Prevalence of Human Papilloma Virus in Urine Among Pregnant Women Attending Kenyatta National Hospital

Abstract

Background: The Human Papilloma Virus (HPV) is a highly prevalent, sexually transmitted infection, with a prevalence of approximately 70% among sexually active people globally. Close to 99.7% of invasive cervical cancers have HPV, a necessary cause of cervical cancer. It is thought that during pregnancy, HPV acquisition increases due to hormonal influences and immunological depression as the pregnancy progresses. HPV infection is also found in the placenta and is believed to be associated with probable placental dysfunction leading to preterm births and spontaneous abortions. Broad Objective: To determine the prevalence of high-risk HPV in urine specimens among pregnant women attending the antenatal clinic in Kenyatta National Hospital. Methodology: One hundred pregnant women aged 18 years and above provided self-collected urine samples. Each urine sample was processed using liquid-based cytology, and DNA was extracted for HPV detection and genotyping using Real-Time PCR. Statistical data analysis was done using R software version 4.0.3. The results are presented as tables and figures and in the form of bar graphs and pie charts. Results: The majority (70%) of the participants were aged 26-35 years and slightly more than a half (51%) in their third trimester. The prevalence of high-risk HPV was 22%, with 13 (59.1%) having a single infection, 6 (27.3%) with two HPV types, and 3(13.6%) having multiple infections. Most of the urine smears (93%) were Negative for High-Grade Urothelial Carcinoma (UCC), while one smear had Low-Grade Urothelial Neoplasia. The urogenital infections identified in smears included bacterial infection (21%), candida (9%), and trichomonas infection (1%). Conclusion: The prevalence of high-risk HPV infection among this cohort of pregnant women is relatively high in urine samples. However, the prevalence of HPV-associated urothelial neoplasia was very low, with only one case reported. Recommendations: Larger studies with paired samples be conducted to validate urine as an alternative screening sample for genitourinary HPV-associated neoplasia, especially during pregnancy when a cervico-vaginal sample is undesirable.