Prevalence and Genotype Distribution of Human Papillomavirus Among a Subpopulation of Jordanian Women

Cervical cancer represents the fourth most frequently diagnosed malignancy in women and the fourth leading cause of cancer-related demise worldwide (1-3). In addition, human papillomavirus (HPV) infection is the leading sexually-transmitted infection (STI) globally (4). Multiple clinical and epidemiological reports have clearly established the role of HPV infection as the primary etiologic factor of cervical cancer (5-7). According to their oncogenicity, HPVs are classified into high-risk (HR), potential high-risk (pHR), and low-risk (LR) groups. The oncogenic HR-HPV genotypes 16 and 18 are the most prevalent types in individuals with cervical carcinoma or cervical intraepithelial neoplasia and are implicated in more than 70% of cervical carcinoma cases (8, 9). Conversely, the LR group genotypes 6 and 11 are implicated in most cases of condylomata and genital warts (10, 11). Given that HPV prevalence and distribution differ geographically and within different populations, there is a constant need for conducting HPV genotype screening routinely. In Jordan, the annual incidence of cervical cancer is estimated at 50-60 cases with a 50% mortality rate (12). These low figures could be largely attributed to predominant conservative sexual practices in Jordan. However, in recent years, globalization has tremendously affected several aspects of social life. Unfortunately, no recent report has examined whether this change has affected HPV infection rates. Furthermore, these changes in sexual practices might still be accompanied by the underutilization of mechanical protection (condoms), which significantly decreases the risk of STIs, which is still a main concern in the Middle East region (13). In this pilot study, Jordanian women attending the Gynecology Clinic at Prince Hamza Hospital were screened to identify the frequency of the HPV infection in this population. Moreover, the distribution of HPV genotypes and the extent of multiple HPV infections were studied in Abstract Objectives: Human papillomavirus (HPV) infection is the leading sexually-transmitted infection (STI) worldwide and the main etiology of cervical cancer. HPV infection rates are important in directing vaccination policies and screening for cervical cancer. Unfortunately, no recent reports have evaluated the prevalence of this infection among Jordanian women despite major globalization-driven changes in sexual behavior. Accordingly, this study aimed to determine the prevalence of HPV infection and its genotypic distribution in the cervical samples of Jordanian women. Materials and Methods: The study was carried out at Prince Hamza Hospital (Amman, Jordan) during 2016-2017. Women (1575 years old) were randomly selected for cervical cell collection. DNA was extracted and then amplified using MY09/11 and GP5+/6+ consensus primers. Finally, positive samples were genotyped by applying real-timepolymerase chain reaction and reverse line blotting. Results: Fourteen out of 348 women tested positive for HPV with a prevalence rate of 4%. In addition, multiple HPV genotypes were observed in 36% (5/14) of infected women while single HPV genotype infection was found in 64% (9/14) of infected women. Further, high-risk (HR), potential high-risk (pHR), and low-risk (LR) HPV genotypes were detected in most cases with a 78.6% (11/14) infection rate, 42.9% (6/14), and 7.1% (1/14) of infected women, respectively. Eventually, 10 different genotypes were detected in infected women and HPV 16 was the most common type (42.9%, 6/14). Conclusions: Our data suggest that the prevalence of HPV infection among Jordanian women is below the global and regional rates. It is hoped that these data should facilitate the implementation of appropriate cervical cancer screening and future HPV vaccination programs.