Human papillomavirus prevalence in the European country with a high incidence of cervical cancer

Background/Objectives: Cervical cancer is caused by human papillomavirus (HPV) and is 4th most common cancer among females worldwide. Latvia implemented a screening program in 2009 that was based on cervical cytology. However, our country remains a European country with a high incidence of cervical cancer, which accounts for an 18.4 age-standardized incidence rate per 100,000
women and remains the 6th highest in Europe. By now, no population-based studies have been conducted in Latvia about the prevalence and determinants of high-risk human papillomavirus (HR-HPV) infection among Latvian women. This study aimed to provide this crucial data.
Methods: The fieldwork of cross-sectional study was conducted from February 2021 to February 2022. The target population for HR-HPV testing was women aged 25-70 years who visited Riga East University Hospital (RAKUS) colposcopy unit (colposcopy population) because of the changes in their Pap smear and the general population who was enrolled from women visiting ten general
practitioners' practices (2 practices per each of the five regions in Latvia). Women were asked to perform unsupervised HPV self-sampling using written instructions and, after the procedure, asked to fill in the questionnaire. Cervicovaginal samples were collected with a self-sample device - a dry cotton swab (FLOQSwabs) manufactured by COPAN. Samples were analyzed with Cobas
4800 System (Roche) for HPV 16 and HPV 18, along with a simultaneous, pooled result for other high-risk genotypes (HPV31/33/35/39/45/51/52/56/58/59/66/68). Statistical analysis of data was performed using SPSS 26.0. HPV-associated factors were identified by constructing a binary logistic regression model where all the factors showing statistical significance in univariate analysis (if p<0.05) were included.
Results: A total of 1313 women were invited to participate in the study, and 1274 participants provided a valid test sample. The prevalence of any HR-HPV was 34.2% (66.8% in the colposcopy population and 11.0% in the general population). In the colposcopy group (n=530), type 16 was present in 34.2%, type 18 in 4.0%, and other HR-HPV types were present in 42.0%. In the general population group (n=744), CPV 16 was present in 3.5%, type 18 in 1.2%, and other high-risk types in 7.5% of cases. In the final regression model, it was found that in the whole research sample, being positive for any type of HPV was significantly associated with being single, divorced, or widowed (vs. married/cohabiting odds ratio (OR) 1.8), being currently sexually active (vs. sexually inactive OR 2.0), with a higher number of lifetime sex partners (6+ vs. 1-2 OR 2.8, 3-5 vs. 1-2 OR 2.8), with last visit to gynecologist 1-5 years ago (vs. last year OR 1.9) and with belonging to the colposcopy study group (vs. general population OR 15.2). In the study-group stratified regression analysis, any type of HPV positivity in the colposcopy group was significantly associated with Latvian ethnicity (vs. other than Latvian) and with current smoker status (vs. never smokers). In the general population group being single, divorced, or widowed (vs. married/cohabiting), a higher number of lifetime sex partners and the last visit to a gynecologist 1-5 years ago (vs. last year) have shown significant associations with any type of HPV.
Conclusions: We documented a high HR-HPV infection burden in Latvia. Any type of HPV positivity was significantly associated with sociodemographic, sexual, and other health behavior as well as healthcare-seeking factors.