Human Papilloma Virus Genotype Distribution in Women With Cervical İntraepithelial Neoplasia Mehmet Bülbül1, Berna Dilbaz1, Bilge Aydın Aktürk2, Filiz Hatipoğlu1, Esra Boyar1 1Adıyaman University Faculty of Medicine, Department of Obstetrics and Gynecology, Adıyaman 2 Adıyaman University Faculty of Medicine, Department of Medical Pathology, Adıyaman

Introduction HPV group causes widespread infection worldwide. Out of 100 genotypes of HPV around 13 are linked with cancers. Of the sexually transmitted 40 HPV genotypes, high-risk strains are mainly HPV16, 18 that cause most of the cervical cancer cases. Other high-risk strains are 31, 33, 45, 52, 58. However there are regional differences about the prevalence of different HPV genotypes.  The aim of this study is to investigate the prevalance of HPV genotypes in patients with cervical intraepithelial neoplasia confirmed by colposcopy-guided biopsies.

Abnormal cervical smear (N=27, 21,1%) Material and Method Adıyaman University Training and Research Hospital Colposcopy Clinic Between April 2015 and March 2017. Colposcopy + Bx N: 128 HPV positive (N=31, 24,2%) Abnormal cervical smear (N=27, 21,1%) Both (N=70, 54,7%)

The pathological findings of the patients with abnormal smear results were as follows: ASCUS (N=46), ASC-H (N=8), LGSIL (N=36), High grade SIL (N=3), Atypical glandular cell (N=3).

Cervical pathologies were confirmed with colposcopy guided- biopsies. 63 patients bening or infectious. 55 patients CIN 1 – CIN 2-3  

Findings Mean±SD Age 41.6±9.6 Gravida 4,6±2,5 Age of first intercourse 19.9±4.6 Out of the 55 patients one patient who was diagnosed to have HG-SIL with cervical smear, was diagnosed to have cervical carcinoma after histopathological analysis of the biopsy specimen taken during colposcopy. 

The most frequently encountered HPV genotype was HPV 16 (42.1%) 54 patients 29 patients CIN1 and 25 patients CIN2-3 The most frequently encountered HPV genotype was HPV 16 (42.1%)

Table 1: The distribution of HPV genotypes in the patient group CIN I 1 (1,9) 8 (14,8) 2 (3,7) 4 (7,4) 3 (5,6) 0 (0,0) CIN II-III 15 (27,8) Total N: 54 23 (42,6) 7 (12,9)

Only one HPV genotype was found in 22 (75 Only one HPV genotype was found in 22 (75.9%) of the patients with CIN I while the remaining had more then one HPV genotype. Out of the 25 patients whose final diagnosis was CIN 2-3, 15 had one HPV genotype (60.0%) while the remaining had at least two HPV genotypes.

Table 2: The presence of HPV genotypes in cervical intraepithelial neoplasias HPV genotypes present 1 >=2 Total CIN I (N=29) 22 (75,9) 7 (24,1) 29 (100) CIN II-III (N=25) 15 (60,0) 10 (40,0) 25 (100) 27 17 54

Discussion As cervical cancer is the one of the leading cause of cancer-related deaths among women worldwide, it is very important to have a nation-wide screening programme for cervical cancer. Previous studies from Turkey reported a prevalence rate of HPV ranging from 1.4% to 26% and the most common HPV types in cytologically abnormal women were HPV 16, HPV 16 and HPV18. Dursun et al reported multiple HPV infection rate in women with normal Pap test as 2.2%. In the presented study multiple infection rate was 35% in patients with hispotahologically confirmed cervical intraepithelial neoplasia (CIN1,2-3).  The presented study points out the importance of colposcopy and colposcopy- guided biopsy in women with abnormal smear or positive HPV testing.

References Tuncer ZS, Basaran M, Ustaçelebi S, Kuzey GM. High-Risk Human Papilloma Virus (HPV) Infection Determined By Hybrid Capture II Assay in a Turkish University Hospital Outpatient Clinic MN-Gorm. 2006. pp. 129–134. Ozçelik B, Serin IS, Gökahmetoğlu S, Başbuğ M, Erez R. Human papillomavirus frequency of women at low risk of developing cervical cancer: a preliminary study from a Turkish university hospital. Eur J Gynaecol Oncol. 2003;24(2):157–9. [PubMed] Seçkin S, Aksoy F, Yıldırım M. Servikal Smearlerde HPV İnfeksiyonu Görülme İndisansı Ankara Numune Eğitim ve Araştırma Hastanesi Tıp Dergisi. 1996;36(1-2-3-4):101–103. Safi Z, Demirezen S, Beksaç MS, Kuzey GM, Kocagöz T, Ustaçelebi Ş, Hasçelik G, Çakar An. İnsan Papilloma Virusunun (IPV) Polimeraz Zincir Reaksiyonu Tekniği İle Servikal Ve Vajinal Akıntı Örneklerinde Saptanması Mn-Klinik Bilimler&Doktor. 2002;8(1):112–114 Dursun P, Senger SS, Arslan H, Kuşçu E, Ayhan A. Human papillomavirus (HPV) prevalence and types among Turkish women at a gynecology outpatient unit. BMC Infect Dis. 2009; 9: 191