Title: Outcome and associated factors of high-risk human papillomavirus infection without
cervical lesions
Version: 5 Date: 30 Sep 2023
Reviewer:  Nora Sabah Rasoul
Reviewer's report:
Dr. Nora Sabah Rasoul
Dear authors
I would like to thank you for your efforts invested in this manuscript. I have some remarks on
it hope you to take them into consideration.
Introduction
In line 146 (mean of 5 years18. HPV-16 was) please change the dot after 5 years to comma.
Methods
1. In line 180 please write the full name of the test before the abbreviation (HC-11) as it is first
mentioned her, and the same for PC in RLU/PC in line 203.
2. You divided the viral load into low and high, can you explain on which base because the
grouping is into 3 (mild, moderate& severe).
I recommend you to read this article:
World Health Organization, International Agency for Research on Cancer. Cervical cancer.
https://www.who.int/cancer/prevention/diagnosis-screening/cervical-cancer/en/.
3. In line 213 please write the full name of the test before the abbreviation (TCT).
4. In line 236, 237 please explain what you mean by double coitus and patient's bladder lithotomy
position.
The font size of (patient's bladder lithotomy position) is 10.5.
5. You choose to study the effect of certain factors on the clearance rate and time of the virus,
why you not choose the contraceptive activity of the women as you know OCP is one of the risk
factors, and it was one of the questions in the questionnaire, and the patient symptoms (abnormal
vaginal discharge).
Please read this article:
Nang, D.W., Tukirinawe, H., Okello, M. et al. Prevalence of high-risk human papillomavirus
infection and associated factors among women of reproductive age attending a rural teaching
hospital in western Uganda. BMC Women's Health 23, 209 (2023). https://doi.org/10.1186/
s12905-023-02342-y
6. In Fig. one after the first follow up I think the status of the patients should be:
HPV(-), TCT(-) clearance, HPV(+), TCT(-)continue follow up, and HPV(+), TCT(+)
colposcopy.
7. Can you explain why you choose patients with AUSCU & LISL while the aim of your study
is (selecting women who tested positive for HR-HPV for the first time and who also had non-
CIN cervical pathology and cervical cancer for follow-up).
8. Table 1: please change to the classical 2X2 table where HPV clearance should have two
categories. This applies also to table 2,3,4,5 and 6. The columns headings is rather confusing.
9. In Tables (2, 4&6) if you choose to compare between the survival curves I recommend to
change the title to long rank output.
10. In Table (7), please change the output as in the following example:
B       SE    wald     df     Sig.       Exp(B)   95% CI (lower & upper)for Exp(B)
age
rx
ecog.ps
resid.ds
Please explain the significance of the B, Wald. You can replace the EXP(B) by the naming it
hazard ratio.
Discussion
1. In line 386 (The in 2009 study conducted by Jaeman Bae et al. reported that 224 high-risk
HPV-positive Korean women with spontaneous cervical cytology) it needs rephrasing.
2. In line 416 what do you mean by (unborn women)?
3. In line 430 can you explain this statement (Thus, we suggest that in the asymptomatic female
population, the abnormal cytology was in predominantly minor lesions and such minor lesions
may not have a significant impact on HPV clearance).
4. In line 434 this statement is confusing (among the multiple factors that have been previously
studied to influence the spontaneous clearance of HR-HPV infection, age is another factor that
has received more intensive study).
5. In line 447 please what do you mean by non-young women?
6. In line 449 (If repeat HPV testing suggests a persistent) I think you mean reveals not suggests.
At the end of the manuscript please add the list of abbreviations.