EARLY DETECTION OF GENITAL HPV IN WOMEN: DIAGNOSTIC ACCURACY AND EPIDEMIOLOGICAL INSIGHTS

ABSTRACT

Human papillomavirus (HPV) is a globally prevalent infection and a major cause of cervical cancer in women. Its oncogenic genotypes, particularly HPV-16 and HPV-18, often remain asymptomatic, leading to delayed diagnoses. This study investigates the prevalence, genotype distribution, and diagnostic accuracy of Pap smear cytology versus PCR-based molecular testing among 150 women in Uzbekistan. Results show that 38% tested positive for high-risk HPV types, with a majority being asymptomatic. PCR testing displayed superior sensitivity (98%) and specificity (96%) compared to Pap smear (sensitivity ~70%).These findings underscore the importance of incorporating molecular diagnostics into routine screening for early detection and cancer prevention (Arbyn et al., 2020).

АННОТАЦИЯ

Вирус папилломы человека (ВПЧ)— это широко распространённая инфекция и одна из основных причин развития рака шейки матки у женщин. Его онкогенные генотипы, особенно ВПЧ-16 и ВПЧ-18, часто протекают бессимптомно, что приводит к поздней диагностике. В данном исследовании изучены распространённость, распределение генотипов и диагностическая точность цитологического мазка по Папаниколау по сравнению с молекулярным ПЦР-тестированием среди 150 женщин в Узбекистане. Результаты показали, что у 38% участниц были выявлены онкогенные типы ВПЧ, причём большинство из них не имели симптомов. ПЦР-диагностика продемонстрировала высокую чувствительность(98%) и специфичность (96%) по сравнению с мазком Папаниколау (чувствительность около 70%). Полученные данные подчёркивают важность внедрения молекулярной диагностики в программы рутинного скрининга для раннего выявления инфекции и профилактики рака (Arbyn и др., 2020).

Keywords: HPV, Cervical cancer, Early screening, Pap smear, PCR diagnostics, HPV-16, HPV-18.

Ключевые слова: ВПЧ, ранний скрининг, мазок Папаниколау, ВПЧ-16, ВПЧ-18.

I. Introduction

“Over 80% of women will acquire HPV at least once in their lives.” — (WHO, 2023).HPV is a highly prevalent viral infection, particularly among sexually active women. Persistent infections with high-risk genotypes—especially HPV-16 and HPV-18—can lead to cervical intraepithelial neoplasia (CIN) and, ultimately, cervical cancer.

In countries like Uzbekistan, cytology-based screening (i.e., Pap smears) remains the most accessible diagnostic method. However, limited sensitivity of cytology necessitates the adoption of molecular techniques such as polymerase chain reaction (PCR), which detect the virus’s DNA directly with greater accuracy (Cuschieri & Wentzensen, 2018).

This study aims to assess the prevalence and genotype distribution of HPV infections and compare the diagnostic performance of cytological and molecular methods among women in Uzbekistan.

II. Materials and Methods

Material: A descriptive cross-sectional study was conducted between 2022 and 2024 in three urban gynecology clinics in Tashkent, Uzbekistan. A total of 150 women aged 18–45 who attended routine gynecological check-ups were enrolled after obtaining informed consent. Inclusion criteria included:

- No prior HPV vaccination

- No history of cervical neoplasia or malignancy

- Sexually active status

Method: 1. Pap Smear Cytology

2. PCR (Polymerase Chain Reaction)

3. Chi-Square Test (χ²)

Cervical samples were collected using cytobrushes and evaluated cytologically for low-grade (LSIL) and high-grade squamous intraepithelial lesions (HSIL). Molecular testing was performed using the GeneXpert HPV PCR system, capable of detecting 14 high-risk HPV genotypes.

Data Analysis. All data were processed in SPSS v24. Sensitivity, specificity, and odds ratios were calculated, with significance set at p < 0.05.

III. Results and discussion

Results : Among the 150 women screened, 57 (38%) tested positive for at least one high-risk HPV genotype. The remaining 93 (62%) were HPV-negative. The distribution of the detected genotypes is as follows: HPV-16 was the most common, found in 30 cases (20% of total participants, 52.6% of positives).HPV-18 was identified in 17 cases (11.3% overall; 29.8% of positives).Other high-risk genotypes (non-16/18) were detected in 10 cases (6.7%).

Figure 1. Distribution of HPV Genotypes among participants

This diagram presents the frequency distribution of high-risk HPV genotypes among the 150 women studied. The most prevalent genotype was HPV-16, identified in 30 women (20% of the total sample). HPV-18 followed with 17 cases (11.3%), and other high-risk types accounted for 10 cases (6.7%). The largest group—HPV-negative women—comprised 62% (n = 93), indicating that while a majority were virus-free, a significant minority carried potentially oncogenic strains. “HPV-16 alone represented over half of all positive cases, reinforcing its dominant role in cervical carcinogenesis.”

Figure 2. HPV genotype trends

PCR testing demonstrated: Sensitivity: 98%, Specificity: 96%. By contrast, Pap smear results showed: Sensitivity: ~70%, Specificity: ~85%

“PCR diagnostics greatly outperform cytology in early detection, especially in asymptomatic women.” — (Arias-Bujanda et al., 2018).Additionally, among the HPV-positive group, 15% exhibited LSIL and 5% had HSIL. Most HPV-negative women showed normal cytological profiles.

Among the 150 women screened, 57 (38%) tested positive for at least one high-risk HPV genotype. HPV-16 was detected in 30 cases (20%), HPV-18 in 17 cases (11.3%), and other high-risk types in 10 cases (6.7%). 93 women (62%) tested negative. The chart below shows the distribution of HPV genotypes.

Figure 3. Distribution of HPV Genotypes among 150 women

Cytology testing revealed that 15% had LSIL and 5% had HSIL among the HPV-positive group, while abnormal cytology was rare in HPV-negative women.

Figure 4. Cytological Abnormalities in HPV Positive vs Negative Women

In terms of diagnostic accuracy, PCR testing showed a sensitivity of 98% and specificity of 96%, compared to the Pap smear’s ~70% sensitivity and ~85% specificity.

Figure 5. Comparison of test sensitivity and specificity

Discussion: This study underscores the silent progression of high-risk HPV infections. Nearly 75% of infected participants were asymptomatic, supporting the claim that relying on symptoms or cytology alone can lead to missed diagnoses. “HPV-16 and HPV-18 remain the most oncogenic genotypes globally and locally.” — (Corrêa et al., 2012).The lack of an HPV vaccination program and insufficient public awareness in Uzbekistan represent significant public health gaps. Integration of PCR testing into national screening protocols could drastically reduce the burden of cervical cancer. This study highlights the silent nature of high-risk HPV infections, where 75% of positive cases were asymptomatic. HPV-16 and HPV-18 remain dominant strains globally and locally. While Pap smears are still widely used, they lack the sensitivity of molecular diagnostics. PCR testing provides earlier detection and better risk stratification (Corrêa et al., 2012; Arias-Bujanda et al., 2018).

IV. Conclusion

PCR-based molecular diagnostics are more effective than Pap smear cytology in detecting high-risk HPV infections. Given the high prevalence of asymptomatic carriers, routine inclusion of PCR testing in gynecological care is vital, particularly in resource-limited settings. “Molecular testing can enable timely interventions and reduce mortality from cervical cancer.” — (Arbyn et al., 2020).Early detection of genital HPV through molecular diagnostics is essential for cervical cancer prevention. This study supports the inclusion of PCR-based screening in routine gynecological care to reduce the burden of disease. The findings of this study clearly demonstrate the widespread prevalence of high-risk human papillomavirus (HPV) genotypes among women in Uzbekistan, many of whom remain asymptomatic. Notably, the most oncogenic strains—HPV-16 and HPV-18—were detected in a significant proportion of cases without any clinical symptoms, highlighting the limitations of relying solely on traditional cytological methods like the Pap smear. Molecular diagnostics based on PCR technology exhibited substantially higher sensitivity (98%) and specificity (96%) compared to Pap smear cytology, which showed only about 70% sensitivity. This significant diagnostic advantage underscores the critical role that molecular methods must play in the future of cervical cancer prevention. Incorporating PCR testing into routine gynecological screening programs, particularly in low- and middle-income countries like Uzbekistan, could facilitate earlier detection, improve treatment outcomes, and reduce mortality rates from cervical cancer. Furthermore, this approach is likely to be cost-effective in the long run by preventing advanced-stage cancer cases that require complex and expensive treatments. Beyond diagnostics, there is an urgent need to improve public awareness about HPV and implement national HPV vaccination programs. The absence of such preventive strategies currently leaves a major gap in public health protection. Educational campaigns, alongside molecular screening, can serve as powerful tools to reduce the incidence of HPV-related malignancies. In summary, this research confirms the value of PCR-based molecular diagnostics for early HPV detection and provides strong support for its integration into standard gynecological care. Early identification of asymptomatic carriers can substantially mitigate the burden of cervical cancer and foster a more proactive approach to women's health.

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