Human papillomavirus cervical infection in Guarani Indians from the rainforest of Misiones, Argentina

Summary Objective: To evaluate the prevalence of human papillomavirus (HPV) cervical infection in women from the South American Guarani Indian tribe located in the rain forest of Misiones, north-eastern Argentina; a region with a high incidence of cervical carcinoma. Methods: A cross-sectional cytological and HPV screening of sexually active Guarani women from nine Indian settlements was conducted. Demographic data, information about sexual behavior, and gynaecological history were recorded. Fresh cervical specimens from 239 patients were collected, of which 207 were included in this study. Cytology and microbiological detection were carried out by the Papanicolaou and Gram stain methods, respectively. HPV detection and typing were analyzed by PCR and RFLP. Results: Pap smears in 96% of all patients showed an inflammatory pattern. A possible etiologic agent was found in 58% of cases: 52% Trichomonas vaginalis, 35% Gardnerella vaginalis and 13% Candida sp. Seven cases had cytological changes compatible with Low Grade Intraepithelial Lesion (LGSIL), one with High Grade Intraepithelial Lesion (HGSIL) and one in situ cervical cancer. The prevalence for generic HPV infection was 64% (133/207). Genotyping gave a 26% prevalence for HPV types 16/18, 13% for types 6/11 and 30% for other types, with nine mixed infections. Conclusion: This work reports for the first time the prevalence of cervical HPV infection in Guarani women. Nearly all Guarani women had some grade of cervical disease. Generic HPV infection prevalence was elevated (64%), with predominanc