Human Papillomavirus (HPV) is a major sexually transmitted infection (STI) worldwide since it affects public health at various levels. HPV consists of more than 200 types of viruses but approximately 40 of these virus types cause genital tract infections [1]. Researchers group HPV viruses into two categories depending on their capacity to cause cervical cancer and other anogenital cancers. Most cervical cancer cases stem from high-risk HPV infection types HPV-16 and HPV-18 but patients typically develop benign lesions from low-risk types that cause genital warts [2]. Knowledge about HPV infections focuses on sexually active females because their infection rates represent an important topic for studying women's health effects. HPV mainly spreads between people through different sexual activities which involve vaginal, anal, and oral contact [3]. The infection risk depends on sexual partner numbers and age of initial sexual activity together with personal defensive capabilities. Young sexually active women face the greatest HPV infection risk since they have more sexual partners [4]. The medical community faces substantial health challenges from persistent HPV infections in low- and middle-income countries because these regions have limited access to both vaccination programs and proper screening and treatment procedures [5]. Persistent high-risk HPV infections cause the majority of cervical cancer cases because this disease ranks as the fourth most common cancer among women worldwide. Medical examiners identify around 570,000 new cervical cancer cases every year and these cases lead to over 300,000 annual deaths [6]. Developing nations face an unfair heavy load when it comes to cervical cancer because they do not have sufficient healthcare systems to implement broad screening and vaccination initiatives. Early diagnosis along with appropriate HPV-related lesion treatment is essential to stop invasive cervical cancer from developing because of how important it is to study HPV infection patterns across high-risk groups [7]. The research investigates HPV infection occurrence in sexually active females to determine which HPV types prevail alongside their relationship to demographic elements and behavioral patterns [8]. This study conducts an assessment of HPV occurrence to generate important epidemiological data regarding HPV transmission and guide public health efforts for prevention and control. This research study will extend existing knowledge about HPV and its effects on women's health through its findings while aiding the development of specific approaches to decrease HPV-related disease burden [9]. Prevalence data about HPV infection serve to create effective vaccination services together with screening schedules, especially for areas with notable cervical cancer occurrences. The research evaluates the challenges that prevent people from utilizing HPV vaccination and screening services with a focus on discovering ways to boost their acceptance and accessibility. The study identifies important problems aiming to support worldwide initiatives that lower HPV-related diseases and create better health outcomes for sexually active females.

This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, in coordination with the Department of Pathology, Govt. Medical College, Mahaboobnagar, Telangana. Institutional Ethical approval was obtained for the study. Written informed consent was obtained from all the participants after explaining the nature of the study in the vernacular language.

Inclusion criteria

1. Females aged 18 – 45 years of age group who gave consent to participate in the study.
2. Sexually active females
3. Females without any medical illness
4. Those willing to participate in the study

Exclusion criteria

1. Pregnant women.
2. Women with a history of cervical malignancy or prior treatment for HPV infection.
3. Those who had undergone a hysterectomy.

A total of 150 sexually active females aged [18–45 years] were included in the study. Participants were recruited from the gynecology outpatient department, and eligibility was based on the following inclusion and exclusion criteria:

Sample Collection and Pap Smear Analysis: Cervical samples were collected using a sterile Ayre’s spatula and endocervical brush. The collected samples were immediately spread onto glass slides, fixed with 95% ethanol, and stained using the Papanicolaou (Pap) staining technique.

Cytological evaluation was performed using the Bethesda System (TBS) to classify findings into [10]:

• Negative for intraepithelial lesion or malignancy (NILM).
• Atypical squamous cells of undetermined significance (ASC-US).
• Low-grade squamous intraepithelial lesion (LSIL).
• High-grade squamous intraepithelial lesion (HSIL).
• Suspicious or suggestive of malignancy.

HPV Diagnosis: The presence of cytological changes indicative of HPV infection, such as koilocytosis, nuclear enlargement, perinuclear halos, and binucleation, was recorded.

Statistical analysis: All the available data was uploaded to an MS Excel spreadsheet and analyzed by SPSS version 22 in Windows format. The categorical variables were represented as mean, standard deviation, and percentages. The categorical variables were calculated using Pearson's chi-square test for p values. The values of p (<0.05) were considered as significant.

A total of 150 cases were analyzed and studied during the duration of our study. The demographic profile of females included in the study is presented in Table 1. The age group analysis reveals the common age group analyzed was 18 – 20 years followed by 21 – 30 years age females. The mean age of the participants was 26.5 ± 8.5 years. The analysis of educational background which is an important consideration for health behavior and access to information that could influence HPV risk shows that most of the cases had only school-level education. About 18% of the sample included females who have an education level of degree or more. Most participants report having only one sexual partner is a relevant factor. While having multiple partners is a known risk factor for HPV.

Table 1: Demographic characteristics of the females included in the study.

Table 2 presents data on the characteristics of the women participating in your study about the prevalence of Human Papillomavirus (HPV) infection.  A minority of the women (24.7%) reported a history of STIs. The majority (75.3%) reported no history of STIs. No contraception use was reported in 62.7% of cases this also included women who had undergone sterilization. Barrier methods were used by 24.6% of participants. Hormonal contraception was used by 12.7% of the participants.

Table 2: characteristics of women participating in your study about the prevalence of Human Papillomavirus

This table presents the overall prevalence of Human Papillomavirus (HPV) infection our study population was found to be 20%. Most of the patients had NILM (Negative for Intraepithelial Lesion or Malignancy) in 36% of cases. ASC-US (Atypical Squamous Cells of Undetermined Significance) were found in 10.7% of cases which indicates that there were cellular abnormalities however the significance was unknown.  LSIL (Low-grade Squamous Intraepithelial Lesion) was reported in 18% of cases indicating low-grade changes that may be associated with HPV infection. HSIL (High-grade Squamous Intraepithelial Lesion) was reported in 22.7% of cases which is indicative of a higher risk of progressing to cervical cancer. Suspicious for malignancy was in 12.7% of cases which required further investigations for diagnosis.

Table 3: Overall Prevalence of HPV Infection (by TBS Category)

The analysis of various factors was done for the females included in the study depicted in Table 4. A critical analysis of the table reveals that females older than 30 years have a higher risk of the outcome compared to those younger (p = 0.003). Women with more than one sex partner have a higher risk of the outcome compared to those with one or no partners (p < 0.001). Females with the lower education have a higher risk of the outcome compared to the reference group (p < 0.001). Females with Sexually Transmitted Infections have a higher risk of the outcome compared to those without STIs (p < 0.001). Individuals using hormonal contraception have a 1.6 times higher risk of the outcome compared to non-users (p = 0.047). Individuals using barrier contraception have a 0.7 times lower risk (or a protective effect) of the outcome compared to non-users (p = 0.19, which is not statistically significant).

Table 4: Risk Factor Analysis

                                   *Significant

This study included 150 sexually active females who had visited our hospital. We analyzed the prevalence of Human Papillomavirus (HPV) infection and its associated risk factors. The results of this study showed that most of the females in the younger age group had a mean age of 26.5 ± 8.5 years. This age distribution is normally observed in the population for two reasons: younger females are likely to be more sexually active. Second, they are more likely to have HPV transmission due to increased sexual activity. In a review by Smith et al. [11] the mean age of the females was less than 30 years, in agreement with the observations of the current study. We evaluated the educational background of the females included in this study because it is a critical determinant of health behavior and awareness due to access to information. The results of this study found that nearly half of the participants had only a high school or lower education level. Significantly lower educational levels appear to be associated with limited health literacy, which can hinder awareness of HPV risks and knowledge of preventive measures [12]. Information on the number of sexual partners revealed that most of the females (71.3 %) had a single-sex partner, which is a protective factor against HPV. Multiple partners are a well-established risk factor for HPV transmission [13].

Overall, India accounts for nearly 18% of global cervical cancer cases, with an estimated 1, 23, 000 new cases and 77,000 deaths annually [14]. It is one of the leading causes of cancer-related death among females in rural India. The overall prevalence of HPV in our study was found to be 20%, and 22.7% of the cases were classified as high-grade squamous intraepithelial lesions (HSIL), which are at a higher risk of progression to cervical cancer. Therefore, early detection and intervention are crucial [15]. This study also found that 12.7% of cases were suspicious of malignancy; these females were subjected to further diagnostic evaluation. Our study showed that the LSIL was 18%, highlighting the burden of HPV-related cellular changes in the population. This also shows that there is a dire need for screening programs for this population. Logistic regression risk factor analysis identified several significant predictors of HPV infection. We found that women aged >30 had 1.8 times higher odds of HPV infection than younger females. Having more than one sexual partner in our analysis showed that the odds of HPV infection increased by 3.5 times in agreement with the existing literature (CDC, 2022). Lower educational levels are associated with a 2.2-fold increase in HPV due to a lack of awareness and access to preventive measures. A history of sexually transmitted diseases increases the risk of HPV infection by 4.1 times. Hormonal contraception use showed only a modest risk, and the use of a barrier method of contraception has a protective effect, highlighting its role in direct exposure to the virus (Winer et al., 2019).

Within the limitations of the current study, we found that the prevalence of HPV in sexually active females was 20%. Most of the burden of HPV infection and its associated risk factors were lower educational levels, multiple sexual partners, and a history of sexually transmitted diseases. Of the cases in this study, 12.7% were suspected to be malignant. Therefore, these findings underscore the need for specific public health interventions, including vaccination, health education, and accessible screening programs. 

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