High-risk Human Papillomavirus (16, 18) are not the most common genotypes associated with cervical pre-cancer lesions: a retrospective study at a University Hospital in the Eastern-Province of Saudi Arabia

Objective High-risk HPV (human papillomavirus) is found to be responsible for 4.5% of all cancer, especially cervical cancer. The prevalence of high-risk HPV associated with cervical lesions is not well- known in Saudi Arabia. This study aims to highlight the genotypes of high-risk HPV associated with pre- malignant cervical lesions. Methods Over 6 years (2013 - 2018), 5091 Pap (Papanicolaou) smears results and 170 high-risk HPV test results were collected from the Information System at King Fahd University Hospital. Statistical analysis was performed using the software SPSS (Statistical Package for Social Sciences). Results Out of 5091 Pap smears, only 1.89% (n=96) were abnormal; 0.18% (n=9) were malignant (7 Squamous cell carcinomas and 2 adenocarcinomas), while 1.7% (n=87) showed pre-cancerous lesions, 44 ASCUS (Atypical Squamous Cells of Undetermined Significance), 17 LSIL (Low-grade Squamous Intraepithelial Lesions), 12 HSIL (High-grade Squamous Intraepithelial Lesions), and 14 AGC (Atypical Glandular Cells). Out of 170 patients co-tested for high-risk HPV, only 13.5% (n=23/170) had positive results (5 cases were positive for HPV16, 1 case was positive for both HPV16 and 18, while the remaining 17 cases were positive for high-risk HPV other than 16 or 18), among them, 6.47% (n=11/170) had normal Pap smear, while 7.06% (n=12/170) patients had abnormal Pap smear; 4 ASCUS, 6 LSIL and 2 HSIL. Statistical analysis showed a significant correlation between HPV findings and the Pap smear results (P- value 0.000), however, no significant correlation was found with the patients’ age and/or nationality. Discussion Our study showed a unique distribution of high-risk HPV genotypes which reflects different geographical infection patterns. Furthermore, the high association of high-risk HPV with normal Pap smears highlights the need, for all women at risk, to be co-investigated for high-risk HPV. These findings could help in customizing regional vaccine-combinations and screening programs.