The high prevalence of genital warts among participants in this study, especially among women aged 26 to 30, underscores the urgency for targeted prevention and screening efforts in this age group. This prevalence aligns with findings from similar studies in developing countries(Chikandiwa et al., 2018; Simo et al., 2021), emphasizing the need for tailored interventions. Indeed, this could be due to sexual activity being more frequent among women in this age group, leading to a higher risk of exposure to HPV(Simo et al., 2021). The higher prevalence among educated women may reflect increased health-seeking behaviour and awareness of preventive measures like HPV vaccination and cervical cancer screening (Chikandiwa et al., 2018; Simo et al., 2021; Wabo et al., 2019). The association between higher parity and increased risk of HPV infection corroborates previous research (Tekalegn et al., 2022). Factors such as changes in the cervix during pregnancy and childbirth may contribute to this association. Additionally, being single may indicate a higher likelihood of engaging in unprotected sexual activity, highlighting broader social and economic factors at play, such as barriers to healthcare access and socioeconomic status. Targeted prevention and screening efforts are crucial to address the high prevalence of genital warts among Cameroonian women. Moreover, addressing broader social and economic factors is essential to ensure equitable access to healthcare and mitigate the burden of HPV-related conditions.
4.1. The Genital wart among women HIV positive and HIV negative
This study demonstrates a significant association between HIV serology and genital warts among women in Cameroon, indicating that HIV-positive individuals are at greater risk of developing genital warts. HIV-induced immune regression is a major risk factor for HPV infection, exacerbating HPV-related symptoms (Sosso et al., 2020; Zayats et al., 2022). The heightened prevalence of genital warts among HIV-positive women underscores the elevated cervical cancer rates observed in Africa (Ba et al., 2021). Notably, HIV-positive individuals exhibit a higher prevalence of high-risk HPV, highlighting HIV as a potential risk factor for genital cancer (Dreyer et al., 2022; Hlahla, 2023; Riddell IV et al., 2022; Sosso et al., 2020). The weakened immune system in HIV facilitates HPV replication and progression, leading to cervical intraepithelial lesions and genital warts (Taku et al., 2020). Study indicated HIV target cells are found to be highly concentrated in the outermost skin layer of anogenital warts, providing a possible explanation for the observed association between HIV and genital warts (S. B. Dhumale et al., 2017). Additionally, a recent study demonstrated that although low-risk HPV co-expression is not directly associated with genital cancer, it can increase DNA damage due to the accumulation of somatic mutations(Pudney et al., 2019; Uehara et al., 2021). The observed association between HPV and HIV infections necessitates comprehensive prevention and management strategies for both conditions, particularly among vulnerable populations in developing countries.
4.2. Characteristic of genital warts among women with negative HIV and positive.
This study reveals distinct characteristics of genital warts among women with positive and negative HIV status. Vaginal localization of genital warts is more prevalent among HIV-positive women, whereas vulvar localization is more common among HIV-negative women. This disparity may be attributed to differences in sexual behavior following counseling and screening, with HIV-positive individuals adopting safer sexual practices. This finding is consistent with a previous study that also reported higher rates of genital warts in the vaginal area among HIV-positive women (S. B. Dhumale et al., 2017). Interestingly, a link was observed between positive HIV serology and vaginal condyloma, while negative HIV serology was associated with vulvar localization (p = 0.037). This disparity may be attributed to differences in sexual behaviour following counselling and screening, with HIV-positive individuals adopting safer sexual practices. In this study, acuminate genital warts were more frequently found in HIV-negative women and may regress with a normal immune response, whereas papule genital warts, which were frequent among HIV-infected women could be less likely to regress (Pudney et al., 2019). Although there are limited studies comparing the types of genital warts in both groups, the results suggest that papule genital warts affect the mucosa more, which is in close proximity to low-grade cervical intraepithelial neoplasia (Shashikant Balakrishana Dhumale et al., 2017; Kosz et al., 2020).
4.2. The risk associated with HPV infection.
Social determinants of health significantly shape the risk associated with HPV and HIV infections in developing countries. This study identifies distinct risk factors among HIV-positive and HIV-negative women, with sexual behaviour emerging as a primary risk factor. Among HIV-positive women, early oral contraceptive use emerged as a prominent risk factor, possibly due to its impact on hormonal concentrations, leading to an increased risk of genital warts (Kosz et al., 2020). Early oral contraceptive use is prominent among HIV-positive women, while smoking and multiple sexual partners are significant risk factors among HIV-negative women (Sarma et al., 2023). The observed association in this study between smoking, multiple sexual partners, and genital warts among HIV-positive women underscores the complex interplay between HPV and HIV infections [21]. The high prevalence of genital warts and HIV among these women underscores the urgency of understanding and addressing these issues within the context of socio-cultural factors. Firstly, the majority of women noticed their genital warts themselves (60%), indicating a proactive approach to their health. However, this also suggests a potential lack of awareness about preventive measures or the importance of regular gynecologist consultations. Moreover, most women sought gynaecologist consultation only after noticing warts (67.14%), indicating a reactive rather than proactive approach to healthcare. This delay in seeking medical attention could be attributed to various factors, including cultural taboos, fear of stigma, or limited access to healthcare facilities. Additionally, a significant proportion of women had not visited a gynaecologist in over 3 months (80%). This highlights a lack of consistent gynaecological care, which may be influenced by socio-economic factors such as financial constraints, transportation issues, or cultural beliefs regarding healthcare utilization. The reliance on traditional medicine or homemade remedies by a considerable number of women (85%) further emphasizes the influence of socio-cultural beliefs on healthcare-seeking behaviour. Traditional medicine may be perceived as more accessible, affordable, or culturally acceptable, leading to its widespread use despite potential risks (Organization, 2015). Moreover, the high prevalence of self-medication (75%) among women reflects the limited access to healthcare services or the lack of trust in the healthcare system. Self-medication can lead to improper treatment, delayed diagnosis, or adverse health outcomes, highlighting the need for improved access to quality healthcare services and public health education initiatives.
Addressing socio-cultural barriers is crucial in improving healthcare-seeking behavior, promoting early detection and treatment, and reducing the burden of genital warts and HIV. Efforts should focus on raising awareness, improving access to healthcare services, and integrating traditional medicine practices into comprehensive healthcare systems. Addressing social determinants of health in prevention strategies can effectively lower HPV and HIV incidence in developing countries, ultimately improving the health outcomes of vulnerable populations (Osazuwa-Peters et al., 2019).
Limitations and recommendation
This study was conducted in a single region of Cameroon and may not be generalizable to other regions or countries. Future studies could assess the psychological and social impact of genital warts on women in Cameroon and explore ways to improve.