Prevalence of human papillomavirus infection among women of reproductive age in the Amur region and its impact on pregnancy course and outcome

   Introduction. Human papillomavirus (HPV) infection adversely affects female reproductive function, increasing the risks of pregnancy loss and obstetric complications.

   Aim. To analyze the prevalence of HPV infection in women of reproductive age and determine its influence on the course and outcome of pregnancy.

   Materials and methods. A prospective comparative study enrolled 50 women of reproductive age. Clinical and anamnestic data, pregnancy course and outcomes were analyzed retrospectively. HPV DNA genotyping and quantification, together with detection of concomitant viral and bacterial infections, were performed by real-time polymerase chain reaction. Cervical intraepithelial neoplasia (CIN) was confirmed by cytological, colposcopic and histological examinations.

   Results. Genotyping showed HPV type 51 in30 % of women, type 16 in 28 %, type 68 in 16 %, type 18 in 12 %, and types 6 and 56 in 10 %. Types 11, 26, 31, 33, 35, 39, 44, 45, 52, 53, 59, 66 and 73 were found in 4% of patients. Multiple-type infection occurred in 30 % of women. High viral load was recorded in 60 %, moderate in 34 % and low in 6 %. Among sexually transmitted infections, Chlamydia trachomatis was diagnosed in 12 %, cytomegalovirus in 14 % and genital herpes in 4 %. Histology confirmed CIN I in 26 % of women, CIN II in 20 %, CIN III in 14 %, anogenital condylomatosis in 34% and cervical-canal polyps in 8 %. CIN I was associated with type 51 in 8 %, type 18 in 6 %, type 68 in 6 %, type 6 in 4 % and type 56 in 4 %; CIN II with type 16 in 10 %, type 51 in 8 %, type 68 in 4 % and type 66 in 4 %; CIN III with type 16 in 8 % and type 44 in 4 %. Vaginal-microbiome analysis revealed absolute normocenosis in 44 % of patients, conditional normocenosis in 24% and pronounced dysbiosis in 32 %. Absolute normocenosis was significantly more common in mono-infection (p < 0.001), whereas conditional normocenosis and pronounced dysbiosis predominated in mixed infection (p < 0.001 for both). Further analysis showed unexplained infertility in 16 % of patients. Pregnancy ended in spontaneous miscarriage in 14 % of women (41.4 % associated with mono-infection, 28.6 % with mixed infection). Missed miscarriage was diagnosed in 22 % of women (81.8 % mono-infection, 18.2 % mixed infection). Third-trimester chronic placental insufficiency occurred in 86 % of women (58.1 % mixed infection, 41.9 % mono-infection). Fetal growth restriction was noted in 9 % (60 % mixed infection, 40 % mono-infection). Threatened preterm labour was observed in 14 % (28.6 % mono-infection, 71.4 % mixed infection). Preeclampsia developed in 75 % of patients with mono-infection and 25 % with mixed infection. Oligohydramnios was found in 6 % of women with mixed infection and polyhydramnios in 2 %. Pregnancy was terminated in the second trimester for fetal central-nervous-system malformations in 6 % of patients.

   Conclusion. HPV mono-infection in women of reproductive age is associated with infertility, early pregnancy loss (spontaneous and missed miscarriage) and preeclampsia. HPV combined with other sexually transmitted infections increases the risk of chronic placental insufficiency, fetal growth restriction and preterm birth.

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