PREVALENCE AND GENOTYPE GROUPS OF HUMAN PAPILLOMAVIRUS AND DIAGNOSTIC PERFORMANCE OF PAP SMEAR IN CERVICAL SAMPLES AT THE UNIVERSITY OF ABUJA TEACHING HOSPITAL, NIGERIA



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Abstract

Aim:

Infections with high-risk genotypes of Human Papillomavirus (HPV) are the primary etiological factor for cervical cancer (CC). However, the Papanicolaou (Pap) test without adjunctive virological confirmation has been the mainstay of CC diagnosis in resource-limited settings. This study determined the frequency of HPV infection, genotype groups, and performance characteristics of the Pap test in cervical samples at the University of Abuja Teaching Hospital (UATH), Nigeria.

Methods:

Ninety-seven (97) cervical smears were retrieved using the cytology register, and previously liquid-based pap smear-stained slides were recalled and re-examined, and the retrieved samples were processed and analysed using the Polymerase chain Reaction (PCR) and microscopy following Pap staining. The agreement level of PCR and Pap staining was evaluated.

Results:

Of the samples tested, 25.8% (n=25) were HPV DNA positive. The prevalence of HPV was significantly higher among participants aged 20-30 years (OR=10, 95% CI: 1.3-79.3, p=0.0293).  About 6.2%, 8.2%, and 17.5% of the participants carried the low carcinogenic risk (group 3), definite carcinogenic risk (group 1), and probable/possible carcinogenic risk (group 2A/B) genotype groups, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the Pap test in detecting HPV-induced cervical changes were 50%, 93.3%, 66.7%, 87.5% and 84.2%, respectively. Remarkably, 24.4% (10/41), 30.7% (12/39) and 33.3% (2/6) of participants with Pap smear-negative, LSIL and HSIL, respectively, were HPV DNA-positive.

Conclusion:

The possible/probable carcinogenic risk HPV genotype group was the most prevalent among participants, exceeding the prevalence of the definite carcinogenic risk genotype group, reflecting regional epidemiological characteristics and underscoring the need to consider these genotypes when selecting optimal test systems. The low sensitivity of the Pap test (50%) in detecting HPV-induced cervical changes underscores the need for HPV-based screening methods.

About the authors

A.O.G. Engom

University of Jos, Jos, Nigeria;
University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Email: ovye.alaba@uniabuja.edu.ng

MSc, Medical Laboratory Scientist, Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Nigeria

J.O. Adisa

University of Jos, Jos, Nigeria

Email: j.adisa@unijos.edu.ng

PhD, Professor of Histopathology, Department of Medical Laboratory Science, University of Jos, Jos, Nigeria

Niger

Idris Nasir Abdullahi

Ahmadu Bello University, Zaria, Nigeria

Email: eedris888@yahoo.com
ORCID iD: 0000-0002-5511-1272

PhD, DSc (Hons)

Department of Medical Laboratory Science,

College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria

Nigeria

Stephen Oricha

University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Email: oricha44@gmail.com

Medical Laboratory Scientist, Department of Medical Laboratory Services, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Nigeria

O. R. Aseku

University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Email: asekuraphael@gmail.com

MBBS, Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Nigeria

B. H. Nongo

University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Email: bennongo@yahoo.com

MBBS, Consultant Obstetrician and Gynaecologist, Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Nigeria

A. O. Adelowo

University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Email: abdul.adelowo@uniabuja.edu.ng

MBBS, Consultant Pathologist, Department of Pathology and Forensic Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Nigeria

B. A. Okonu

University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Author for correspondence.
Email: bobify@yahoo.com

MBBS, Consultant Physician, Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Nigeria

References

  1. Abubakar, Y., Ajang, A. Y., Ella, E. E., Oguntayo, A. O., & Aminu, M. Prevalence of Human Papillomavirus Infection and its Association with the Risk of Cervical Cancer among HIV-Positive Women in Plateau State, North-Central Nigeria. UMYU Journal of Microbiology Research (UJMR), 2024, 9(1), 147–157. https://doi.org/10.47430/ujmr.2491.016
  2. Adejo, D., Aminu, M., Ella, E., Oguntayo, O., & Obishakin, O. Prevalence of high-risk human papillomavirus genotypes among apparently healthy women with normal and abnormal cervical cytology in Kaduna State, Nigeria. African Journal of Clinical and Experimental Microbiology, 2024, 25(1), 17–27. https://doi.org/10.1038/s41598-024-68344-4
  3. Akarolo-Anthony, S. N., Famooto, A. O., Dareng, E. O., Olaniyan, O. B., Offiong, R., Wheeler, C. M., & Adebamowo, C. A. Age-specific prevalence of human papilloma virus infection among Nigerian women. BMC public health, 2014, 14, 656.
  4. https://doi.org/10.1186/1471-2458-14-656
  5. Ali, M., Sinha, R., Kumar, A., Karim, S., Irfan, M., Kumar, S., Sinha, S., Kumar, A., Ghosh, A., & Singh, M. HPV DNA status and clinical history of patients are supplements for accurate reporting of the cytological Pap smear. Scientific reports, 2024, 14(1), 17486. https://doi.org/10.1038/s41598-024-68344-4
  6. Alrajjal, A., Pansare, V., Choudhury, M. S. R., Khan, M. Y. A., & Shidham, V. B. Squamous intraepithelial lesions (SIL: LSIL, HSIL, ASCUS, ASC-H, LSIL-H) of Uterine Cervix and Bethesda System. CytoJournal, 2021, 18, 16.
  7. https://doi.org/10.25259/Cytojournal_24_2021
  8. Anoruo, O., Bristow, C., Mody, N., & Klausner, J. D. Estimated prevalence of human papillomavirus among Nigerian women: A systematic review and meta-analysis. African journal of reproductive health, 2022, 26(6), 89–96.
  9. https://doi.org/10.29063/ajrh2022/v26i6.10
  10. Ashaka, O. S., Omoare, A. A., James, A. B., Adeyemi, O. O., Oladiji, F., Adeniji, K. A., Okunade, K. S., & Agbede, O. O. Prevalence and Risk Factors of Genital Human Papillomavirus Infections among Women in Lagos, Nigeria. Tropical medicine and infectious disease, 2022, 7(11), 386.
  11. https://doi.org/10.3390/tropicalmed7110386
  12. Cervical cancer causes, risk factors, and prevention. Cancer.gov. 2024.
  13. https://www.cancer.gov/types/cervical/causes-risk-prevention.
  14. Cosmas, N. T., Nimzing, L., Egah, D., Famooto, A., Adebamowo, S. N., & Adebamowo, C. A. Prevalence of vaginal HPV infection among adolescent and early adult girls in Jos, North-Central Nigeria. BMC infectious diseases, 2022, 22(1), 340.
  15. https://doi.org/10.1186/s12879-022-07215-7
  16. Emeribe, A. U., Abdullahi, I. N., Etukudo, M. H., Isong, I. K., Emeribe, A. O., Nwofe, J. O., Umeozuru, C. M., Shuaib, B. I., Ajagbe, O. R. O., Dangana, A., Egenti, B. N., & Ghamba, P. E. The pattern of human papillomavirus infection and genotypes among Nigerian women from 1999 to 2019: a systematic review. Annals of medicine, 2021, 53(1), 944–959.
  17. https://doi.org/10.1080/07853890.2021.1938201
  18. Ezebialu, C. U., Ezebialu, I. U., Ezeifeka, G. O., Nwobu, R. a. U., Okani, C. O., & Chukwubuike, C. M. Prevalence of cervical human pappillomavirus infection in Awka, Nigeria. Journal of Biosciences and Medicines, 2020, 08(03), 37–47.
  19. https://doi.org/10.4236/jbm.2020.83005
  20. Fowler, J.R., Maani, E.V., Dunton, C.J., Gasalberti, D.P., Jack, B.W. Cervical cancer. StatPearls - NCBI Bookshelf. 2023. https://www.ncbi.nlm.nih.gov/books/NBK431093/
  21. Gupta, R., & Gupta, S. Point-of-care tests for human papillomavirus detection in uterine cervical samples: A review of advances in resource-constrained settings. The Indian journal of medical research, 2023, 158(5&6), 509–521.
  22. https://doi.org/10.4103/ijmr.ijmr_1143_23
  23. HPV and Pap Test Results: Next Steps after an Abnormal Test. Cancer.gov. 2024.
  24. https://www.cancer.gov/types/cervical/screening/abnormal-hpv-pap-test-results
  25. Kabir, A., Bukar, M., Nggada, H. A., Rann, H. B., Gidado, A., & Musa, A. B. Prevalence of human papillomavirus genotypes in cervical cancer in Maiduguri, Nigeria. The Pan African medical journal, 2019, 33, 284. https://doi.org/10.11604/pamj.2019.33.284.18338
  26. McBride A. A. Human papillomaviruses: diversity, infection and host interactions. Nature reviews. Microbiology, 2022, 20(2), 95–108.
  27. https://doi.org/10.1038/s41579-021-00617-5
  28. Molina, M. A., Steenbergen, R. D. M., Pumpe, A., Kenyon, A. N., & Melchers, W. J. G. HPV integration and cervical cancer: a failed evolutionary viral trait. Trends in molecular medicine, 2024, 30(9), 890–902.
  29. https://doi.org/10.1016/j.molmed.2024.05.009
  30. Morhason-Bello, I. O., Baisley, K., Pavon, M. A., Adewole, I. F., Bakare, R., de Sanjosé, S., Francis, S. C., & Watson-Jones, D. Prevalence and genotype specific concordance of oro-genital and anal human papillomavirus infections among sexually active Nigerian women. Infectious agents and cancer, 2021, 16(1), 59.
  31. https://doi.org/10.1186/s13027-021-00398-9
  32. Mustafa, R. A., Santesso, N., Khatib, R., Mustafa, A. A., Wiercioch, W., Kehar, R., Gandhi, S., Chen, Y., Cheung, A., Hopkins, J., Ma, B., Lloyd, N., Wu, D., Broutet, N., & Schünemann, H. J. Systematic reviews and meta-analyses of the accuracy of HPV tests, visual inspection with acetic acid, cytology, and colposcopy. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2016, 132(3), 259–265. https://doi.org/10.1016/j.ijgo.2015.07.024
  33. Nanda, K., McCrory, D. C., Myers, E. R., Bastian, L. A., Hasselblad, V., Hickey, J. D., & Matchar, D. B. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: a systematic review. Annals of internal medicine, 2020, 132(10), 810–819. https://doi.org/10.7326/0003-4819-132-10-200005160-00009
  34. Ohihoin, A. G., Okwuraiwe, P. A., Musa, A. Z., Olorunfemi, G., Onwuamah, C. K., Ige, F., Amoo, O. S., Audu, R., Okogbo, F., Daniyan, B., Swende, T., Onyemelukwe, G., Daru, H., Usman, H., Shittu, O., Musa, J., Ezechi, O. C., & Ujah, I. A. Prevalence and predictors of High-Risk HPV in Nigeria. Advances in Infectious Diseases, 2022, 12(04), 745–757.
  35. https://doi.org/10.4236/aid.2022.124052
  36. Okoeguale, J., Samuel, S., Amadi, S., Njoku, A., & Okome, G. Prevalence and distribution of cervical high-risk human papillomavirus infection in a rural community of Edo State, Nigeria. African Journal of Clinical and Experimental Microbiology, 2022, 23(4), 437–441.
  37. https://doi.org/10.4314/ajcem.v23i4.12
  38. Onwuamah, C. K., Feng, N., Momoh, A. E., Uwandu, M., Ahmed, R. A., Idigbe, I., Vincent, G. D., Ogbu, C. A., Okonkwo, N., Sokei, J., Abimbola, B. S., Ojopagogo, T., Okoli, L. C., Adesina, M., Ezemelue, P. N., Sowunmi, O., Okwuzu, J., Labo Popoola, O. H., Shaibu, J. O., Ohihoin, G. A., … Ezechi, O. C. Prevalence and risk factors for high-risk human papillomavirus infection among women from three southern geopolitical zones of Nigeria. Frontiers in oncology, 2023, 13, 1254304.
  39. https://doi.org/10.3389/fonc.2023.1254304
  40. Rasheed, F. A., Yakasai, I. A., Abdurrahman, A., Usman, A., & Yusuf, N. Human papillomavirus serotypes and determinants among women with invasive cervical cancer in Katsina state, Northwest-Nigeria: a multicentre study. Ecancermedicalscience, 2024, 18, 1714.
  41. https://doi.org/10.3332/ecancer.2024.1714
  42. Rume, J., Morhason-Bello, I. O., & Oladokun, A. Assessment of knowledge of human papillomavirus transmission and prevention among tertiary institution students in the Plateau Central Senatorial District, Nigeria. PLOS global public health, 2024, 4(9), e0003273.
  43. https://doi.org/10.1371/journal.pgph.0003273
  44. van den Borst, E., Bell, M., Op de Beeck, K., Van Camp, G., Van Keer, S., & Vorsters, A. Lineages and sublineages of high-risk human papillomavirus types associated with cervical cancer and precancer: a systematic review and meta-analysis. Journal of the National Cancer Institute, 2025, 117(12), 2461–2476.
  45. https://doi.org/10.1093/jnci/djaf118
  46. World Health Organization. Nigeria to vaccinate 7.7 million girls against leading cause of cervical cancer. [online] Africa Renewal.
  47. https://www.un.org/africarenewal/magazine/october-2023/nigeria-vaccinate-77-million-girls-against-leading-cause-cervical-cancer
  48. World Health Organization: WHO. Cervical cancer. 2019.
  49. https://www.who.int/health-topics/cervical-cancer
  50. World Health Organization: WHO. Global Leaders Unite to Accelerate Cervical Cancer Elimination Efforts. WHO. 2025. https://www.who.int/westernpacific/news/item/19-06-2025-global-leaders-unite-to-accelerate-cervical-cancer-elimination-efforts
  51. World Health Organization: WHO. WHO recommends DNA testing as a first-choice screening method for cervical cancer prevention. WHO. 2021.
  52. https://www.who.int/europe/news/item/11-09-2021-who-recommends-dna-testing-as-a-first-choice-screening-method-for-cervical-cancer-prevention
  53. Ye, J., Zheng, L., He, Y., & Qi, X. Human papillomavirus associated cervical lesion: pathogenesis and therapeutic interventions. MedComm, 2023, 4(5), e368.
  54. https://doi.org/10.1002/mco2.368
  55. Zakka, A., Ayolabi, C., & Olusola, B.. Human papillomavirus (HPV) genotypes and risk determinants among Nigerian women with cervical lesions. Microbes and Infectious Diseases /Microbes and Infectious Diseases, 2023, 5(2), 501-515.
  56. https://doi.org/10.21608/mid.2023.235872.1618
  57. Wei, F., Georges, D., Man, I., Baussano, I., & Clifford, G. M. Causal attribution of human papillomavirus genotypes to invasive cervical cancer worldwide: a systematic analysis of the global literature. Lancet (London, England), 2024, 404(10451), 435–444. https://doi.org/10.1016/S0140-6736(24)01097-3
  58. St-Martin, G., Thamsborg, L. H., Andersen, B., Christensen, J., Ejersbo, D., Jochumsen, K., Johansen, T., Larsen, L. G., Waldstrøm, M., & Lynge, E. Management of low-grade cervical cytology in young women. Cohort study from Denmark. Acta oncologica (Stockholm, Sweden), 2021; 60(4), 444–451. https://doi.org/10.1080/0284186X.2020.1831061
  59. Bruno, M. T., Cassaro, N., Bica, F., & Boemi, S. Progression of CIN1/LSIL HPV Persistent of the Cervix: Actual Progression or CIN3 Coexistence. Infectious diseases in obstetrics and gynecology, 2021, 6627531. https://doi.org/10.1155/2021/6627531

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