Screening for cervical abnormalities associated with EBV, HPV and HSV-2 infections in South-West Nigeria: A tale between sex and non-sex workers

Abstract

Aim: This study investigated socio-economic and clinical correlates of cervical abnormalities and some viral infections such as Human Papilloma virus (HPV), Epstein-Barr virus (EBV) and Herpes Simplex virus type 2 (HSV-2) among commercial sex workers (CSWs) and non-sex workers (NSWs) of reproductive age. It also estimated serum levels of SCCA1, p16 and Ki67 as potential non-invasive biomarkers of cervical abnormalities. Methods: This cross-sectional study included 203 consenting participants (NSWs = 98 and CSWs = 105) within the age-range of 20–49 years. Interview based risk factor questionnaire was administered, Pap smears were made from cervical scrapings and classified accordingly while serum levels of SCCA1, Ki67 and p16, EBV, HPV and HSV2 antibodies were determined by ELISA method. Multivariate and multiple logistic regression analysis were on generated data carried out and significance set at p < 0.05. Result: Among NSWs, higher prevalence of cervicitis, atypical squamous cell of undetermined significance (ASCUS), low grade squamous cell intraepithelial lesion (LSIL) and high grade squamous cell intraepithelial lesion (HSIL) were 18.4%, 16.3%, 11.2% and 8.2%, respectively while the prevalence of the cervical abnormalities were 7.6%, 7.6%, 8.6% and 3.8%, respectively among CSWs (p = 0.04). Decreasing and increasing sero-prevalence of viral infections were observed from cervicitis, ASCUS, LSIL to HSIL among NSWs (77, 56, 54.5 and 50%) and CSWs (75, 87.5, 100 and 100%), respectively (p = 0.08). When only ASCUS, LSIL and HSIL were considered, statistics showed p16 sensitivity and specificity of 64.7% and 79.5%, respectively (Odd ratio {OR} 0.7118), SCCA1 sensitivity and specificity of 83.8% and 97%, respectively (OR 166.9) and ki67 sensitivity and specificity of 63.2% and 94.0%, respectively (OR 26.83). It revealed that serum levels of SCCA1, ki67 and p16 were sensitivity to the classes of Pap smear at p = 0.00; p = 0.00 and p = 0.01, respectively. Conclusion: This study suggests that while HPV infection could independently could promote the development of cervical abnormalities among CSWs, EBV infection and other factors may be potential factors among NSWs. It also suggests that serum levels of SCCA1, ki67 and p16 could be used as effective Pap smear complementary diagnostic biomarkers. Keywords: Epstein-Barr virus, Herpes simplex virus type 2, Human papilloma virus, Sex workers, Cervical lesions, Biomarkers