Bacterial Vaginosis Linked to HPV in Tribal Women: Study emphasizes on Early Screening and Treatment

The study, published in the Indian Journal of Dermatology, Venereology and Leprology, found that 6.5% of sexually active tribal women were infected with human papillomavirus. There was a significant association between bacterial vaginosis, which had a prevalence of 41.5%, and HPV positivity, with co-infections increasing the risk. Cases of candidiasis and chlamydia were also identified, highlighting the importance of early detection and treatment of reproductive tract infections to reduce the risk of cervical cancer.

The vaginal microenvironment plays a crucial role in the infection and persistence of human papillomavirus, a key factor in cervical carcinogenesis. Tribal women, particularly those in Dahanu taluka, Maharashtra, face an increased risk of HPV and cervico-vaginal infections due to factors such as polygamy, poor hygiene, and illiteracy. To better understand this association, Kiran Munne, Department of Child Health Research, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India, and colleagues evaluated the prevalence of common cervico-vaginal infections and their link to HPV infection and cervical precancers in this vulnerable population.

For this purpose, the researchers recruited tribal women from Dahanu taluka for a cross-sectional study. Cervical brushing samples were collected and tested for human papillomavirus using the Hybrid Capture 2 method, while polymerase chain reaction was employed to detect Chlamydia trachomatis. Vaginal samples were also collected for gram staining to identify candidiasis and bacterial vaginosis, followed by visual inspection of the cervix using acetic acid.

The study led to the following findings:

• A total of 501 sexually active tribal women were recruited for the study.
• The human papillomavirus (HPV) infection rate among the participants was 6.5%.
• Vaginal smears evaluated by Nugent’s scoring showed bacterial vaginosis in 208 women (41.5%), candidiasis in 30 women (5.98%), and chlamydia in 5 women (1%).
• The prevalence of bacterial vaginosis was higher in women who tested positive for high-risk HPV.
• The presence of clue cells was associated with HPV positivity, suggesting a link between bacterial vaginosis and HPV infection, indicating an increased risk of HPV infection when co-infected with bacterial vaginosis.

The researchers note that the study was limited by the fact that only tribal women were screened, with no screening conducted for other sexually transmitted infections. Additionally, since participants were recruited from healthcare centers rather than through random sampling, this may have impacted the estimates of infection rates.

"Due to regional variations in sexual behaviors and gynecological morbidities, the findings cannot be generalized to tribal women from other regions. Early detection and management of reproductive tract and sexually transmitted infections are crucial in preventing co-infections and reducing the risk of cervical carcinogenesis," the researchers concluded.

Reference:

Munne KR, Birje S, Patil AD, Akula A, Mayekar A, Bhekare G, et al. Association between high-risk human papillomavirus and cervico-vaginal infections in tribal women screened for cervical precancers and cancers in Maharashtra, India: A cross-sectional study. Indian J Dermatol Venereol Leprol. doi: 10.25259/IJDVL_1501_2024