Association between visual inspection of the cervix with acetic acid examination and high-risk human papillomavirus infection, Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in Papua New Guinea

Andrew J. Vallely, Pamela J. Toliman, Claire Ryan, Glennis Rai, Johanna Wapling, Josephine Gabuzzi, Antonia Kumbia, Benny Kombuk, Zure Kombati, Lisa M. Vallely, Angela Kelly-Hanku, Handan Wand, Sepehr N. Tabrizi, Glen D.L. Mola, John M. Kaldor

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Papua New Guinea (PNG) has among the highest estimated burdens of cervical cancer globally but currently has no national cervical screening program. Visual inspection of the cervix with acetic acid (VIA) is a low-cost screening strategy endorsed by the World Health Organization that has been adopted in many low-resource settings but not previously evaluated in PNG. 

Aim: To evaluate the association between VIA examination findings and high-risk HPV (hrHPV) infection; and the impact of concomitant genital Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis on the interpretation of VIA findings. Methods: A prospective clinical cohort study among women aged 30–59 years attending Well Woman Clinics in PNG. Main outcome measures were VIA examination findings and laboratory-confirmed hrHPV, C. trachomatis, N. gonorrhoeae and T. vaginalis

Results: A total of 614 women were enrolled, of whom 87.5% (537/614) underwent VIA, and 12.5% (77/614) did not due to pre-existing cervicitis or inability to visualise the transformation zone. Among the 537 women who underwent VIA, 21.6% were VIA positive, 63.7% VIA negative, and 14.7% had indeterminate findings. The prevalence of hrHPV infection (n = 614) was 14.7%; C. trachomatis, 7.5%; N. gonorrhoeae, 8.0%; and T. vaginalis, 15.0%. VIA positive women were more likely to have HPV16 (odds ratio: 5.0; 95%CI: 1.6–15.6; P = 0.006) but there was no association between HPV18/45, all hrHPV types (combined), C. trachomatis, N. gonorrhoeae or T. vaginalis

Conclusions: VIA positivity was associated with HPV16, but not with other hrHPV infections, nor with genital C. trachomatis, N. gonorrhoeae or T. vaginalis in this setting.

Original languageEnglish
Pages (from-to)576-581
Number of pages6
JournalAustralian and New Zealand Journal of Obstetrics and Gynaecology
Volume58
Issue number5
DOIs
Publication statusPublished - Oct 2018
Externally publishedYes

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