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Evaluation of Different Diagnostic Modalities for Screening and Molecular Characterization of Human Papillomavirus
Arti Agrawal1, Archana1, Pragya Shakya1
1Department of Microbiology, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.
Background:
Cervical cancer remains a major global health challenge, ranking as the fourth most common cancer and a leading cause of cancer-related deaths among women. Persistent infection with human papillomavirus (HPV) is recognized as the primary etiological factor. Effective screening methods such as HPV DNA testing, Papanicolaou (Pap) smear cytology, and visual inspection with acetic acid (VIA) are critical for early detection, particularly in resource-limited settings.
Aim:
This study evaluated the performance of different diagnostic approaches for cervical cancer screening and assessed the prevalence and distribution of HPV genotypes among symptomatic women in northern India, with special emphasis on high-risk genotypes beyond HPV16 and 18.
Materials And Methods:
A cross-sectional observational study was conducted over 21 months, which enrolled 200 symptomatic females attending a tertiary care center. Cervical specimens were analyzed using real-time polymerase chain reaction for HPV, including 14 high-risk genotypes. VIA and Pap smear tests were concurrently performed. Associations between variables and HPV status were analyzed using Pearson's Chi-square and Fisher's exact tests.
Results:
High-risk genotypes were detected in 22 participants (11%). HPV16 was the predominant genotype (6%), followed by HPV39 (3.5%). Other oncogenic types, including HPV45, 51, 56, 58, and 66, were also detected. Significant associations were found between HPV positivity and VIA results (P < 0.001) as well as abnormal Pap smear findings, notably low-grade squamous intraepithelial lesion, atypical squamous cells of undetermined significance, and carcinoma cervix (P < 0.001). No significant correlations were noted with most sociodemographic or behavioral risk factors.
Conclusion:
HPV DNA testing demonstrated superior diagnostic accuracy, confirming its role as the gold standard for cervical cancer screening. VIA and Pap smear remain cost-effective alternatives in low-resource settings. The detection of high-risk genotypes beyond HPV16 and 18 emphasizes the need for broader-spectrum HPV vaccines and tailored screening strategies to reduce cervical cancer burden in northern India.
