Human papillomavirus (HPV)-type distribution in relation to oral contraceptive use in women with cervical intraepithelial neoplasia, Durban, South Africa.

OBJECTIVE: To determine HPV-type distribution among women with cervical dysplasia in relation to oral contraceptive usage. METHODS: Prospective cross-sectional study of four groups of patients according to oral contraceptive usage: non-users, users of less than five years duration, users of between five years and ten years, and users of more than ten years duration. Swabs of the cervix were analysed for HPV DNA using the polymerase chain reaction method. RESULTS: A total of 124 women were recruited for the study. There were 75 patients who were HIV-infected (seroprevalence 61%). There were 102 patients who were HPV positive (82%), of which 79 patients had high-risk HPV DNA (78%). In terms of the four oral contraceptive groups, high-risk HPV DNA was detected in 70% (n = 21), 79% (n = 22), 90% (n = 21) and 71% (n = 15) of patient, respectively. The odds of having HPV DNA was six times higher for the combination of contraceptive users of less than five years duration/non-users (OR 5.9, 95% CI: 1.87-18.77). There was no change when adjustment was made for age (OR 6.1, 95% CI: 1.9-19.4). HPV DNA type 16 and/or 18 was present in a total of 21 patients (49%) (non-contraceptive users and users < 5 years duration) versus 15 patients (42%) (oral contraceptive users of more than 5 years duration) (p = 0.524). HPV type 16 was the commonest HPV type detected (20.2%) and HPV type 58 was the next commonest hihg-risk HPV type (16.1%). HPV types 58 and 33 were detected in a much greater percentage of our population and HPV 16 in a much smaller percentage of our population compared with a non-South African population. CONCLUSION: The findings of this study demonstrate an interesting distribution of HPV types in a South African population.

Prevalence of pre-cancerous lesions and cervical cancer in South Africa--a multicentre study.

OBJECTIVES: To describe the age-specific prevalence rates of cancer of the cervix in South African women presenting for screening. DESIGN: A multicentre prevalence survey in 10 geographically defined areas following a common core protocol. Services were located in existing service sites, with the exception of KwaZulu-Natal which used a mobile service. Women aged 20 years and above were eligible for inclusion. OUTCOME MEASURES: Age-specific cervical cytologically diagnosed abnormality rates according to the Bethesda classification. RESULTS: During the study 20,603 women participated. Eighty per cent of the sample had never had a Pap smear before and just over 91% had not had a Pap smear in the last 5 years. In this study population 468 women screened (2.42%) were found to have low-grade squamous intra-epithelial lesions (LSIL) and the average age of these women was 33.1 years; 366 (1.8%) had high-grade SIL (HSIL) and these women were statistically significantly older at 37.97 years of age; and 92 women (0.47%) were found to have cytologically diagnosed invasive cancer. These women were significantly older, with an average age of 51.3 years. A clear relationship was found between age and LSIL, with younger women having a high rate of LSIL which decreases with increasing age. A similar but inverse relationship between age and invasive cancer is described, with the rate being low in young women and increasing with increasing age. A clear relationship between HSIL and age is not described in these data. The adequacy rate (satisfactory and satisfactory but limited) of the slides was 95%, and just under 92% of the study sample received their results. Not all women were appropriately referred and it was not possible to assess if women referred for treatment received it. CONCLUSIONS: These data indicate that cancer of the cervix is a common disease and that, similar to other countries, it is a disease of older women. These data give some positive indicators for future screening--older women will present for screening and the majority of women received their results. However, improvements in health system functioning are needed. A uniform national cytology reporting system is required as well as clear guidelines for providers on what action to take based on cytology reports. Linkage between the site of screening and treatment centre is inadequate and requires urgent attention in order to decrease cervical cancer mortality.