Title: Outcome and associated factors of high-risk human papillomavirus infection without
cervical lesions
Version: 0 Date: 18 Sep 2022
Reviewer's report:
At first, I would like to express my thanks to let me reviewing your manuscript. Actually, this
manuscript is dealing with an important subject and can open the window to understand the
factors which accelerate or decelerate the natural clearance rate of high-risk human papilloma
virus. This manuscript is written in scientific and academic way and can enrich the clinical
sciences with important data and facts.
However, there are few points need to be considered before accepting your manuscript, and they
are as follow:
Introduction
1. I think you missed the first reference in the introduction!
2. You mentioned that the women who involved in the study are 3 groups:
((1. women who tested positive for HR-HPV for the first time 2. who also had non-CIN cervical
pathology 3. cervical cancer for follow-up))
Materials and methods
Study subjects:
The selected cases for the study are 7 groups of women (not 3 groups as what mentioned in
the introduction!), and, why do you include women with cervical pathology results for CIN or
cervical cancer and then you exclude them in your study?!
Follow up:
1. Look at this statement from the manuscript:
((In this situation, if the histological results were still non-CIN or cervical cancer, the follow-
up was continued))
Do you mean that if the result confirm cervical cancer the follow up will continue? Please make
this statement clear because you mentioned in figure 1 that CC (cervical cancer) were exclude
from the study and the follow up was terminated!
2. What is the rationale of exclusion CIN and invasive cervical cancer from the study?
Results
All your figures illustrating the relationship between infection rate (Y axis) and the follow up
time (X axis), but you mention in figure legend natural clearance rate instead of infection rate!
In addition to that, you did not mention the follow up time (in months). If you had replaced the
setting of the figure into natural clearance rate and follow up time, the graph will be changed
and reversed into a stepping-up fashion rather than stepping-down.
2.1 subject demographic information:
Figure 2 does not show the median age of the women. I think you missed this figure!
2.2 Outcome of HR-HPV infection
84 cases become negative from HR-HPV, 11 cases developed CIN, what about the outcome of
the remaining cases (68 cases).
The graph should have a sign denote to the median time of spontaneous clearance
2.3 Relationship between age and natural clearance of HPV infection
Table 2 you should mention the median time of natural clearance rather than No. of HPV
clearance cases!
Age              No. of cases#n=163#  No. of HPV clearance cases#%# X2                     P
#35 years         57                                                           10.0                                                           62.466    <0.001
>35 years        106                                                    27.0
Figure 5: is not fully labelled!
Discussion
Look at this statement form your manuscript:
((In the multifactorial analysis of this study, menopause, full-term delivery, smoking or passive
smoking, and initial cytologic findings did not show any correlation with the clearance of HPV
infection)).
It is against your findings!
Your results demonstrated that menopause is associated with low rate of natural clearance rate,
and full-term deliveries are associated with high rate of natural clearance. These results confirm
the association between them and the natural clearance rate!
You do not discuss your findings about the association between the menopause and full-term
deliveries with rate of natural clearance!
References
You have cited 30 references but your references are just 16 references!
With all the best