HPV-Associated Cervical and Lower Urinary–Genitourinary Cancer Precursors Among Female Commercial Sex Workers: Urological Implications for Urinary Tract Health

Abstract

Women commercial sex workers (CSWs) remain a high-risk group of people with cervical abnormalities and lower genitourinary (GU) diseases, but integrated screening of both has been minimal. Infection with human papillomavirus (HPV) is a cause of lesions in the cervix and can also cause peri-urethral and lower urinary tract inflammation, and thus this group is especially important to the urological research. The aim of the study was to find out the incidence of HPV-related cervical abnormalities and the evaluation of GU inflammatory disease with a possible urological implication among female CSWs. A total of 307 CSWs who were aged 30-65 years in Budhwar Peth, Pune, were involved in a descriptive cross-sectional study. Pap smear results were done and results with suspicious cytology were sent out to testing of HPV DNA. The cervical lesions, HPV positivity and GU abnormalities were identified using descriptive statistics. Aboriginal cytology was found in 214 women (70%). The pre-cancerous lesions (HSIL and LSIL) contribute 9% and 1 case of cervix cancer proved. Major GU-abnormalities were cervicitis (46%), squamous metaplasia (24%), and ASCUS (22%). Of the 23 women who had been tested on HPV, 6 (26%) were found to be the high-risk HPV positive, and four of them were HIV co-infected. LSIL was more common in women of younger age, whereas HPV positivity was more common in older ages. The presence of inflammatory and epithelial lesion is a significant burden, which raises the need to examine the cervical and lower urinary tract as a whole.