Prevalence, Genotype Distribution, and Risk Factor Analysis of High-Risk Human Papillomavirus Among Reproductive-Aged Women in Central Gujarat: A Community-Based Screening Study

Prevalence, Genotype Distribution, and Risk Factor Analysis of High-Risk Human Papillomavirus Among Reproductive-Aged Women in Central Gujarat: A Community-Based Screening Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence, Genotype Distribution, and Risk Factor Analysis of High-Risk Human Papillomavirus Among Reproductive-Aged Women in Central Gujarat: A Community-Based Screening Study Gunjan Shrivastava, Dr. Vali Faras, Ashish Jawarkar, Hemantkumar Patadia This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8324888/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Cervical cancer ranks as the second leading cause of cancer death among Indian women, driven primarily by persistent high-risk HPV (hr HPV) types 16 and 18 . Community data on the genotype distribution and lifestyle-related risk factors among the Central Gujarat population are very scant. Methods: A cross-sectional screening study was conducted among 625 women aged between 30–60 years. The participants underwent cytology, testing & High-Risk HPV (hrHPV) DNA , and information about sociodemographic and diet was collected. Statistical analysis included chi-square tests, logistic regression, and trend analysis. Results: The overall hrHPV prevalence was 3.2% . Interestingly, HPV 18 (1.6%) was the most common genotype, exceeding HPV 16 (1.12%). High parity (OR 2.16), early marriage (OR 2.44), and irregular menstruation (OR 2.55) were significant predictors of hrHPV positivity. Dual positivity on liquid-based cytology and HPV DNA testing demonstrated the highest predictive value for CIN III (PPV 50%) . Poor intake of fruits, vegetables, and folate was associated with increased lesion severity. Conclusion: This study underlines the importance of targeted screening and nutritional interventions in Central Gujarat. The regional finding of HPV 18 dominance, coupled with the high predictive value of the dual test, strongly supports the integration of HPV vaccination and dual-test strategies to effectively reduce cervical cancer risk among reproductive-aged women. HPV prevalence cervical cancer genotype distribution sociodemographic risk factors dietary risk screening efficacy Gujarat Figures Figure 1 Introduction Cervical cancer remains a significant global health challenge, standing as the fourth most common cancer among women worldwide (1) and the second leading cause of cancer-related death among women in India, disproportionately affecting those in low- and middle-income countries (2) . The primary and necessary etiology for nearly all cervical cancers is persistent infection with high-risk Human Papillomavirus (hrHPV) types (1,3) , with genotypes HPV 16 and HPV 18 being the most frequently identified globally (1,3) . In response to this burden, the World Health Organization (WHO) launched a strategy aimed at accelerating the elimination of cervical cancer (4) . However, achieving this goal in populous, diverse nations like India is hampered by substantial barriers such as inadequate infrastructure, limited laboratory facilities, and lack of trained personnel — especially in rural and semi-urban areas (5,6) . While vaccination targets the root cause, effective secondary prevention through screening remains critical for the current reproductive-aged population (4,8) . National screening coverage in India is notably low, often characterized by unorganized, opportunistic services, resource constraints, and limited accessibility, particularly in rural and semi-urban communities (5,6,7) . Furthermore, the prevalence and distribution of hrHPV genotypes exhibit significant regional disparities (5, 9, 10) . For instance, while studies in some parts of India have reported moderate hrHPV prevalence, such regional figures may not accurately reflect the burden in neighbouring, yet distinct, geographic areas. Crucially, the local epidemiology of hr-HPV and the associated risk factors remain insufficiently documented for many regions — including central Gujarat. To effectively reduce the burden of cervical cancer, screening programmes must be complemented by a thorough understanding of local risk factors that influence both hrHPV acquisition and progression to high-grade lesions. These factors often include sociodemographic variables (like marriage age and parity) and lifestyle/reproductive factors (such as high parity, rural residence, low socioeconomic status), which have been linked to HPV infection and lesion severity (10, 11, 12) .Therefore, this community-based screening study was undertaken to address this critical knowledge gap. The study's primary objectives were to: Determine the prevalence and genotype distribution of hrHPV among reproductive-aged women (30–60 years) in Central Gujarat. Identify significant sociodemographic and lifestyle-related risk factors associated with hrHPV positivity. Materials and Methods 2.1. Study Design and Setting This was a cross-sectional, community-based screening study with an auxiliary component from Out-Patient Departments (OPD) of the participating health facility. The study was conducted in western India . Recruitment primarily targeted women residing in rural and semi-urban communities surrounding the Parul Sevashram Hospital (PSH) in Vadodara district, which served as the central facility for sample processing and diagnostic confirmation. A smaller proportion of participants were recruited from the hospital's general OPD to ensure a balanced representation of the reproductive-aged population seeking care. 2.2. Study Population and Sample Size The target study population included 625 women aged between 30 to 60 years . This age range was selected as it represents the population most at risk for persistent hrHPV infection and the development of cervical precancerous lesions. 2.3. Ethical Approval and Consent The study protocol, consent forms, and procedures were reviewed and approved by the Institutional Ethics Committee (IEC) of Parul University (Reference No will add). Written informed consent was obtained from all participants prior to enrollment and sample collection. Counselling regarding the procedure and the significance of the screening results was provided in the local language. 2.4. Inclusion and Exclusion Criteria Inclusion Criteria: Women aged 30 to 60 years. Willingness to provide written informed consent. Exclusion Criteria: Women who were pregnant at the time of screening. Women who were currently menstruating . Women with a prior history of hysterectomy (removal of the uterus). Women with a previous diagnosis of cervical cancer . 2.5. Data Collection and Clinical Procedures Socio-demographic and Risk Factor Data: A structured, pre-tested questionnaire was administered face-to-face by trained female health workers. The questionnaire collected detailed information on sociodemographic factors (age, education, income, parity, age at first marriage), reproductive history (menstrual regularity), and specific dietary habits (frequency of fruit, vegetable, and folate intake). Sample Collection and Laboratory Procedures: All participants underwent a pelvic examination and sample collection for both cytology and HPV DNA testing. Liquid-Based Cytology (LBC): A sample was collected using a cervical brush/spatula and preserved in a liquid medium for subsequent microscopic examination and classification according to the Bethesda System . hrHPV DNA Testing: A separate cervical sample was collected. DNA extraction and amplification were performed using commercially available Co-Dx Polymerase Chain Reaction (PCR) kits . This assay was designed to detect and genotype the high-risk HPV types, specifically focusing on the most common genotypes, HPV 16 and HPV 18 . 2.6. Statistical Analysis "Analyses used SPSS version 25.0; descriptive statistics summarized prevalence, chi-square/Fisher's exact tests assessed associations, binary logistic regression identified predictors (multivariable model with univariate-significant variables), and Spearman's correlation evaluated dietary-lesion links. Descriptive statistics were used to summarize the prevalence and genotype distribution. Inferential statistics included: Chi-square tests or Fisher’s exact test (where appropriate, for small cell counts) to assess the association between categorical variables (e.g., hrHPV status, lesion severity) and sociodemographic or dietary risk factors. Binary Logistic Regression analysis to identify independent predictors (expressed as Odds Ratios, ORs with 95% Confidence Intervals, CIs) of hr HPV positivity. Variables significant in the univariate analysis were included in the multivariable model. Spearman's rank correlation was used to assess the association between dietary intake (as an ordinal measure) and lesion severity (as an ordinal measure). Predictive value analysis was performed to calculate the Sensitivity, Specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of LBC and hrHPV DNA testing, both individually and in combination (dual testing), for the detection of high-grade cervical intraepithelial neoplasia (CIN II/CIN III). A p-value of <0.05 was considered statistically significant for all analyses. Results The study screened a total of 625 reproductive-aged women (30–60 years) from Central Gujarat. The mean age of the participants was 44.5 ± 7.8 year. 3.1 hrHPV Prevalence and Genotype Distribution Overall hrHPV prevalence was 3.2% (20/625), increasing significantly with age (p<0.05) to 5.4% in women aged 51-60 years. The prevalence increased significantly with age, peaking at 5.4% in the 51–60 years age group. This finding is lower than the 8.4% prevalence previously reported in Western India by Shah et al. (2025). A notable finding was the distribution of the two most common oncogenic genotypes. "HPV 18 was most prevalent at 1.6% (10/625; 50% of positives), exceeding HPV 16 at 1.1% (7/625; 35%)." (Table 1). Table 1 : Prevalence and Genotype Distribution of hrHPV in Central Gujarat Genotype Count (n=20) Prevalence (n=625) Percentage of hrHPV Positives HPV 18 10 1.60% 50.00% HPV 16 7 1.12% 35.00% Other HR Types 3 0.48% 15.00% Total hrHPV Positives 20 3.20% 100.00% 3.2 Sociodemographic Risk Factors Binary logistic regression analysis identified several independent sociodemographic and reproductive factors significantly associated with hrHPV positivity (Table 2) Table 2: Significant Predictors of hrHPV Positivity Predictor Odds Ratio (OR) 95% Confidence Interval (CI) p-value High Parity (>2 children) 2.16 (1.01–4.63) 0.026 Early Marriage (<18 years) 2.44 (1.01–5.91) 0.021 Irregular Menstruation 2.55 (1.17–5.55) 0.005 Women with irregular menstrual cycles showed the strongest association with hrHPV infection (OR 2.55). High parity and marriage before 18 years were also significant independent predictors, aligning with similar findings in regional studies (Shah et al., 2025). 3.3 Cervical Lesion Detection Among hrHPV-Positive Women Among the 20 women who tested positive for hrHPV, the distribution of cervical lesions classified by Liquid-Based Cytology (LBC) and subsequent histology revealed a significant burden of high-grade disease (Table 3). Table 3: Classification of Cervical Lesions Detected in hrHPV-Positive Women Lesion Type No. of Cases (n=20) Percentage (%) CIN I (Low-grade) 8 40.00% CIN II (High-grade) 5 25.00% CIN III (High-grade) 4 20.00% Invasive Carcinoma 3 15.00% 3.4 Screening Efficacy The predictive capacity of LBC, hrHPV DNA testing, and the dual-test combination for identifying CIN III or greater lesions was assessed (Table 4). Table 4: Efficacy of Single and Dual Screening Methods for CIN III Detection Method Positives (n=625) Positive Predictive Value (PPV) for CIN III LBC (Atypical/Positive) 41 2.44% hrHPV DNA Testing 20 10.00% Dual Positive (LBC + hrHPV DNA) 10 50.00% The dual-positive result (a positive LBC concurrent with a positive hrHPV DNA test) demonstrated the highest predictive value for CIN III, with a PPV of 50.0%. This result strongly reinforces the utility of combined screening modalities. 3.5 Dietary Risk Factors and Lesion Severity Spearman's rank correlation analysis indicated a significant association between poor dietary factors and increased severity of cervical lesions (CIN I to Invasive Carcinoma) among the hrHPV-positive cohort (Table 5). Both low fruit/vegetable intake and low folate intake showed a moderate, statistically significant correlation with higher-grade lesions, suggesting a possible protective role of these nutrients against disease progression. Table 5: Correlation Between Low Dietary Intake and Cervical Lesion Severity Factor p-value Spearman's ρ Interpretation Low fruit/vegetable intake 0.021 0.52 Moderate positive correlation with severity Low folate intake 0.038 0.47 Moderate positive correlation with severity Discussion The present community-based study provides important epidemiological insights into the burden and genotype distribution of hrHPV among reproductive-aged women in Central Gujarat. The overall hrHPV prevalence of 3.2% observed in our study is substantially lower than the 8.4% reported from Western India (9) and also lower than prevalence estimates from other regions of India, such as Odisha (14.0%) , Tamil Nadu (7.6%) , and Bihar (12.2%) (11,12,13). These findings confirm significant inter-regional differences in hrHPV epidemiology across India, emphasizing the need for localized screening strategies. A striking finding of this study is the predominance of HPV 18 (1.6%) over HPV 16 (1.12%) . This deviates from the typical global genotype pattern where HPV 16 is universally dominant , contributing to more than 50% of cervical cancer cases worldwide (3). Although regional studies from Odisha (11) and Bihar (12) continue to report HPV 16 as the most common genotype, our data align with emerging evidence from Western India suggesting shifting genotype profiles (9). These genotype variations have significant implications for vaccine planning , supporting the adoption of the nonavalent HPV vaccine , which ensures broad protection against circulating oncogenic types. The identified sociodemographic determinants — high parity , early marriage , and irregular menstruation — are consistent with findings from previous Indian studies (10,12,13). High parity and marriage at an early age are recognized drivers of persistent HPV infection due to increased cervical ectopy and prolonged exposure to viral transmission risk (10). Our study additionally highlights irregular menstruation as a significant independent predictor, a factor less frequently reported in Indian literature, suggesting potential hormonal or inflammatory pathways that merit further investigation. The diagnostic performance analysis further reinforces the utility of dual testing (LBC + hrHPV DNA) . In our study, dual positivity yielded the highest PPV (50%) for CIN III lesions, substantially outperforming LBC (2.44%) or HPV DNA testing alone (10%). This reflects global evidence showing that combining cytology with molecular HPV detection enhances both specificity and predictive accuracy , reducing unnecessary referrals while ensuring timely identification of high-grade lesions (1,3). Dietary influences on lesion severity represent another important finding. Poor intake of fruits, vegetables, and folate showed a moderate positive correlation with higher-grade lesions. Similar associations were noted in earlier studies, where micronutrient deficiencies — particularly folate, vitamins A, C, and E — were linked with impaired immune clearance of HPV and increased lesion progression (14,15). These results underscore the importance of integrating nutritional counselling within cervical cancer prevention frameworks, especially in resource-limited populations. Conclusion This study fills a critical gap in the epidemiological understanding of hrHPV infection among women in Central Gujarat. The unique dominance of HPV 18 , combined with the comparatively low overall hrHPV prevalence, demonstrates the importance of region-specific data to guide screening and vaccination policies. The statistically significant association of hrHPV with high parity , early marriage , and irregular menstruation highlights the need for targeted health education interventions. The superior predictive performance of dual testing further supports its inclusion in community-level screening programs. Additionally, the identified dietary correlations reinforce the value of nutritional interventions as complementary preventive strategies. Declarations Overall, the findings strongly advocate for the implementation of dual-test–based screening , regionally appropriate vaccination strategies , and dietary risk mitigation programs to effectively reduce the burden of cervical cancer among reproductive-aged women in Central Gujarat. Ethics Approval and Consent to Participate: The study was reviewed and approved by the Institutional Ethics Committee of Parul University (Approval No.: PUIECHR/PIMSR/00/081734/6816 ). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional ethics committee and the Declaration of Helsinki (2013 revision) . Written informed consent was obtained from all participants prior to their inclusion in the study. Consent for Publication Written informed consent for publication of anonymized data was obtained from all participants. Availability of Data and Materials The datasets analysed during the current study are not publicly available due to institutional ethical restrictions but are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding This study was supported by University Funding, Parul University. The funding body had no role in the design of the study, collection, analysis, or interpretation of data, or in writing the manuscript. Authors’ Contributions All authors conceptualized and designed the study. All authors initials carried out data collection and laboratory analysis. All authors performed data analysis and interpretation. All authors drafted the manuscript. All authors read, critically revised, and approved the final manuscript. Acknowledgements The authors would like to acknowledge Parul Sevashram Hospital and Parul University for providing the necessary infrastructure and institutional support to conduct this study. The authors are also grateful to Mr. Nitinkumar D Sharma for organising camps in community. I also grateful all the study participants for their cooperation and voluntary participatint. References World Health Organization. Human papillomavirus (HPV) and cervical cancer. WHO Fact Sheet. 2023. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–249. de Sanjosé S, Quint WG, Alemany L, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11(11):1048–1056. WHO launches strategy to eliminate cervical cancer; can India achieve the target. LiveMint . (about WHO strategy and global elimination aims) mint Challenges and opportunities to making Indian women cervical cancer free. Indian Journal of Medical Research . (discussing infrastructural, resource, social barriers in India) IJMR Screening for cervical cancer: Choices & dilemmas. Indian Journal of Medical Research . (about difficulties implementing screening programmes in LMICs including rural India) IJMR Over 10.18 Crore Women Screened For Cervical Cancer In India; Experts Urge For A 3-Pronged Preventive Strategy. Outlook India (mentions the role of screening + vaccination per WHO-style strategy). Outlook India Patterns in the prevalence and wealth-based inequality of cervical cancer screening in India. PMC / PubMed (reports very low national screening prevalence ~2%) , Kothari V, Khullar S, Hemavaishnave TS, et al. Prevalence of genotype patterns associated with high-risk human papillomavirus in cervical lesions in the western zone of India. Cureus. 2024;16(4):e58300. Cureus+1 Senapati MN, et al. Distribution of HPV genotypes and involvement of risk factors in cervical lesions and invasive cervical cancer: A study in an Indian population. J Obstet Gynaecol India. 2014;64(1):59–67. PMC+1 Pattnaik S, et al. HPV genotypes distribution in Indian women with and without cervical carcinoma: Implication for HPV vaccination program in Odisha, Eastern India. PLoS One. 2017;12(9):e0184845. PubMed Study from Bihar: Prevalence, risk factors and genotype distribution of human papillomavirus infection among women with and without invasive cervical cancer. NMJI. 2024. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8324888","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":562640131,"identity":"5e9edbcf-e802-48fc-a38b-4ed5ee0021db","order_by":0,"name":"Gunjan Shrivastava","email":"","orcid":"","institution":"Parul University","correspondingAuthor":false,"prefix":"","firstName":"Gunjan","middleName":"","lastName":"Shrivastava","suffix":""},{"id":562640132,"identity":"d80d971e-c6b4-4151-99ca-c63e514a5626","order_by":1,"name":"Dr. Vali Faras","email":"","orcid":"","institution":"Sterling Hospitals","correspondingAuthor":false,"prefix":"Dr.","firstName":"Vali","middleName":"","lastName":"Faras","suffix":""},{"id":562640133,"identity":"d8e5bd66-0510-4620-b26b-997881d9c2ec","order_by":2,"name":"Ashish Jawarkar","email":"","orcid":"","institution":"Parul University","correspondingAuthor":false,"prefix":"","firstName":"Ashish","middleName":"","lastName":"Jawarkar","suffix":""},{"id":562640134,"identity":"4d83e0f7-da67-45ca-adad-e713ac32d5fa","order_by":3,"name":"Hemantkumar Patadia","email":"data:image/png;base64,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","orcid":"","institution":"Parul Institute of Allied \u0026 Healthcare Sciences (PIAHS), Parul University","correspondingAuthor":true,"prefix":"","firstName":"Hemantkumar","middleName":"","lastName":"Patadia","suffix":""}],"badges":[],"createdAt":"2025-12-10 08:24:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8324888/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8324888/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101792907,"identity":"30521159-1a9b-42ef-a989-b5a2c022fa2c","added_by":"auto","created_at":"2026-02-03 16:15:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48633,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGraph 1- Shows distribution of HR-HPV Genotype.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8324888/v1/1def6ab455355a6b10786aab.png"},{"id":101792917,"identity":"74c026f2-72eb-4976-aa56-da1cc2c31e7f","added_by":"auto","created_at":"2026-02-03 16:15:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1740502,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8324888/v1/b838e848-cb5a-45a9-8489-f51f88952bee.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePrevalence, Genotype Distribution, and Risk Factor Analysis of High-Risk Human Papillomavirus Among Reproductive-Aged Women in Central Gujarat: A Community-Based Screening Study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer remains a significant global health challenge, standing as the fourth most common cancer among women worldwide \u003cstrong\u003e\u003csup\u003e(1)\u003c/sup\u003e\u003c/strong\u003e and the second leading cause of cancer-related death among women in India, disproportionately affecting those in low- and middle-income countries \u003cstrong\u003e(2)\u003c/strong\u003e. The primary and necessary etiology for nearly all cervical cancers is persistent infection with high-risk Human Papillomavirus (hrHPV) types \u003cstrong\u003e\u003csup\u003e(1,3)\u003c/sup\u003e\u003c/strong\u003e\u003csup\u003e,\u003c/sup\u003e with genotypes HPV 16 and HPV 18 being the most frequently identified globally \u003cstrong\u003e\u003csup\u003e(1,3)\u003c/sup\u003e\u003c/strong\u003e\u003csup\u003e.\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn response to this burden, the World Health Organization (WHO) launched a strategy aimed at accelerating the elimination of cervical cancer \u003cstrong\u003e(4)\u003c/strong\u003e. However, achieving this goal in populous, diverse nations like India is hampered by substantial barriers such as inadequate infrastructure, limited laboratory facilities, and lack of trained personnel \u0026mdash; especially in rural and semi-urban areas \u003cstrong\u003e(5,6)\u003c/strong\u003e. While vaccination targets the root cause, effective secondary prevention through screening remains critical for the current reproductive-aged population \u003cstrong\u003e(4,8)\u003c/strong\u003e. National screening coverage in India is notably low, often characterized by unorganized, opportunistic services, resource constraints, and limited accessibility, particularly in rural and semi-urban communities \u003cstrong\u003e(5,6,7)\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eFurthermore, the prevalence and distribution of hrHPV genotypes exhibit significant regional disparities \u003cstrong\u003e(5, 9, 10)\u003c/strong\u003e. For instance, while studies in some parts of India have reported moderate hrHPV prevalence, such regional figures may not accurately reflect the burden in neighbouring, yet distinct, geographic areas. Crucially, the local epidemiology of hr-HPV and the associated risk factors remain insufficiently documented for many regions \u0026mdash; including central Gujarat. To effectively reduce the burden of cervical cancer, screening programmes must be complemented by a thorough understanding of local risk factors that influence both hrHPV acquisition and progression to high-grade lesions. These factors often include sociodemographic variables (like marriage age and parity) and lifestyle/reproductive factors (such as high parity, rural residence, low socioeconomic status), which have been linked to HPV infection and lesion severity \u003cstrong\u003e(10, 11, 12)\u003c/strong\u003e.Therefore, this community-based screening study was undertaken to address this critical knowledge gap. The study\u0026apos;s primary objectives were to:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eDetermine the \u003cstrong\u003eprevalence and genotype distribution\u003c/strong\u003e of hrHPV among reproductive-aged women (30\u0026ndash;60 years) in Central Gujarat.\u003c/li\u003e\n \u003cli\u003eIdentify significant \u003cstrong\u003esociodemographic and lifestyle-related risk factors\u003c/strong\u003e associated with hrHPV positivity.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1. Study Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a \u003cstrong\u003ecross-sectional, community-based screening study\u003c/strong\u003e with an auxiliary component from Out-Patient Departments (OPD) of the participating health facility.\u003c/p\u003e\n\u003cp\u003eThe study was conducted in \u003cstrong\u003ewestern India\u003c/strong\u003e. Recruitment primarily targeted women residing in \u003cstrong\u003erural and semi-urban communities\u003c/strong\u003e surrounding the \u003cstrong\u003eParul Sevashram Hospital\u003c/strong\u003e (PSH) in Vadodara district, which served as the central facility for sample processing and diagnostic confirmation. A smaller proportion of participants were recruited from the hospital\u0026apos;s general OPD to ensure a balanced representation of the reproductive-aged population seeking care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2. Study Population and Sample Size\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe target study population included \u003cstrong\u003e625 women\u003c/strong\u003e aged between \u003cstrong\u003e30 to 60 years\u003c/strong\u003e. This age range was selected as it represents the population most at risk for persistent hrHPV infection and the development of cervical precancerous lesions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Ethical Approval and Consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol, consent forms, and procedures were reviewed and approved by the \u003cstrong\u003eInstitutional Ethics Committee (IEC)\u003c/strong\u003e of Parul University (Reference No will add). \u003cstrong\u003eWritten informed consent\u003c/strong\u003e was obtained from all participants prior to enrollment and sample collection. Counselling regarding the procedure and the significance of the screening results was provided in the local language.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4. Inclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eWomen aged 30 to 60 years.\u003c/li\u003e\n \u003cli\u003eWillingness to provide written informed consent.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion Criteria:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eWomen who were \u003cstrong\u003epregnant\u003c/strong\u003e at the time of screening.\u003c/li\u003e\n \u003cli\u003eWomen who were currently \u003cstrong\u003emenstruating\u003c/strong\u003e.\u003c/li\u003e\n \u003cli\u003eWomen with a prior history of \u003cstrong\u003ehysterectomy\u003c/strong\u003e (removal of the uterus).\u003c/li\u003e\n \u003cli\u003eWomen with a previous diagnosis of \u003cstrong\u003ecervical cancer\u003c/strong\u003e.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Data Collection and Clinical Procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSocio-demographic and Risk Factor Data:\u003c/p\u003e\n\u003cp\u003eA structured, pre-tested questionnaire was administered face-to-face by trained female health workers. The questionnaire collected detailed information on sociodemographic factors (age, education, income, parity, age at first marriage), reproductive history (menstrual regularity), and specific dietary habits (frequency of fruit, vegetable, and folate intake).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Collection and Laboratory Procedures:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants underwent a pelvic examination and sample collection for both cytology and HPV DNA testing.\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003e\u003cstrong\u003eLiquid-Based Cytology (LBC):\u003c/strong\u003e A sample was collected using a cervical brush/spatula and preserved in a liquid medium for subsequent microscopic examination and classification according to the \u003cstrong\u003eBethesda System\u003c/strong\u003e.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ehrHPV DNA Testing:\u003c/strong\u003e A separate cervical sample was collected. DNA extraction and amplification were performed using commercially available \u003cstrong\u003eCo-Dx Polymerase Chain Reaction (PCR) kits\u003c/strong\u003e. This assay was designed to detect and \u003cstrong\u003egenotype\u003c/strong\u003e the high-risk HPV types, specifically focusing on the most common genotypes, \u003cstrong\u003eHPV 16 and HPV 18\u003c/strong\u003e.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003e2.6. Statistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026quot;Analyses used SPSS version 25.0; descriptive statistics summarized prevalence, chi-square/Fisher\u0026apos;s exact tests assessed associations, binary logistic regression identified predictors (multivariable model with univariate-significant variables), and Spearman\u0026apos;s correlation evaluated dietary-lesion links. Descriptive statistics were used to summarize the prevalence and genotype distribution. Inferential statistics included:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eChi-square tests\u003c/strong\u003e or \u003cstrong\u003eFisher\u0026rsquo;s exact test\u003c/strong\u003e (where appropriate, for small cell counts) to assess the association between categorical variables (e.g., hrHPV status, lesion severity) and sociodemographic or dietary risk factors.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBinary Logistic Regression\u003c/strong\u003e analysis to identify independent predictors (expressed as \u003cstrong\u003eOdds Ratios, ORs\u003c/strong\u003e with 95% Confidence Intervals, CIs) of hr HPV positivity. Variables significant in the univariate analysis were included in the multivariable model.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eSpearman\u0026apos;s rank correlation\u0026nbsp;\u003c/strong\u003e was used to assess the association between dietary intake (as an ordinal measure) and lesion severity (as an ordinal measure).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003ePredictive value analysis\u003c/strong\u003e was performed to calculate the Sensitivity, Specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) of LBC and hrHPV DNA testing, both individually and in combination (dual testing), for the detection of high-grade cervical intraepithelial neoplasia (CIN II/CIN III).\u003c/li\u003e\n \u003cli\u003eA \u003cstrong\u003ep-value of \u0026lt;0.05\u003c/strong\u003e was considered statistically significant for all analyses.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Results","content":"\u003cp\u003eThe study screened a total of \u003cstrong\u003e625 reproductive-aged women\u003c/strong\u003e (30–60 years) from Central Gujarat. The mean age of the participants was 44.5 ± 7.8\u0026nbsp;year.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1 hrHPV Prevalence and Genotype Distribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall hrHPV prevalence was 3.2% (20/625), increasing significantly with age (p\u0026lt;0.05) to 5.4% in women aged 51-60 years. The prevalence increased significantly with age, peaking at \u003cstrong\u003e5.4%\u003c/strong\u003e in the 51–60 years age group. This finding is lower than the 8.4% prevalence previously reported in Western India by Shah et al. (2025).\u003c/p\u003e\n\u003cp\u003eA notable finding was the distribution of the two most common oncogenic genotypes. \u003cstrong\u003e\"HPV 18 was most prevalent at 1.6% (10/625; 50% of positives), exceeding HPV 16 at 1.1% (7/625; 35%).\"\u0026nbsp;\u003c/strong\u003e(Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e: Prevalence and Genotype Distribution of hrHPV in Central Gujarat\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eGenotype\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCount\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=20)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePrevalence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=625)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage of hrHPV Positives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHPV 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHPV 16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.12%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eOther HR Types\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.48%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal hrHPV Positives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e3.20%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e100.00%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Sociodemographic Risk Factors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBinary logistic regression analysis identified several independent sociodemographic and reproductive factors significantly associated with hrHPV positivity (Table 2)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Significant Predictors of hrHPV Positivity\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePredictor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eOdds Ratio\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(OR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e95% Confidence Interval\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHigh Parity (\u0026gt;2 children)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.01–4.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eEarly Marriage (\u0026lt;18 years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.01–5.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eIrregular Menstruation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e(1.17–5.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eWomen with \u003cstrong\u003eirregular menstrual cycles\u003c/strong\u003e showed the strongest association with hrHPV infection (OR 2.55). High parity and marriage before 18 years were also significant independent predictors, aligning with similar findings in regional studies (Shah et al., 2025).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Cervical Lesion Detection Among hrHPV-Positive Women\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 20 women who tested positive for hrHPV, the distribution of cervical lesions classified by Liquid-Based Cytology (LBC) and subsequent histology revealed a significant burden of high-grade disease (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3:\u003c/strong\u003e Classification of Cervical Lesions Detected in hrHPV-Positive Women\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"613\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLesion Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo. of Cases (n=20)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCIN I (Low-grade)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e40.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCIN II (High-grade)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eCIN III (High-grade)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eInvasive Carcinoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Screening Efficacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe predictive capacity of LBC, hrHPV DNA testing, and the dual-test combination for identifying \u003cstrong\u003eCIN III or greater\u003c/strong\u003e lesions was assessed (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4:\u003c/strong\u003e Efficacy of Single and Dual Screening Methods for CIN III Detection\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePositives\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(n=625)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Predictive Value (PPV)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efor CIN III\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eLBC (Atypical/Positive)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.44%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ehrHPV DNA Testing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDual Positive (LBC + hrHPV DNA)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50.00%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe \u003cstrong\u003edual-positive result\u003c/strong\u003e (a positive LBC concurrent with a positive hrHPV DNA test) demonstrated the \u003cstrong\u003ehighest predictive value\u003c/strong\u003e for CIN III, with a PPV of 50.0%. This result strongly reinforces the utility of combined screening modalities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 Dietary Risk Factors and Lesion Severity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpearman's rank correlation analysis indicated a significant association between poor dietary factors and increased severity of cervical lesions (CIN I to Invasive Carcinoma) among the hrHPV-positive cohort (Table 5).\u003c/p\u003e\n\u003cp\u003eBoth low fruit/vegetable intake and low folate intake showed a \u003cstrong\u003emoderate, statistically significant correlation\u003c/strong\u003e with higher-grade lesions, suggesting a possible protective role of these nutrients against disease progression.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5:\u003c/strong\u003e Correlation Between Low Dietary Intake and Cervical Lesion Severity\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFactor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman's ρ\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eInterpretation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLow fruit/vegetable intake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eModerate positive correlation with severity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLow folate intake\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.038\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eModerate positive correlation with severity\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present community-based study provides important epidemiological insights into the burden and genotype distribution of hrHPV among reproductive-aged women in Central Gujarat. The overall hrHPV prevalence of \u003cstrong\u003e3.2%\u003c/strong\u003e observed in our study is substantially lower than the \u003cstrong\u003e8.4% reported from Western India\u003c/strong\u003e (9) and also lower than prevalence estimates from other regions of India, such as \u003cstrong\u003eOdisha (14.0%)\u003c/strong\u003e, \u003cstrong\u003eTamil Nadu (7.6%)\u003c/strong\u003e, and \u003cstrong\u003eBihar (12.2%)\u003c/strong\u003e (11,12,13). These findings confirm significant \u003cstrong\u003einter-regional differences\u003c/strong\u003e in hrHPV epidemiology across India, emphasizing the need for localized screening strategies.\u003c/p\u003e\n\u003cp\u003eA striking finding of this study is the \u003cstrong\u003epredominance of HPV 18 (1.6%) over HPV 16 (1.12%)\u003c/strong\u003e. This deviates from the typical global genotype pattern where \u003cstrong\u003eHPV 16 is universally dominant\u003c/strong\u003e, contributing to more than \u003cstrong\u003e50% of cervical cancer cases worldwide\u003c/strong\u003e (3). Although regional studies from Odisha (11) and Bihar (12) continue to report HPV 16 as the most common genotype, our data align with emerging evidence from Western India suggesting shifting genotype profiles (9). These genotype variations have significant implications for \u003cstrong\u003evaccine planning\u003c/strong\u003e, supporting the adoption of the \u003cstrong\u003enonavalent HPV vaccine\u003c/strong\u003e, which ensures broad protection against circulating oncogenic types.\u003c/p\u003e\n\u003cp\u003eThe identified sociodemographic determinants \u0026mdash; \u003cstrong\u003ehigh parity\u003c/strong\u003e, \u003cstrong\u003eearly marriage\u003c/strong\u003e, and \u003cstrong\u003eirregular menstruation\u003c/strong\u003e \u0026mdash; are consistent with findings from previous Indian studies (10,12,13). High parity and marriage at an early age are recognized drivers of persistent HPV infection due to increased cervical ectopy and prolonged exposure to viral transmission risk (10). Our study additionally highlights \u003cstrong\u003eirregular menstruation\u003c/strong\u003e as a significant independent predictor, a factor less frequently reported in Indian literature, suggesting potential hormonal or inflammatory pathways that merit further investigation.\u003c/p\u003e\n\u003cp\u003eThe diagnostic performance analysis further reinforces the utility of \u003cstrong\u003edual testing (LBC + hrHPV DNA)\u003c/strong\u003e. In our study, dual positivity yielded the highest PPV (50%) for CIN III lesions, substantially outperforming LBC (2.44%) or HPV DNA testing alone (10%). This reflects global evidence showing that combining cytology with molecular HPV detection enhances both \u003cstrong\u003especificity and predictive accuracy\u003c/strong\u003e, reducing unnecessary referrals while ensuring timely identification of high-grade lesions (1,3).\u003c/p\u003e\n\u003cp\u003eDietary influences on lesion severity represent another important finding. Poor intake of fruits, vegetables, and folate showed a moderate positive correlation with higher-grade lesions. Similar associations were noted in earlier studies, where \u003cstrong\u003emicronutrient deficiencies \u0026mdash; particularly folate, vitamins A, C, and E \u0026mdash; were linked with impaired immune clearance of HPV and increased lesion progression\u003c/strong\u003e (14,15). These results underscore the importance of integrating \u003cstrong\u003enutritional counselling\u003c/strong\u003e within cervical cancer prevention frameworks, especially in resource-limited populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study fills a critical gap in the epidemiological understanding of hrHPV infection among women in Central Gujarat. The \u003cstrong\u003eunique dominance of HPV 18\u003c/strong\u003e, combined with the comparatively low overall hrHPV prevalence, demonstrates the importance of \u003cstrong\u003eregion-specific data\u003c/strong\u003e to guide screening and vaccination policies. The statistically significant association of hrHPV with \u003cstrong\u003ehigh parity\u003c/strong\u003e, \u003cstrong\u003eearly marriage\u003c/strong\u003e, and \u003cstrong\u003eirregular menstruation\u003c/strong\u003e highlights the need for targeted health education interventions. The superior predictive performance of \u003cstrong\u003edual testing\u003c/strong\u003e further supports its inclusion in community-level screening programs. Additionally, the identified dietary correlations reinforce the value of nutritional interventions as complementary preventive strategies.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003eOverall, the findings strongly advocate for the implementation of \u003cstrong\u003edual-test\u0026ndash;based screening\u003c/strong\u003e, \u003cstrong\u003eregionally appropriate vaccination strategies\u003c/strong\u003e, and \u003cstrong\u003edietary risk mitigation programs\u003c/strong\u003e to effectively reduce the burden of cervical cancer among reproductive-aged women in Central Gujarat.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was reviewed and approved by the Institutional Ethics Committee of \u003cem\u003eParul University\u003c/em\u003e (Approval No.: \u003cstrong\u003ePUIECHR/PIMSR/00/081734/6816\u003c/strong\u003e). All procedures involving human participants were conducted in accordance with the ethical standards of the institutional ethics committee and the \u003cstrong\u003eDeclaration of Helsinki (2013 revision)\u003c/strong\u003e. Written informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of anonymized data was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analysed during the current study are not publicly available due to institutional ethical restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by University Funding, Parul University. The funding body had no role in the design of the study, collection, analysis, or interpretation of data, or in writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors conceptualized and designed the study.\u003c/p\u003e\n\u003cp\u003eAll authors initials carried out data collection and laboratory analysis.\u003c/p\u003e\n\u003cp\u003eAll authors performed data analysis and interpretation.\u003c/p\u003e\n\u003cp\u003eAll authors drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read, critically revised, and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge Parul Sevashram Hospital and Parul University for providing the necessary infrastructure and institutional support to conduct this study. The authors are also grateful to Mr. Nitinkumar D Sharma for organising camps in community. I also grateful all the study participants for their cooperation and voluntary participatint.\u0026nbsp;\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Human papillomavirus (HPV) and cervical cancer. WHO Fact Sheet. 2023.\u003c/li\u003e\n\u003cli\u003eSung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209\u0026ndash;249.\u003c/li\u003e\n\u003cli\u003ede Sanjos\u0026eacute; S, Quint WG, Alemany L, et al. Human papillomavirus genotype attribution in invasive cervical cancer: a retrospective cross-sectional worldwide study. Lancet Oncol. 2010;11(11):1048\u0026ndash;1056.\u003c/li\u003e\n\u003cli\u003eWHO launches strategy to eliminate cervical cancer; can India achieve the target. \u003cem\u003eLiveMint\u003c/em\u003e. (about WHO strategy and global elimination aims) mint\u003c/li\u003e\n\u003cli\u003eChallenges and opportunities to making Indian women cervical cancer free. \u003cem\u003eIndian Journal of Medical Research\u003c/em\u003e. (discussing infrastructural, resource, social barriers in India) IJMR\u003c/li\u003e\n\u003cli\u003eScreening for cervical cancer: Choices \u0026amp; dilemmas. \u003cem\u003eIndian Journal of Medical Research\u003c/em\u003e. (about difficulties implementing screening programmes in LMICs including rural India) IJMR\u003c/li\u003e\n\u003cli\u003eOver 10.18 Crore Women Screened For Cervical Cancer In India; Experts Urge For A 3-Pronged Preventive Strategy. \u003cem\u003eOutlook India\u003c/em\u003e (mentions the role of screening + vaccination per WHO-style strategy). Outlook India\u003c/li\u003e\n\u003cli\u003ePatterns in the prevalence and wealth-based inequality of cervical cancer screening in India. \u003cem\u003ePMC / PubMed\u003c/em\u003e (reports very low national screening prevalence ~2%)\u003c/li\u003e\n\u003cli\u003e, Kothari V, Khullar S, Hemavaishnave TS, et al. \u003cem\u003ePrevalence of genotype patterns associated with high-risk human papillomavirus in cervical lesions in the western zone of India.\u003c/em\u003e Cureus. 2024;16(4):e58300. Cureus+1\u003c/li\u003e\n\u003cli\u003eSenapati MN, et al. \u003cem\u003eDistribution of HPV genotypes and involvement of risk factors in cervical lesions and invasive cervical cancer: A study in an Indian population.\u003c/em\u003e J Obstet Gynaecol India. 2014;64(1):59\u0026ndash;67. PMC+1\u003c/li\u003e\n\u003cli\u003ePattnaik S, et al. \u003cem\u003eHPV genotypes distribution in Indian women with and without cervical carcinoma: Implication for HPV vaccination program in Odisha, Eastern India.\u003c/em\u003e PLoS One. 2017;12(9):e0184845. PubMed\u003c/li\u003e\n\u003cli\u003eStudy from Bihar: \u003cem\u003ePrevalence, risk factors and genotype distribution of human papillomavirus infection among women with and without invasive cervical cancer.\u003c/em\u003e NMJI. 2024. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HPV prevalence, cervical cancer, genotype distribution, sociodemographic risk factors, dietary risk, screening efficacy, Gujarat","lastPublishedDoi":"10.21203/rs.3.rs-8324888/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8324888/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Cervical cancer ranks as the second leading cause of cancer death among Indian women, driven primarily by persistent high-risk HPV (hr HPV) types 16 and 18\u003cem\u003e. \u003c/em\u003eCommunity data on the genotype distribution and lifestyle-related risk factors among the Central Gujarat population are very scant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eA cross-sectional screening study was conducted among \u003cstrong\u003e625 women\u003c/strong\u003e aged between 30–60 years. The participants underwent cytology, testing \u0026amp; \u003cstrong\u003eHigh-Risk HPV (hrHPV) DNA\u003c/strong\u003e, and information about sociodemographic and diet was collected. Statistical analysis included chi-square tests, logistic regression, and trend analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThe overall hrHPV prevalence was \u003cstrong\u003e3.2%\u003c/strong\u003e. Interestingly, HPV 18 (1.6%) was the most common genotype, exceeding HPV 16 (1.12%). \u003cstrong\u003eHigh parity\u003c/strong\u003e (OR 2.16), \u003cstrong\u003eearly marriage\u003c/strong\u003e (OR 2.44), and \u003cstrong\u003eirregular menstruation\u003c/strong\u003e (OR 2.55) were significant predictors of hrHPV positivity. Dual positivity on liquid-based cytology and HPV DNA testing demonstrated the \u003cstrong\u003ehighest predictive value for CIN III (PPV 50%)\u003c/strong\u003e. Poor intake of fruits, vegetables, and folate was associated with increased lesion severity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThis study underlines the importance of \u003cstrong\u003etargeted screening\u003c/strong\u003e and \u003cstrong\u003enutritional interventions\u003c/strong\u003e in Central Gujarat. The regional finding of HPV 18 dominance, coupled with the high predictive value of the dual test, strongly supports the \u003cstrong\u003eintegration of HPV vaccination and dual-test strategies\u003c/strong\u003e to effectively reduce cervical cancer risk among reproductive-aged women.\u003c/p\u003e","manuscriptTitle":"Prevalence, Genotype Distribution, and Risk Factor Analysis of High-Risk Human Papillomavirus Among Reproductive-Aged Women in Central Gujarat: A Community-Based Screening Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-03 16:15:17","doi":"10.21203/rs.3.rs-8324888/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b39497e2-d9b5-476a-a1d1-d74b9695a5da","owner":[],"postedDate":"February 3rd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-03T16:15:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-03 16:15:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8324888","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8324888","identity":"rs-8324888","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}