Isolation and Molecular Characterization of Bacterial Vaginosis and Human Papilloma Virus among Saudi Females Under Reproductive Age in Al-Madinah AlMonawara Region, KSA

Abstract

ABSTRACT Bacterial vaginosis (BV) is an infection that occurs when the balance of bacteria in the vagina is altered. It is a common condition affecting millions of women. Although the syndrome is curable, relapse rates are high. The infection can have gynaecological and obstetric complications. Hence BV may has a role in cervical cancer. On the other hand, different theories suggested the infection with papilloma virus, especially genotypes that belong to high-risk human papilloma virus (HR-HPV) group to be one of the most important causes of uterine and cervical malignancy and premalignancy lesions in human. Two groups of Saudi females were included in this study. Group A include one hundred and nineteen ( n= 119) Saudi females under reproductive age attending Maternity and Children Hospital (MCH) , at Almadenah Almonawarh from April 2016 to May 2017. High vaginal swap (HVS) was taken for culture, biochemical tests and PCR. On the other hand, two hundred an d thirty eight (n=238) cervical scrapings in LBC ( liquid based cytology) were collected in group B, processed for PCR targeting HPV as well as BV and cytological examination. For the first part of the study in which it was aimed to determine the frequency of G. vaginalis among group A. The results confirm the existence of vaginal infection in 63.8% of the study population asV follows: G. vaginalis in (20/76) 26.3%;( 7/46) 15.3% were pregnant while (13/30) 43.3% were non-pregnant. streptococcus spp. was reported in (27.6%), Candida spp. were in (46.1%). G. vaginalis were found to be more frequent in age group (20-29) followed by age group (30-39) and (less than 20 and more than 40years). The result of PCR in this group confirmed the presence of G. vaginalis among enrolled subjects with a ratio (20/119) 17% from the study subjects. Regarding group (B) population, PCR was performed to examine the presence of HR-HPV different genotypes as well as bacterial agents (G. vagialis, P. lacrimalis and L.iners) . Low incidence of precancerous epithelial lesions was observed among enrolled patients 13 (5.5%) with the following distribution: high-grade squamous intraepithelial lesion in 5 cases (38.5%), low-grade squamous intraepithelial lesion in 4 (30.8%) and four cases (30.8%) as a typical squamous cells of un determined significance. Nevertheless, HR-HPV was detected only in 6 (2.5%) cases and overall prevalence of HR-HPV in abnormal Pap smears was (2/13)15.4%. On the other hand, HPV was also detect in (4/238) 1.9% among smears that were registered free from any type of malignancy (NILM). On the other hand, only 170 samples in LBC were available to detect bacterial agent by PCR (the rest was lost during transportation). TheVI results showed (21/170) 12.4% of the study population were suffered from BV. Low incidence of G.vaginalis and P. lacrimalis population was observed (2.3%) for each pathogen. While L. iners was identified among 7.6% among the study. Co-infection with HPV was detected in two patients one of them was HPV type 52 and other was type 58 .Both of them elicited with no epithelial changes. On the other hand two of six positive HPV have epithelial change but there is no bacterial vaginosis. The study concluded very low prevalence of HR-HPV in routine cervical screening samples among suspected Saudi women, weak relation between HPV and the incidence of cervical neoplasia was also observed. Additionally there is no association between BV and HPV in uterine cervical neoplasia . Low incidence of bacterial vaginosis in group B (21/170) 12.4% This is due to indirect place for bacteria (cervical) not original site for this bacteria).This study may direct the clinicians and researchers to look for other suspected HPV genotypes in this regards and the high occurrence of BV among Saudi females.VII