Prevalence and attributes of cervicovaginal human papillomavirus infection among a 35-year- age- cohort of ever-married women in a district of Sri Lanka: a cross-sectional study.

Abstract

Background: All cervical cancers are virtually associated with sexually transmitted cervicovaginal human papillomavirus (HPV) infection. The objective of the study was to determine the prevalence and risk factors of cervicovaginal Human Papillomavirus infection among a 35-year-old-age cohort of ever-married women in Kalutara district.

Methods: A community-based descriptive cross-sectional study was conducted from 1st of July 2018 to 30th November 2018 among ever-married women 35 years of age in Kalutara district. Three women from each cluster (n = 413) were selected by consecutive sampling technique. HPV/DNA cervical specimen collection (n = 822) was carried out. Cervical specimens were tested by well-trained cyto-screeners with cobas 4800 HPV/DNA automated Polymerase Chain Reaction (PCR) machine. An Interviewer-administered questionnaire was used to gather information regarding socio-demographics, reproductive health, contraceptive methods, and sexual behaviours. Multivariate logistic regression was performed and expressed as odds ratio (OR) and 95% confidence interval (CI).

Results: The prevalence of HPV infection was 6.2% (95% CI: 6.18%-6.22%), while the prevalence of high-risk genotypes 16 and 18 was 1.94% (95% CI: 1.93%-1.95%). The prevalence of 12 pooled high-risk HPV infection was 4.14% (95% CI:4.13%-4.15%). In multivariate logistic regression analysis, age at marriage ≤ 24 years (OR = 4.04, 95% CI:1.75-9.34), any abortion including both induced and miscarriages (OR = 10.1, 95% CI: 3.07-33.7), use of hormonal contraceptives for ≥ 3 months (OR = 45.5, 95% CI: 18.7-110.5) and a number of vaginal deliveries > 2 (OR = 9.7, 95% CI: 3.7-25.2) were found to have a significant risk association with HPV infection, while average monthly income > Rs. 15,000 (OR = 0.12, 95% CI, 0.04-0.32) and ever use of a condom by a spouse (OR = 0.04, 95% CI: 0.01-0.16) were found to have a significant protective association with HPV infection.

Conclusions: Exposure to HPV infection is determined by risk factors such as early marriage, any abortions, prolonged usage of hormonal contraceptives, and high number of vaginal deliveries. Strengthening behaviour change communication to alleviate underlying risk factors and to promote prevention is very important.