Ureaplasma Species and Human Papillomavirus Coinfection and Associated Factors Among South African Adolescent Girls and Young Women

Ureaplasma species are associated with various reproductive health issues, while human papillomavirus (HPV) is associated with cervical, vaginal and vulvar cancers. Data on the association between Ureaplasma species and HPV are limited in South Africa. This study investigated the prevalence of Ureaplasma urealyticum (U. urealyticum), Ureaplasma parvum (U. parvum), and HPV coinfection and their associated factors, among adolescent girls and young women (AGYW) in the Eastern Cape Province, South Africa. A total of 214 partici-pants were retrospectively recruited, and secondary data on HPV, U. urealyticum, U. par-vum, demographics, and sexual behavior were used. HPV was detected using the Roche Linear Array HPV Genotyping Test, while U. urealyticum and U. parvum were detected us-ing Allplex™ sexually transmitted infection (STI) essential Assay. Statistical analyses were performed using GraphPad Prism Version 8.0.1.244. The prevalence of U. urealyticum was 43.9% (94/214) and increased significantly with age (p = 0.036, R2 = 0.8497); while U. parvum prevalence was 68.7% (147/214) and was not influenced by age. Having four to six lifetime sexual partners (PR:1.77, 95% CI: 1.04–3.00, p = 0.043) was associated with in-creased risk of U. urealyticum. A proportion of 36.3% (77/212) had HPV-U. urealyticum coinfection and its risk was increased among those with 3–6 lifetime sexual partners (PR: 1.59, 95% CI: 1.10–2.53, p = 0.017), 2–4 new partners past three months (PR: 2.14, 95% CI: 1.19–2.42, p = 0.021); vaginal sexual intercourse frequency past 1-month (2–3 vaginal in-tercourse: PR: 1.54, 95% CI: 1.06–2.53, p = 0.037; 4–10 vaginal intercourse: PR: 1.91, 95% CI: 1.83–1.91, p = 0.005) and alcohol consumption (PR: 1.85, 95% CI: 1.20–3.28, p = 0.004). U. urealyticum positives had a significantly higher risk of HPV types targeted by Cervarix® HPV vaccine than negatives (PR: 2.56, 95% CI: 1.23–5.37, p = 0.013), Gardasil®4 (PR: 2.16, 95% CI: 1.25–3.75, p = 0.006) and Gardasil®9 (PR: 1.70, 95% CI: 1.25–2.32, p = 0.001). AGYW of Eastern Cape Province, South Africa had high prevalence of U. urealyticum-HPV and U. parvum-HPV coinfections. Ureaplasma species coinfection was associated with HPV prevalence and distribution of genotypes. The U. urealyticum prevalence and its coinfection with HPV were associated with sexual behavior. Data from this study could contribute to the design of sexual health and STI interventions and could serve as a baseline for future epidemiological studies, which include ongoing surveillance of HPV genotype prevalence to evaluate the impact and effectiveness of HPV vaccination programs in the population.

解脲脲原体属（Ureaplasma species）与多种生殖健康问题密切相关，而人类乳头瘤病毒（human papillomavirus, HPV）则与宫颈癌、阴道癌及外阴癌存在显著关联。目前南非地区关于解脲脲原体属与HPV感染相关性的研究数据较为匮乏。本研究针对南非东开普省的青春期少女与青年女性（adolescent girls and young women, AGYW）展开调查，旨在明确解脲脲原体（Ureaplasma urealyticum, U. urealyticum）、微小脲原体（Ureaplasma parvum, U. parvum）与HPV的混合感染率及其相关影响因素。本研究共回顾性纳入214名研究对象，采用的二次数据涵盖HPV、解脲脲原体、微小脲原体的检测结果，以及研究对象的人口学特征与性行为相关信息。HPV检测采用罗氏线性阵列HPV基因分型检测试剂盒（Roche Linear Array HPV Genotyping Test），解脲脲原体与微小脲原体的检测则采用Allplex™ 性传播感染（sexually transmitted infection, STI）核心检测试剂盒。统计学分析采用GraphPad Prism 8.0.1.244版本完成。解脲脲原体的感染率为43.9%（94/214），且随年龄增长呈显著上升趋势（p=0.036，R²=0.8497）；而微小脲原体的感染率为68.7%（147/214），其感染率不受年龄因素影响。既往终身性伴侣数量为4~6名的研究对象，其感染解脲脲原体的风险显著升高（患病率比（prevalence ratio, PR）=1.77，95%置信区间（confidence interval, CI）：1.04~3.00，p=0.043）。共有36.3%（77/212）的研究对象存在HPV与解脲脲原体混合感染，且当研究对象既往终身性伴侣数量为3~6名（PR=1.59，95%CI：1.10~2.53，p=0.017）、近3个月内新增性伴侣数量为2~4名（PR=2.14，95%CI：1.19~2.42，p=0.021）、近1个月内阴道性交频率为2~3次（PR=1.54，95%CI：1.06~2.53，p=0.037）或4~10次（PR=1.91，95%CI：1.83~1.91，p=0.005），以及有饮酒行为时，其发生该混合感染的风险均显著升高。解脲脲原体检测阳性者，其感染希瑞适®（Cervarix®）HPV疫苗所覆盖的HPV亚型的风险显著高于阴性者（PR=2.56，95%CI：1.23~5.37，p=0.013），感染四价佳达修®（Gardasil®4）所覆盖亚型的风险同样显著升高（PR=2.16，95%CI：1.25~3.75，p=0.006），且感染九价佳达修®（Gardasil®9）所覆盖亚型的风险亦显著增加（PR=1.70，95%CI：1.25~2.32，p=0.001）。南非东开普省的青春期少女与青年女性中，解脲脲原体-HPV与微小脲原体-HPV的混合感染率均处于较高水平。解脲脲原体属的混合感染与HPV感染率及基因型分布存在相关性。解脲脲原体的感染率及其与HPV的混合感染情况均与性行为因素相关。本研究所得数据可为生殖健康与性传播感染干预方案的制定提供参考，同时可作为未来流行病学研究的基线数据——此类研究将持续开展HPV基因型感染率的监测工作，以评估HPV疫苗接种计划在该人群中的实施效果与有效性。