Human papillomavirus genotype distribution in genital warts among women in Harare-Zimbabwe

Abstract

This study aimed to determine the prevalence of HPV genotypes in genital warts among women in Harare, Zimbabwe. Women aged 18–45 years attending gynaecology and genitourinary clinics with a clinical diagnosis of genital-warts were recruited. HPV-DNA was extracted from tissue biopsies. HPV-DNA testing and typing was done by Southern Dot Blot Hybridisation. A hundred samples from 100 women were analysed. Median age of participants was 30.3 years (range 18–45 years). Seventy-eight percent of participants were HIV infected. HPV prevalence was 98%. Low risk genotypes predominated at 86% prevalence. The most prevalent genotypes were 11 (47%), 6 (42%) and 16 (14%). This is the first study on HPV genotype distribution among women with genital warts in Zimbabwe. The high prevalence of HR-HPV 16 in clinically benign lesions shows that warts should have histological analysis to exclude pre-malignancy and malignancy.

Impact statement

• What is already known on this subject? Genital warts (GWs), also known as condylomata acuminata (EAC), are a clinical manifestation of persistent infection with ‘low risk’ or non-oncogenic HPV genotypes. HPV 6 and 11 are examples of low risk genotypes, and both are associated with 90% of GWs. Data on HPV genotypes causing genital warts in the population under study are scarce.

• What do the results of this study add? A high prevalence (98%) of HPV DNA in genital warts, confirms that the biopsied lesions were HPV related. Over and above the high prevalence of low risk HPV 11 (47%) and HPV 6 (42%), the women had 14% prevalence of HPV 16, an oncogenic genotype, in genital warts. Seventy-eight percent of the participants were HIV infected. The HIV infected women had a 33.3% prevalence of HR-HPV as compared to the 15.8% prevalence in the HIV uninfected women.

• What are the implications of these findings for clinical practice and/or further research? The population under study will benefit more if an HPV vaccine that includes anti-HPV 6 and 11 is used. The high prevalence of the HR-HPV in apparently benign lesions shows that warts should have histological analysis to exclude vulvar cancer and vulvar intraepithelial neoplasia. All women presenting with genital warts should be offered an HIV test.

Keywords:

• Human papillomavirus
• genital warts
• HIV
• women
• Zimbabwe

Acknowledgements

The authors would like to acknowledge UZCHS-CTRC Central laboratory for their technical assistance with special mention to Dr Marshall Munjoma. They also thank the UZ HPV research group for their contributions during the project.

Author contributions

NRM, ZMC, TM and JMP designed the study research question and objectives. NRM recruited the participants and collected the samples. FM, KM and RSDM performed the laboratory tests. NRM, ZMC, JMP, TM, BM and RSDM interpreted and summarised the results. NRM and RSDM wrote the paper. All authors critically reviewed the manuscript.

Declaration statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by NIH through University of Zimbabwe-NECTAR, grant number IR24TW008881-04.