Screening for Atypical Cervical Transformations from October 1 to 31, 2022: 646 Cases in Port-Gentil

Objective: To describe the atypical transformations of the cervix observed during the “October Rose 2022” screening campaign in Port-Gentil and identify the associated factors. Patients and method: This was a cross-sectional analytical study conducted from October 1 to 31, 2022, in four screening centers in Port-Gentil. The final sample included 646 women who voluntarily consulted for cervical screening by Visual Inspection with Acetic Acid (IVA) and Lugol (IVL). Sociodemographic and clinical data were collected by standardized questionnaire. A step-by-step descending multivariate logistic regression was carried out. The significance threshold was set at 5%. Results: Out of 1,022 women screened, 646 files were selected. The average age was 40.2 (± 12.8) years. Almost half of the participants had a low socioeconomic level (44.9%). Professional status was dominated by employees or workers (59.6%), while the level of education indicated participants were mostly at the secondary level (62.8%). The average gravidity was 4.0 (± 3.1) and ranged from 0 to 15. Multigravid and grand-multigravid women accounted for 23.5% and 27.9% of the sample, respectively. The average parity was 2.6 (± 2.3), ranging from 0 to 11. The pauciparous represented 28.8% and the nulliparous 24.6%. The participants reported having had between 0 and 12 sexual partners, with an average age of first sexual intercourse at 17.6 years; 38.5% of them had had early intercourse. A history of Chlamydia infection was reported by 19.0% of women, and 0.6% reported being HIV-positive. Unprepared visual inspection revealed metrorrhagia in 5 women (0.8%) and an inflammatory cervix in 13 women (2%). The results of the IVA and IVL tests were positive in 0.5% and 1.2% of women, respectively, i.e., an overall prevalence of atypical transformations of 1.7% (95% CI: 1.0 - 3.0). In multivariate analysis, a low socio-economic level (ORa = 3.5; 95% CI: 1.2 - 10.1; p = 0.02), a history of Chlamydia infection (ORa = 2.9; 95% CI: 1.1 - 7.6, p = 0.03), and a high number of sexual partners (≥5; ORa = 4.2; 95% CI: 1.3 - 13.5; p = 0.02) were associated with atypical lesions. In the absence of lesions of advanced appearance, the management consisted mainly of psychosocial and drug support, followed by referral to a specialized gynecological consultation for monitoring. Conclusion: Cervical cancer remains one of the main female cancers in Gabon, ranking second after breast cancer in terms of incidence and mortality. However, it is a preventable cancer thanks to the prevention and early detection of cervical lesions. Our study conducted in Port-Gentil, the second city in the country, shows a low prevalence of atypical transformations of the cervix, lower than that reported in Libreville, the capital, but also in the sub-region. The Visual Inspection tests for Acetic Acid (IVA) and Lugol (IVL), used in this campaign, proved to be simple, inexpensive tools adapted for primary screening in a context of limited resources. The identified risk factors, including low socioeconomic level, history of Chlamydia infection, multiplicity of sexual partners, and early initiation of sexual activity, underline the need to strengthen prevention strategies for vulnerable populations.