Eastern Cape girls 'at risk of cervical cancer' as HPV infections soar: study

Of more than 200 sexually active girls in the rural Eastern Cape at least 70% had HPV infection - raising fears of cervical cancer later.
Of more than 200 sexually active girls in the rural Eastern Cape at least 70% had HPV infection - raising fears of cervical cancer later.
Image: Simphiwe Nkwali

More than three-quarters of teenage girls in the Eastern Cape are infected with human papillomavirus (HPV), a new study has found, revealing for the first time the prevalence of the cancer-causing virus among school-going girls in that province.

According to the study by the National Health Laboratory Services and Nelson Mandela Academic Hospital, young girls who consumed alcohol were almost three times more likely to have HPV infections compared to their non-drinking counterparts, and researchers are convinced that this is due to high-risk sexual behaviour.

Of more than 200 sexually active high school girls in two rural school in the OR Tambo district, HPV was detected in about 76% of them. HPV prevalence was not found to differ between HIV-negative and HIV-positive girls.

In the research paper, which has been published in the PLOS One journal, researchers described the 76% HPV infection rate as of “public concern”. The current prevalence was found to be higher than the 68% HPV prevalence among HIV-negative young women (aged 16-24) in the Western Cape, and the 65% reported in Gauteng.

Researchers also detected more multiple HPV infections than single HPV infections in the 2019 study. About 32% of study participants had a sexual debut at 16, with 54% reporting having multiple sexual partners. At least 35% didn’t use condoms and 32% didn’t use contraceptives.

All the girls who participated in the study never received the HPV vaccine, which was introduced in schools in 2014 as they were too old when the vaccination programme was introduced to nine-year-old girls.

HPV is the most common sexually transmitted virus, with its peak prevalence observed in adolescents and young women soon after sexual debut and decreasing with increasing age in women. HPV prevalence (both low and high-risk) ranges between 44% and 85% among South African adolescents and young women (15—25 years). Compared to HIV-negative individuals, HIV-positive women are more likely to be infected by HPV and co-infected with multiple HPV types, persistent infection, reactivation, and are at risk of developing HPV-associated cancers later in life.

Cervical cancer is the second most common cancer in South African women, and black African women are particularly at risk.

HPV 16 and 18 strains, which are responsible for almost 70% of cervical cancers, were detected in 20.66% of girls. The two strains are covered by two HPV vaccines, Cervarix and Gardasil, which are registered in SA. But the schools vaccination programme, which is rolled out among nine-year-old girls, largely uses Cervarix while Gardasil is mainly used in the private sector.

Gardasil also prevents HPV 6, 11, 16, 18, 31, 33, 45, 52 and 58, which are responsible for genital warts, which were found in 37% of girls. The statistic is similar to that in previous studies in the Western Cape and Gauteng. Researchers argued that Gardasil should be more widely used as it offered protection to more HPV strains.

HPV-35, known to be common in African-ancestry women with cervical cancer, was common in at least 9.4% of study participants. High-risk virus strains such as HPV- 59, 61 and 62 were also found to be the most prevalent types among study participants.

Writing in PLOS, lead researcher Zizipho Mbulawa said it’s important to note that the study was conducted in only two communities, which do not represent the population of the Eastern Cape, “and cannot be generalised”. “Despite these limitations, the information reported remains essential for this province and SA as there is limited HPV information on this population,” she said.

“There are few chances that the participants could have received the HPV vaccine during the national school HPV vaccination programme or elsewhere. However, the possibility of receiving the HPV vaccine is not completely ruled out because the vaccines were available in the country.”

“The high prevalence of HPV types targeted by the Gardasil vaccine encourages the introduction of the Gardasil vaccine. It is envisaged that these results will contribute to HPV baseline data among adolescents and young women of Eastern Cape and will be used to evaluate the effect of HPV vaccination. Research or surveillance projects to monitor HPV prevalence and distribution among HPV vaccinated and unvaccinated adolescents and young women are necessary to monitor theeffect of HPV vaccination in SA,” Mbulawa said.

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