patients were HIV-positive. Genital warts are strongly linked to sexual behaviour (in this study the majority of women were sexually active and had had more than one sexual partner), and weakly associated with cigarette smoking (cigarette smoking is biologically associated with decreased antiviral immune cells in the cervical epithelium).…”