The Prevalence of Cervical Human Papillomavirus Infection and the Most At-risk Genotypes Among Iranian Healthy Women: A Systematic Review and Meta-analysis

Prevalence of HIV, HBV, HCV, HPV and syphilis among female sex workers in Kurdistan, west of Iran

Background

Female sex workers (FSWs) in most societies run a high risk of health problems, including sexually transmitted infections (STIs) such as viral infections and syphilis. The present study examines the prevalence of viral infections and syphilis among FSWs.

Methods

This cross-sectional study recruited 100 female sex workers (April 2019 to April 2020) who visited the Counseling Center for Behavioral Diseases or were selected via purposeful (snowball) sampling. A questionnaire (demographic information and STI risk factors) was completed in a face-to-face interview with the participants. Blood samples were then taken to test the markers for HBV, HCV Ab, HIV Ab, Rapid Plasma Reagin (RPR) for syphilis and a PCR was taken to test for HPV (in vaginal sex workers from the cervix and anal sex workers from the anal region). The data were analyzed in Stata 14.

Results

Among 100 FSWs, 6 (6%) were infected with HIV, 1 (1%) with hepatitis B, and 2 (2%) were anti-HCV positive. 1 (1%) participant was suspected of having syphilis. Based on the PCR tests, 16 (16%) participants were infected with HPV. Moreover, 68 (68%) FSWs reported having unprotected sex.

Conclusion

Due to the prevalence of viral infections and syphilis and unprotected sex in FSWs, immediate preventive measures are critical for this vulnerable group to control the transmission of these viral infections in society.

Type distribution of human papillomaviruses in ThinPrep cytology samples and HPV16/18 E6 gene variations in FFPE cervical cancer specimens in Fars province, Iran

BACKGROUND

There exists strong evidence that human papillomavirus (HPV) is associated with cervical cancer (CC). HPV E6 is a major oncogene whose sequence variations may be associated with the development of CC. There is not sufficient data on the distribution of HPV types in ThinPrep cytology specimens and HPV 16/18 E6 gene variations among CC patients in the southwest of Iran. This study was conducted to contribute to HPV screening and vaccination in Iran.

METHODS

A total of 648 women screened for cervicitis, intraepithelial neoplasia or CC were included in the study. All participants underwent ThinPrep cytology testing, single-step HPV DNA detection and allele-specific reverse hybridization assays. Moreover, a total of 96 specimens previously tested positive for single infection with HPV16 or 18 were included for variant analysis. HPV16/18 lineages and sublineages were determined by PCR assays followed by sequencing the E6 gene and the construction of neighbor-joining phylogenetic trees.

RESULTS

Overall, HPV DNA was detected in 62.19% of all the screened subjects. The detection rates of HPV DNA among individuals with normal, ASC-US, ASC-H, LSIL, and HSIL cervical cytology were 48.9%, 93.6%, 100%, 100%, and 100%, respectively. Low-risk HPVs were detected more frequently (46.9%) than high-risk (38.9%) and possible high-risk types (11.1%). Of 403 HPV-positive subjects, 172 (42.7%) had single HPV infections while the remaining 231 (57.3%) were infected with multiple types of HPV. Our results indicated a remarkable growth of high-risk HPV66 and 68 and low-risk HPV81 which have rarely been reported in Iran and HPV90 and 87 that are reported for the first time in the country. In addition, 3 lineages (A, D, and C) and 6 sublineages (A1, A2, A4, C1, D1, and D2) of HPV16, and one lineage and 4 sublineages (A1, A3, A4, and A5) of HPV18 were identified. The studied HPV16 and 18 variants mainly belonged to the D1 and A4 sublineages, respectively.

CONCLUSION

The present study suggests that the prevalence of HPV infection in women of all age groups with or without premalignant lesions in the southwestern Iran is high and the predominant HPV types in the southwest of Iran may differ from those detected in other parts of the country. This study also highlights the necessity of not only initiating HPV vaccination for the general population but also developing new vaccines that confer immunity against the prevalent HPV types in the area and national cervical screening programs using a combination of thinPrep cytology test and HPV detection assays in order to improve the accuracy of the screening.

Genotype heterogeneity of high-risk human papillomavirus infection in Ethiopia

Cervical cancer is a vaccine-preventable sexually transmitted disease. In the year 2020, there were an estimated 604,000 new cases and 342,000 deaths worldwide. Although its incidence is global, it is much higher in sub-Saharan African countries. In Ethiopia, there is a scarcity of data about the prevalence of high-risk HPV infection and its association with cytological profiles. Therefore, this study was conducted to fill this information gap. A hospital-based cross-sectional study was conducted from April 26 to August 28, 2021, and enrolled 901 sexually active women. Socio-demographic and other relevant bio-behavioral and clinical data were collected using a standardized questionnaire. Visual inspection with acetic acid [VIA] was done as an initial screening method for cervical cancer. The cervical swab was then collected using L-Shaped FLOQSwabs in eNAT nucleic acid preservation and transportation medium. A Pap test was done to determine the cytological profile. Nucleic acid was extracted using STARMag 96 ProPrep Kit on SEEPREP32. A Real-time multiplex assay was performed to amplify and detect the HPV L1 gene used for genotyping. The data were entered into Epi data version 3.1 software and exported to STATA version 14 for analysis. A total of 901 (age range from 30 to 60 years, mean age = 34.8 years, and SD± 5.8) women were screened for cervical cancer using VIA and 832 women had a valid co-testing (Pap test and HPV DNA testing) results for further process. The overall prevalence of hr HPV infection was 13.1%. Out of 832 women, 88% of them had normal and 12% had abnormal Pap test results. The proportion of high risk HPV was significantly higher among women with abnormal cytology (X ² = 688.446, p < 0.001) and younger age (X ² = 15.3408, p = 0.018). Among 110 women with hr HPV, 14 genotypes (HPV-16, -18, -31, -33, -35, -39, -45, -51, -52, -56, -58, -59, -66, and -68) were identified while HPV-16, -31, -52, -58, and -35 genotypes were highly prevalent. The high risk HPV infection continues to be a significant public health problem among women 30-35 years old. The presence of high-risk HPV irrespective of genotypes is highly correlated with cervical cell abnormalities. Genotype heterogeneity is observed suggesting the importance of periodic geospatial genotyping surveillance for vaccine effectiveness.

The Prevalence of Human Papillomavirus Genotypes in Women with Genital Warts Using Polymerase Chain Reaction (PCR)

Background: The genotypic distribution of human papillomavirus (HPV) needs to be determined with detail as it is an important issue when it comes to public health and preparing vaccines since the HPV type may be different in various areas. Objectives: This study aimed at reporting the frequency of HPV types among women in Sari in the north of Iran. Methods: From 2018 October to 2019 April, 50 sterile swabs of vaginal and cervical discharge of women with genital warts, which were performed by a gynecologist, were examined to determine the prevalence of HPV genotyping by using polymerase chain reaction (PCR). Results: From 50 vaginal swab samples of patients with genital warts, the frequency distribution of types of HPV in women with genital warts included 5 patients (10.0%) with 2 high-risk serotypes as simultaneous serotypes 4% (16, 18), 4% (18, 35), 2% (66, 67), 1 patient (2%) HPV 33, 1 patient (2%) HPV 34, 1 patient (2%) 1 patient (2%) HPV 35, 2 patients (4%) HPV 66, 1 patient (2%) HPV 67, and 1 patient (2%) HPV 68. Conclusions: Since HPV genotype varies in diverse areas, these results can be used for screening, management, and vaccination of the target population against the common types of virus in Sari.

Challenges and Needs of HPV-Positive Women

HPV is the most prevalent sexually transmitted diseases causing a variety of clinical manifestations ranging from warts to cancer. This study aimed to examine the challenges and needs of HPV-positive women. In this qualitative study, we analyzed data extracted from semi-structured face-to-face interviews with 31 Iranian HPV-positive women using a conventional content analysis approach using MAXQDA.10 software. Data were collected from her at the women's clinic from 21 January 2022 to her 19 February 2022. The sampling process was purposeful, and the accuracy of this study was ensured according to her 4 criteria suggested by Guba and Lincoln. Four themes were identified from the interviewing of HPV-positive women that include: Needing support and counseling to adapt to the disease, needing counseling and training to improve the disease, needing a qualified health care provider, needing proper health care services. HPV-positive women had many adverse such as reproductive health challenges (Menstruation cycle, delivery type, fertility, pregnancy, and breastfeeding), low control, confusion, cancer-related concerns, relationship problems, sexual concerns, uncertainty, stigma, low trust, social impact, non-disclosure of results, idiosyncratic prevention, indirect clinical interaction, changes in sexual behavior. HPV-positive women face many challenges and seek information to address them. Therefore, at the primary level, providers need to be aware of the needs of these patients needs in order to make the necessary consultations.

Prevalence of Human Papillomavirus Genotypes in Tehran, Iran

BACKGROUND

Human papillomavirus (HPV) infection is a major cause of cervical cancer worldwide. Knowledge of the geographical distribution and epidemiology of the most common HPV genotypes is a crucial step in developing prevention strategies. Therefore, this study aimed to investigate HPV genotype distribution among HPV-positive women and men in Tehran, Iran.

STUDY DESIGN

A case series study.

METHODS

The study was performed on 219 HPV-positive individuals (160 females and 59 males) from Tehran, Iran. Samples were obtained from the cervix and vagina of female subjects and the genital warts of male subjects. DNA was extracted from samples, and a polymerase chain reaction (PCR)-reverse dot blot genotyping chip was used to examine HPV genotypes. Formalin-fixed, paraffin-embedded tissue samples of 51 patients from the study population were also included in this study.

RESULTS

The proportion of high-risk (HR)-HPV was 67.12%. The most common HR-HPV types were HR-HPV16 (17.4%), HR-HPV68 (11.4%), and HR-HPV51 (7.8%). The most common low-risk (LR)-HPV types included LR-HPV6 (31.1%), LR-HPV81 (11.9%), and LR-HPV62 (11.4%). The highest prevalence of HPV was in the age group of > 30 years (42.9%). Co-infection with multiple HR-HPV types was observed in 22.4% of specimens. Moreover, HR-HPV was found in 50% of women with normal cytology, 100% with a low-grade squamous intraepithelial lesion, and 84.61% with atypical squamous cells of undetermined significance.

CONCLUSION

The results indicated the remarkable growth of HR-HPV68, which has rarely been reported in Iran. The findings add knowledge to HPV epidemiological investigation and emphasize the need for introducing educational programs in high schools and appropriate vaccination in Iran.

Evaluation Frequency of Human Papillomavirus and Its Related Genotypes in Women of the General Population Living in 11 Provinces of Iran

Introduction

Persistent infection with one of the most high-risk genotypes of human papillomavirus causes all cases of cervical cancer and a significant proportion of other genital cancers. The HPV virus, unlike any other infection that leads to cancer, is transmitted only through sexual intercourse and is less affected by the general changes and development in lifestyle and medical standards, so only vaccination and screening can prevent the HPV virus and cancers caused by it. Therefore, determining the prevalence and distribution of HPV genotypes are of utmost importance in screening strategies regarding cervical cancer and vaccination decisions against HPV that vary based on the geographical and cultural characteristics of the study area. As a result, this study aimed to determine the frequency of human papillomavirus and the distribution of this virus's genotypes in the general population of women living in 11 provinces of Iran.

Materials and Methods

This study is a community-based survey study. Sampling was done by the cluster sampling method. Women aged 15–59 years old from the general population living in 11 provinces of Iran were included in the study after considering the inclusion and exclusion criteria. Data were collected using a questionnaire and vaginal examination. The study was performed on 2562 vaginal specimens that were referred to the laboratory of the present study. HPV genome was detected by the nested MY-GP method and papillomavirus genotyping was performed using the PCR multiplex method to identify 19 papillomavirus genotypes.

Results

The general prevalence of HPV in the 11 provinces was obtained at 2.4% (108 out of 2562 people). The highest prevalence of the virus was in the age group of 25–34 years. The prevalence of HPV was statistically significant among different provinces. Hormozgan province with 22 cases (5.9%) had the highest and Isfahan province with 6 cases (2.2%) had the lowest incidence of HPV. The prevalence of high-risk HPV and medium-risk HPV is 3%, and the prevalence of low-risk HPV was estimated to be 2.1% of the total female population. Also, the highest prevalence was related to genotype 16.

Conclusion

According to the high prevalence of the HPV virus in young age groups in Iran, it is necessary to pay attention to screening programs to reduce the incidence of cervical cancer.

Prevalence of human papilloma virus (HPV) genotypes between outpatients males and females referred to seven laboratories in Tehran, Iran

Background

Human papilloma virus (HPV) causes the most common sexually-transmitted infection especially among sexually-active individuals. The aim of study was to characterize the molecular characterization of HPV genotypes between 5176 female and male patients.

Methods

HPV DNA was extracted from genital swabs of the study participants and amplified by Real Time Polymerase Chain Reaction (PCR). Genotyping was performed for 2525 cases using REALQUALITY RQ-Multi HPV Detection Kit for the identification of 14 high risk (HR) and 2 low risk (LR) HPV genotypes. Demographic figures were analyzed in correlation with virological data statistically.

Results

Out of 5176 cases from 7 laboratories, 2727 (53%) were positive for HPV, of which. 2372(87%) women and 355 (13%) men were HPV positive. However, in an intra-gender analysis, positive rate was higher in men (355/637, 55.7%) than in women (2372/4539, 52%; P value 0.007). HPV positive patients were younger than negative individuals. Positive rate was higher among age categories 20–40. Genotyping was performed for 2525 cases. Out of 1219 (48%) patients who contained single genotypes, 566 (22%) and 653 (26%) harboured HR and LR genotypes, respectively. In females and males, 1189 (54%) and 117 (37%) contained multiple genotypes. No substantial associations were found between different age categories and HR/LR and multiple genotypes distribution.

Conclusion

The prevalence of HPV infection in both genders was high. However, men had a higher rate of infection. These observations highlighted the necessity for a plan for targeted education to younger population in the society as well as application of infection control measures against HPV infection, especially in terms of general population mass HPV vaccination.

Mothers' preferences and willingness-to-pay for human papillomavirus vaccines in Iran: A discrete choice experiment study

•

The relative importance for serious side effects was the highest among all attributes.

•

Mothers express more WTP for the quadrivalent vaccine compared to bivalent due to its protection against genital warts.

•

Quadrivalent vaccination could be the most suitable candidate for implementation in the national immunization schedule.

This study aimed to identify mothers’ preferences and willingness-to-pay (WTP) for human papillomavirus (HPV) vaccines (in this case, bivalent and quadrivalent) in Iran. We used a discrete choice experiment (DCE) method to present mothers with choices between two hypothetical profiles of vaccines, described by combinations of five attributes, each with two or three levels. We analyzed the DCE results using conditional logistic regression and measured WTP estimates for each attribute. Our response rate was 53.96%, while the completion rate for questioner was 93.57%. We identified protection against cervical cancer, protection against genital warts, protection duration, serious side effects, and cost to influence mothers’ preferences for HPV vaccination. The relative importance for serious side effects was the highest among all attributes. Mothers’ WTP for bivalent and quadrivalent HPV vaccines was in US $ −432 (US $1 = IRR 42,000) and US $ 380, respectively. Quadrivalent vaccination could be the most suitable candidate for implementing the national immunization schedule. The reason is that mothers express more WTP for the quadrivalent vaccine than bivalent due to its protection against genital warts.

Estimating the Number of Genital Warts Cases in Bushehr City (Southwest Iran) in 2019 Using the Multiplier Method

Background: There is an information gap concerning the prevalence of genital warts infection in Iran. Objectives: The present study aimed to estimate the number of genital warts cases in the city of Bushehr using the multiplier method, which previously there was no accurate information. Methods: This 2019 cross-sectional study directly counted the number of cases of genital warts referred to private and public clinics in Bushehr City over a month (June). In July, a survey was conducted on the general population of the city in order to obtain information with reference to the number of people with a history of genital warts in the last month and to assess the patients who were referred to a healthcare center. We also interviewed physicians and midwives. Eventually, the number of genital warts cases calculated using the multiplier method (S = P1/P2 × m formula). In order to accurately estimate the confidence interval, a Monte Carlo analysis was used in STATA version 14. Results: The number of genital warts cases referred to a provider in the investigated month, separated by general practitioners, dermatologists, gynecologists, midwives, urologists, and infectious diseases specialists, was estimated at 258, 195, 77, 48, 22, 22, and 9, respectively. Conclusions: The estimated number of genital warts cases in the study population was significantly higher than the reported cases for the investigated month by the Bushehr University of Medical Sciences Centers for Disease Control and Prevention (CDC). Understanding the true number of cases of genital warts can help policymakers in designing genital wart control and prevention programs for the general population and at-risk individuals.

Adherence to the new policy framework of the World Cancer Research Fund International in developing a policy package for the prevention of gastrointestinal cancers in Iran: a Delphi study

BACKGROUND

Gastrointestinal cancers in Iran are among the major non-communicable diseases with a considerable burden on the health system. Changes in lifestyles as well as environmental factors have resulted in the emergence of these cancers.

OBJECTIVE

To elicit and quantitatively verify experts' opinions regarding the potential public health impact, feasibility, economic impact, and budgetary impact of gastrointestinal cancer prevention policies in Iran.

METHODS

Sixteen experts from Iran were recruited in an email-based, two-round Delphi study. In each round, a questionnaire of policy options for preventing gastrointestinal cancers, which adhered to the new policy framework of the World Cancer Research Fund International, was given to participants. In the first round, experts were asked to provide opinions for and against the policy options. The second round evaluated the policy options for their public health impact, feasibility, economic impact, and budgetary impact.

RESULTS

A total of 32 policy options were organized based on three domains: health-enhancing environments, system changes, and behavior change communications. Of the 32 policy options, there were consensus in 31 (96%) and 30 (93%) options for public health impact and feasibility, respectively. On study completion, experts reached a consensus in 29 of 32 (90%) policy options for economic impact; only on 26 (81%) of these policy options did participants reached consensus for budgetary impact.

CONCLUSION

Findings indicated that although nearly all policy options reached a consensus for their public health impact, some options are not feasible or do not appear to have an economic rationale for being implemented. Moreover, it is crucial to take into account the inter-sectoral collaboration between health and non-health sectors. Findings from this study can be helpful for health policymakers in identifying support for evidence-informed approaches regarding gastrointestinal cancer prevention.

Human papillomavirus vaccination and prevention of intraepithelial neoplasia and penile cancer: review article

PURPOSE OF REVIEW

The objective of the current article is to promote a literature revision of the relationship between the prevention of intraepithelial neoplasms (PeIN) and invasive penile cancer, and human papillomavirus (HPV) vaccination, aiming to enumerate the pros and cons of immunization.

RECENT FINDINGS

The immunization against the HPV is sufficiently safe and many countries have incorporated the vaccine to their immunization calendar. Compared with men, the sampling size and the evidence quality of scientific researches among the female population are more robust. Some randomized and nonrandomized studies suggest that vaccination reduces the incidence of genital warts and no PeIN and penile cancer cases were developed in the vaccinal group. However, 70% of patients can evolve with the neoplasia despite having been immunized and even among HPV infected patients, only 1% will develop cancer.

SUMMARY

The studies about vaccination against HPV and prevention on penile cancer are conflicting and the main academic urology societies still have not incorporated vaccination of men in their guidelines. Future studies are necessary to confirm the efficiency and cost-benefit of the vaccine in men to prevent intraepithelial neoplasms and invasive penile cancer.

Integration rates of human papilloma virus genome in a molecular survey on cervical specimens among Iranian patients

The human papilloma virus (HPV) as a major causative agent of different cancers is under investigation globally. In this study, we aim to investigate HPV infection in different cytological and pathological stages by different molecular methods, and then the viral genome integration of HPV-16 and -18 is determined by a specific real-time PCR method. The study included women who underwent liquid-based cytology. HPV PCR was conducted by MY09/11 universal primers, HPV genotyping was performed by INNO-LiPA HPV genotyping assay, and the viral genome status was defined by two real-time PCR assays. The statistics were calculated by SPSS v.22 software. In 1668 women included in the study with mean age±std. deviation of 35.6±0.7, HPV was detected in 632 (38%) participants. Following genotyping analyses, 16 HPV types and 713 strains were detected. HPV-16 and HPV-18 from high-risk types and HPV-6 and HPV-11 from low-risk types were the dominant types. We found HPV-16 strains in mixed form (58.8%), and of the HPV-18 strains, the episomal form was prevalent (92.9%). The statistics revealed significant presence of HPV-6 and within normal limits cases; HPV-16 and atypical squamous cells of undetermined significance; HPV-33 as well as HPV-39 and low-grade squamous intraepithelial lesion; HPV-6 and atypical squamous cells of undetermined significance; and HPV-35 as well as HPV-56 and squamous cell carcinoma. Our study showed high prevalence of HPV in low-grade cervical lesions, although it is associated with higher grades. The HPV molecular testing extra to cytology is recommended. HPV-16 and HPV-18 have different programs in genome integration in infected cells.

Can the prophylactic quadrivalent HPV vaccine be used as a therapeutic agent in women with CIN? A randomized trial

Background

Human papillomavirus (HPV) is one of the most significant risk factors for cervical cancer. The HPV vaccine has a very significant impact on the incidence of cervical cancer. The present study aimed to investigate the impact of prophylactic quadrivalent HPV vaccine in the treatment of women with cervical intraepithelial neoplasia (CIN 1–3).

Methods

This randomized controlled trial was conducted in the Shahid Sadoughi University of Medical Sciences (SSUMS), Yazd, Iran, from October 2011 to November 2015 in women with histologically confirmed residual/recurrent CIN 1 or high-grade CIN (CIN 2–3). Eligible women were assigned randomly to an intervention and a control group. Women in the intervention group were given HPV vaccinations while those in the control group were not. Participants were followed up for 24 months. Primary and secondary outcomes, and adverse effects of the treatment in the two groups were compared using Student’s t test, the chi-square test, or Fisher’s exact test. P values < 0.05 or less were considered statistically significant.

Results

Three-hundred and twelve women were randomized to the two groups; the data of 138 in the intervention group and 104 in the control group were analyzed. The mean age of the women was 32.59 ± 4.85 years. Differences in age, marital status, and grades of CIN weren’t significant between the two groups. At the end of the two-year follow-up period, the number of women with CIN 2–3 in the intervention and control groups was reduced by 75% (from 93 to 23) versus 40% (from 69 to 41). The efficacy of the HPV vaccine in women with CIN 1–3 was 58.7% (p = 0.018). No serious adverse effects related to the vaccines were reported.

Conclusions

The prophylactic quadrivalent HPV vaccine after treatment may have a therapeutic effect in women with residual/recurrent CIN 1 or high-grade CIN (CIN 2–3).

Trial registration

Iranian Registry of Clinical Trials, IRCT20190603043801N1. Registered 24 July 2019 – Retrospectively registered, http://www.irct.ir/user/trial/40017/view

Comparing the Efficacy of Sequential and Standard Quadruple Therapy for Eradication of H. Pylori Infection

BACKGROUND

The aim of this study was comparison the effectiveness of sequential and standard quadruple therapy on eradication of H. pylori infection.

METHODS

This clinical trial study was conducted on 160 patients with dyspepsia or gastroduodenal ulcer. Patients were randomly divided into two groups. Group A (standard regimen) received omeprazole, amoxicillin, clarithromycin and bismuth subcitrate for 2 weeks. Group B (sequential regimen) received omeprazole and amoxicillin in 5 days and omeprazole, tinidazole and levofloxacin in 5 days. After the end of treatment regimens, 20 mg omeprazole was administered twice daily for 3 weeks. H. pylori eradication was assessed 2 months after antibiotic treatment via fecal antigen.

RESULTS

Frequency of H. pylori eradication in group A and B was observed in 55 (68.8%) and 63 patients (78.8%), respectively. No significant difference was seen between two groups, regarding H. pylori eradication (p = 0.15). The most common side effects in group A, B were bitterness of mouth (63.8%) and nausea (16.2%), respectively (p H. pylori infection, higher rate of H. pylori eradication was seen in group B than group A. Thus, sequential regimen was a more appropriate regimen with fewer complications.

Frequent inappropriate use of unweighted summary statistics in systematic reviews of pathogen genotypes or genogroups

OBJECTIVES

Our study aimed to systematically assess and report the methodological quality used in epidemiological systematic reviews (SRs) and meta-analysis (MA) of pathogen genotypes/genogroups.

STUDY DESIGN AND SETTING

Nine electronic databases and manual search of reference lists were used to identify relevant studies. The method types were divided into three groups: 1) with weighted pooling analysis (which we call MA), (2) unweighted analysis of the study-level measures (which we call summary statistics), and (3) without any data pooling (which we call SR only). Characteristics were evaluated using Assessment of Multiple Systematic Reviews (AMSTAR), Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), and Risk Of Bias In Systematic reviews (ROBIS) tools. The protocol was registered in PROSPERO with CRD42017078146.

RESULTS

Among 36 included articles, 5 (14%) studies conducted SR only, 16 (44%) performed MA, and 15 (42%) used summary statistics. The univariable and multivariable linear regression of AMSTAR and PRISMA scores showed that MA had higher quality compared with those with summary statistics. The SR only and summary statistics groups had approximately equal scores among three scales of AMSTAR, PRISMA, and ROBIS. The methodological quality of epidemiological studies has improved from 1999 to 2017.

CONCLUSION

Despite the frequent use of unweighted summary statistics, MA remains the most suitable method for reaching rational conclusions in epidemiological studies of pathogen genotypes/genogroups.

The Prevalence of HPV Genotypes in Iranian Population: An Update

Background & Objective:

Human papillomavirus (HPV) is the main cause of genital warts and some anogenital cancers in male and female subjects which is commonly transmitted by sexual contacts. The objective of this cross-sectional study was to examine the prevalence of HPV genotypes in 10,266 Iranian male and female population, according to their age.

Methods:

Samples were collected from the penile and anal sites of male subjects and the vagina and cervix of female subjects in a time period between 2011 and 2016. HPV DNA was detected in PCR using the MY09 and MY11 primers, and the INNO-LiPA assay was applied for HPV genotyping. To investigate the relevance of HPV infection and age, the samples were classified into 4 age groups (13-29, 30-44, 45-59, and 60-74).

Results:

Totally, the most common low risk HPV genotypes detected in the studied male and female subjects were HPV-6 (77.7% and 43.3%) and HPV-11 (13.7% and 11.4%), and more frequent high risk HPV genotypes were HPV-16 (5.5% and 16.6%) and HPV-52 (3.2% and 9.6%), respectively. High burden of the HPV infection was observed at ranges of 30 and 44 years (51.8%) with a peak at ranges between 30 and 32 years. No considerable statistically significant correlation was found between HPV infection and age (P=1).

Conclusion:

This study gave an epidemiological overview of circulating HPV genotypes in Iranian population to develop future vaccination policies, though the findings of prevalent HPV genotypes in female subjects were inconsistent with the previous studies reported in Iran.

Knowledge and Attitude Toward Human Papillomavirus and HPV Vaccination in Iranian Population: A Systematic Review

Background and objective:

Human papillomavirus (HPV) is the main cause of cervical cancer. This systematic review was performed to provide an overview of knowledge and attitude about HPV infection and HPV vaccine in Iranian population.

Materials and Methods:

The information was identified by searching international and national databases; pubmed/MEDLINE (NCBI), Embase (Elsevier), Google Scholar, Scientific Information Database, MagIran, and IranDoc. The current research was performed using the terms of medical subject headings (MeSH) and combinations of the keywords including: “human papillomavirus” or “human papillomavirus vaccine” with the words “knowledge,” “awareness,” “attitude” and “Iran.” Studies were evaluated according to the checklist of STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE).

Results:

A total of 10 observational studies that met the inclusion criteria were included in this review. The overall knowledge and awareness of the Iranian population (parents, women, university students, medical students, nurses and hospital staff) about HPV and HPV vaccination was low; however, the attitude toward this issue was positive and strong.

Conclusion:

Due to the low levels of knowledge about HPV infection and its methods of prevention, efforts should be increased to enhance the knowledge of the general population about HPV infection and vaccination in order to prevent its incidence and complications.

Human papillomavirus in Ethiopia

Over 99% of cervical cancer cases are associated with genital infection by certain types of human papillomaviruses (HPVs). To outline optimal vaccination strategies and HPV based cervical cancer screening, synthesized data on the genotype distribution of HPV is fundamental that is otherwise missed in Ethiopia. The aim of this study is to compile the findings on HPV genotyping in Ethiopia. Published articles were systematically searched using comprehensive search strings from PubMed/Medline and SCOPUS. Further, Google Scholar and the Google databases were also searched manually for grey literature. The included studies in the review employed 859 women (age range 15-85 years) with different kinds of cervical abnormalities. A total of 534 HPV sequences were reported; the proportion of high risk HPVs was varied 80.4-100%. The top five identified genotypes were HPV 16 (45.3%; 95% CI 41.1-49.6%), HPV 52 (9.4%; 95% CI 7.2-12.1%), HPV 18 (8.2%; 95% CI 6.2-10.9%), HPV 58 (6.9%; 95% CI 5.1-9.4%) and HPV 45 (5.2%; 95% CI 3.7-7.5%). The combined prevalence of HPV 16/18 was at 53.6% (95% CI 49.3-57.8%). In this review, HPV 16 in particular, but also HPV 52 and 18, warrant exceptional consideration in vaccination and HPV based screening programs in Ethiopia. To the best of our knowledge, this study represents the first of its kind to establish the genotype distribution of HPV from different kinds of cervical lesions in Ethiopia although it was synthesized out of few studies. Hence, additional nationwide data are needed to strengthen our finding.

The Prevalence of Genus Alpha Human Papillomavirus in Women with Uterine Cervical Infection and/or Inflammation in Western Iran

Introduction:

Human papillomavirus (HPV) infection is strongly associated with risk of cervical cancer and genital warts.

Aim:

The study aimed to report the prevalence of genus alpha human papillomavirus (HPV) types in women with cervical infection and/or inflammatory in Western Iran.

Materials and Methods:

In a cross-sectional study, 435 women were clinically diagnosed with cervical infections. The method of HPVs detection was polymerase chain reaction (PCR). The majority of patients (304 patients) did Pap smear based on liquid-based specimens.

Results:

Out of 435 patients, 150 patients (34.5%) had HPV positivity that the prevalence of high-risk HPVs was 52.7%. Out of 76 patients with Pap smear positivity, 68.4% had atypical squamous cells of undetermined significance cytology class and 31.6% had low-grade squamous intraepithelial lesion cytology class. The most prevalence rate of HPV was in age ≤30 years. HPV 16 and HPV 56 were the most prevalence rate among high-risk HPVs. Overall HPV alpha-10 (59%) and HPV alpha-9 (32.2%) had the most prevalence rate.

Conclusions:

Among high-risk HPVs, HPV 16 was the most common HPV detected in our population with a very low prevalence of HPV 18. In addition, HPV 6 and then HPV 11 had the most prevalence rate in the women with uterine cervix (cervical) infection among low-risk HPVs.

Helicobacter pylori Infection in Pediatric Patients: Update on Diagnosis and Eradication Strategies

Helicobacter pylori infection is acquired mainly in childhood and remains an essential cause of peptic ulcer disease and gastric cancer. This article provides commentary on the last ESPGHAN/NASPGHAN guidelines and on publications made after the consensus conference of 2015. The majority of infected children are asymptomatic and pediatric studies do not support a role for H. pylori in functional disorders such as recurrent abdominal pain. The role of H. pylori infection in failure to thrive, children's growth, type I diabetes mellitus (T1DM), and celiac disease remains controversial. The diagnosis of infection should be based on upper-digestive endoscopy with biopsy-based methods. Eradication control after treatment should be based on validated non-invasive tests. Nodular gastritis is the main endoscopic finding of childhood H. pylori infection, but gastroduodenal erosions/ulcers are seen in some children, especially after 10 years of age. When indicated, eradication treatment should be given when good compliance is expected and based on the antimicrobial susceptibility profile.

Immunization of mice by a multimeric L2-based linear epitope (17-36) from HPV type 16/18 induced cross reactive neutralizing antibodies

Current licensed and commercially available prophylactic human papillomavirus (HPV) vaccines (Cervarix and quadrivalent/nine valents Gardasil) are based on major capsid protein L1 virus-like particles (VLPs) production which are expensive and type specific. Minor capsid L2-RG1 linear epitope (17-36) is a known candidate for induction of cross-neutralizing antibodies to develop low-cost pan-HPV vaccines. Herein, we report construction and expression of a three tandem repeats of L2-RG1 derived from HPV16 and 18 fused with the same head to tail pattern (HPV16:17-36×3+ HPV18:17-36×3; hereafter termed dual-type fusion L2 peptide) in E. coli and provide the results of its immunogenicity in mice. SDS-PAGE and western blot analyses indicated proper expression of the peptide that could be further purified by Ni-NTA affinity chromatography via the located C-terminal 6xHis-tag. Mice immunized by formulation of the purified peptide and Freund adjuvant raised neutralizing antibodies which showed proper cross reactivity to HPV L2 (11-200) of types: 18, 16, 31 and 45 (which totally are responsible for 90% of cervical cancers) and efficiently neutralized HPV18/16 pseudoviruses in vitro. Our results imply the possibility of development of a simple, low-cost preventive HPV vaccine based on this dual-type fusion L2 peptide in bacterial expression system with broad spectrum.

Efficacy of Human Papillomavirus L1 Protein Vaccines (Cervarix and Gardasil) in Reducing the Risk of Cervical Intraepithelial Neoplasia: A Meta-analysis

Human papillomavirus (HPV) can induce cervical intraepithelial neoplasia (CIN). Vaccination against HPV can play an important role in CIN prevention. This study aims to estimate the efficacy of L1 protein vaccines (Cervarix and Gardasil) in CIN 1, 2, 3 risk reduction using meta-analysis. Relevant articles were identified by two independent researchers searching international databanks. After application of inclusion/exclusion criteria and quality assessment, eligible articles were entered into the final meta-analysis. Inverse variance method and fixed effect model were used to combine the results of the primary studies. The heterogeneity between the results was assessed using Cochrane and I² indices. Of 11,530 evidence identified during the primary search, three papers were found eligible for meta-analysis, including 7213 participants in the intervention groups and 7170 healthy controls. The efficacy (95% confidence interval) of HPV 6, 11, 16, 18 monovalent and quadrivalent vaccines against CIN 1, CIN 2, and CIN 3 were estimated as of 95% (88–98), 97% (85–99), and 95% (78–99), respectively. This study showed that L1 protein vaccines Cervarix and Gardasil are highly protective vaccines playing an effective role in the prevention of HPV 6, 11, 16, 18 which are responsible for CIN 1, CIN 2, and CIN 3.

Relative frequency of human papillomavirus genotypes and related sociodemographic characteristics in women referred to a general hospital in Tehran, 2014-2015: A cross-sectional study

BACKGROUND

Human papilloma virus (HPV) is one of the major public health problems and the main causes of cervical cancer. The prevalence HPV infection in developing countries with low financial resources is high.

OBJECTIVE

This study aimed to determine the relative frequency of HPV genotypes and its sociodemographic characteristics in women referred to a general hospital in Tehran, Iran from 2014-2015.

MATERIALS AND METHODS

This cross-sectional study was performed in 400 women with Pap smear samples, referring to to a general hospital in Tehran, Iran from 2014-2015. The detection of 28 HPV genotypes was performed by using the Multiplex PCR technique. The sociodemographic survey was conducted for each HPV positive woman.

RESULTS

HPV-positive infection was detected in 155 (38.75%) women aged 17-85 years. HPV 16 (19.1%) was the most prevalent type, followed by HPV 39 (12.5%) and HPV 18 (8.9%). The highest rate of HPV infection was observed at the age of 36 years (7.7%). The level of education and economic situation of each woman were showed most of HPV-positive women had a high school diploma (34.6%) and average economic situation (67,9%). 60.9% of these women were a housewife, and 67.3% lived in the capital .

CONCLUSION

Determination of HPV genotype and risk factor related to HPV infection in each geographical region can lead to the production of effective vaccines against the HPV virus. It can also be useful for disease management and high sensitivity diagnosis of cervical intraepithelial neoplasia.

Gender and age-specific seroprevalence of human papillomavirus 16 and 18 in general population in Tehran, Iran

The assessment of the gender and age-specific seroprevalence of human papillomavirus (HPV) is essential for planning of HPV vaccine implementation into the preventive programs. In this study, we aimed to determine the age-specific seroprevalence of HPV-16 and 18 in both males and females in Tehran, Iran. Three hundred and seventy-eight women (10-35 years) and 162 men (10-25 years) from Tehran, Iran, were enrolled. Anti-HPV IgG antibodies against HPV-16 and HPV-18 were detected by ELISA using papillomavirus type 16 and 18 L1-capsids as antigen. HPV-16 antibody was detected in 15.6 and 13.6% of women and men, respectively. Antibody against HPV-18 was found positive in 12.7 and 8% of women and men, respectively. The highest seroprevalence of HPV-16 and 18 were seen in women aged 26-30 years (22.2 and 19.4%, respectively), and the lowest HPV-16 and 18 seropositivity rates were seen in males and females aged 10-15 years (9.3 and 1.9%, respectively). In our cohort of study, in males, both anti-HPV-16 and 18 increased after age 15 years, peaking in men aged 21-25 years. In women, both HPV-16 and 18 seropositivity increased after 15 years, declined at 21-25 years, peaked in women aged 26-30 years and again decreased after 30 years. Our data showed increasing exposure rate to high-risk HPV vaccine types in our studied population over 15 years of age. In order to prevent the HPV-related cancers, implementation of HPV vaccine into the national immunization program in Iran and vaccination of females and males less than 15 years of age are suggested.