Association between high-risk human papillomavirus and cervico-vaginal infections in tribal women screened for cervical precancers and cancers in Maharashtra, India: A cross-sectional study

Background The vaginal microenvironment is thought to impact infection and persistence of the human papillomavirus which is a necessity for cervical carcinogenesis. Tribal women are at risk for human papillomavirus and cervicovaginal infections due to polygamy, poor hygiene, and illiteracy. Aims We evaluated the association of common cervico-vaginal infections with human papillomavirus infection and cervical precancers among the tribal women of Dahanu taluka, Maharashtra, India. Methods For this cross-sectional study, tribal women from Dahanu taluka were recruited. Cervical brushing samples were collected from them and tested for human papillomavirus by the Hybrid Capture 2 method and polymerase chain reaction for Chlamydia trachomatis. Vaginal samples were collected for gram staining and examined for candidiasis and bacterial vaginosis, followed by visual inspection of the cervix with acetic acid. Results A total of 501 sexually active tribal women were recruited, among whom the human papillomavirus infection rate was 6.5%. Evaluation of vaginal smears by Nugent's scoring revealed bacterial vaginosis in 208 (41.5%), candidiasis in 30 (5.98%), and chlamydia in five (1%) participants. Bacterial vaginosis prevalence was higher in high-risk human papillomavirus-positive women. The presence of clue cells was associated with human papillomavirus positivity, suggesting an association between bacterial vaginosis and human papillomavirus infection and indicating an increased risk of human papillomavirus infection on co-infection with bacterial vaginosis. Limitations Only tribal women were screened, with no screening for other sexually transmitted infections. Since participants were recruited from healthcare centres instead of random sampling, this may have affected infection rate estimates. Due to regional differences in sexual behaviours and gynaecological morbidities, our findings cannot be generalised to tribal women from other regions. Conclusion Early detection and management of reproductive tract and sexually transmitted infections is paramount for preventing co-infections and reduces the risk of cervical carcinogenesis.