Prevalence and Correlation between High-Risk HPV Genotypes and Pap Smear Findings in Bahrain: A Retrospective Approach

A. M. Alnoaimi, T. H. Feda, Mariam Azam, Saba Syed, Khadija Hafiz, H. M. Saad, Mahera Roohi, M. Y. Mohammed

For citation: Alnoaimi AM, Feda TH, Azam M, Syed S, Hafiz K, Saad HM, Roohi M, Mohammed MY. Prevalence and Correlation between High-Risk HPV Genotypes and Pap Smear Findings in Bahrain: A Retrospective Approach. International Journal of Biomedicine. 2024;14(1):52-58. doi:10.21103/Article14(1)_OA7
Originally published March 1, 2024


Background: Human papillomavirus (HPV) is currently the most common pathogen responsible for cervical cancer (CC), a major cause of cancer-related deaths in women. This study aimed to estimate the current HPV prevalence in Bahrain and to determine the association of high-risk HPV (HR-HPV) genotypes with cytological findings, age, and clinical history of the patients.
Methods and Results: Our study used a retrospective approach. Convenience sampling was used to gather 100 cases of HPV-positive women with abnormal and normal Pap smear findings from January 2017 to April 2023 in the Cytology Department at King Hamad University Hospital. Out of 100 HR-HPV positive cases, non-16/18/45 HR-HPV was found in 62%, and 73% had abnormal Pap smear findings. Among Pap smear findings, ASC-US/ASC-H (P=0.038) and LSIL/HSIL(P=0.017) were significantly associated with HR-HPV genotypes.
ASC-US was found to be more frequently associated with HPV16+non-16/18/45 HR-HRV and LSIL with HPV18/45+non-16/18/45 HR-HRV. Most HR-HPV cases (59%) were aged ≤40 years, 25% - from 41 to 50 years old, while only 16% were >50. The age group ≤40 had the highest peak with non-16/18/45 HR-HPV genotype (35%) and HPV16 (19%). The predominant genotypes for age groups 41-50 and >50 were non-16/18/45 HR-HPV types (19% and 8%, respectively).
Conclusion: In Bahrain, non-16/18/45 HR-HPV infection is becoming more prevalent, with ASC-US being the most common abnormal Pap finding and the highest HPV infection in women aged 40 years or younger.  Based on our findings, we recommend effective screening and vaccine programs for women aged 40 years and younger, as early detection can lower infection rates and improve recovery.

HR-HPV • cervical cancer • Pap smear • ASC-US
  1. World Health Organization: Cervical cancer. 17 November 2023. Available from:
  2. Zhang S, Xu H, Zhang L, Qiao Y. Cervical cancer: Epidemiology, risk factors and screening. Chin J Cancer Res. 2020 Dec 31;32(6):720-728. doi: 10.21147/j.issn.1000-9604.2020.06.05. PMID: 33446995; PMCID: PMC7797226.
  3. Jassim G, Obeid A, Al Nasheet HA. Knowledge, attitudes, and practices regarding cervical cancer and screening among women visiting primary health care Centres in Bahrain. BMC Public Health. 2018 Jan 11;18(1):128. doi: 10.1186/s12889-018-5023-7. PMID: 29325528; PMCID: PMC5765703.
  4. National Cancer Institute. Cervical Cancer Symptoms. 13 October 2022. Available from:
  5. Cibas ES, Ducatman BS. Cytology E-Book: Diagnostic Principles and Clinical Correlates. Elsevier Health Sciences; 2019.
  6. Shambayati B. Cytopathology. Oxford University Press; 2018.
  7. Kombe Kombe AJ, Li B, Zahid A, Mengist HM, Bounda GA, Zhou Y, Jin T. Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation. Front Public Health. 2021 Jan 20;8:552028. doi: 10.3389/fpubh.2020.552028. PMID: 33553082; PMCID: PMC7855977.
  8. Kussaibi H, Al Dossary R, Ahmed A, Muammar A, Aljohani R. Correlation of High-Risk HPV Genotypes with Pap Test Findings: A Retrospective Study in Eastern Province, Saudi Arabia. Acta Cytol. 2021;65(1):48-55. doi: 10.1159/000509669. Epub 2020 Aug 12. PMID: 32784299.
  9. Elmi AA, Bansal D, Acharya A, Skariah S, Dargham SR, Abu-Raddad LJ, Mohamed-Nady N, Amuna P, Al-Thani AA, Sultan AA. Human Papillomavirus (HPV) Infection: Molecular Epidemiology, Genotyping, Seroprevalence and Associated Risk Factors among Arab Women in Qatar. PLoS One. 2017 Jan 3;12(1):e0169197. doi: 10.1371/journal.pone.0169197. PMID: 28046025; PMCID: PMC5207789.
  10. Mallik MK, Alramadhan B, Dashti H, Al-Shaheen A, Al Juwaiser A, Das DK, George SS, Kapila K. Human papillomaviruses other than 16, 18 and 45 are the major high risk HPV genotypes amongst women with abnormal cervical smear cytology residing in Kuwait: Implications for future vaccination strategies. Diagn Cytopathol. 2018 Dec;46(12):1036-1039. doi: 10.1002/dc.24035. Epub 2018 Oct 24. PMID: 30353685.
  11. Moosa K, Alsayyad AS, Quint W, Gopala K, DeAntonio R. An epidemiological study assessing the prevalence of human papillomavirus types in women in the Kingdom of Bahrain. BMC Cancer. 2014 Dec 3;14:905. doi: 10.1186/1471-2407-14-905. PMID: 25466757; PMCID: PMC4265506.
  12. Ali MAM, Bedair RN, Abd El Atti RM. Cervical high-risk human papillomavirus infection among women residing in the Gulf Cooperation Council countries: Prevalence, type-specific distribution, and correlation with cervical cytology. Cancer Cytopathol. 2019 Sep;127(9):567-577. doi: 10.1002/cncy.22165. Epub 2019 Aug 7. PMID: 31390155.
  13. Correa RM, Baena A, Valls J, Colucci MC, Mendoza L, Rol M, Wiesner C, Ferrera A, Fellner MD, González JV, Basiletti JA, Mongelos P, Rodriguez de la Peña M, Saino A, Kasamatsu E, Velarde C, Macavilca N, Martinez S, Venegas G, Calderón A, Rodriguez G, Barrios H, Herrero R, Almonte M, Picconi MA; ESTAMPA Study Group. Distribution of human papillomavirus genotypes by severity of cervical lesions in HPV screened positive women from the ESTAMPA study in Latin America. PLoS One. 2022 Jul 29;17(7):e0272205. doi: 10.1371/journal.pone.0272205. PMID: 35905130; PMCID: PMC9337688.
  14. Seyoum A, Assefa N, Gure T, Seyoum B, Mulu A, Mihret A. Prevalence and Genotype Distribution of High-Risk Human Papillomavirus Infection Among Sub-Saharan African Women: A Systematic Review and Meta-Analysis. Front Public Health. 2022 Jul 8;10:890880. doi: 10.3389/fpubh.2022.890880. PMID: 35875040; PMCID: PMC9304908.
  15. Yu YQ, Hao JQ, Mendez MJG, Mohamed SB, Fu SL, Zhao FH, Qiao YL. The Prevalence of Cervical HPV Infection and Genotype Distribution in 856,535 Chinese Women with Normal and Abnormal Cervical Lesions: A Systemic Review. J Cytol. 2022 Oct-Dec;39(4):137-147. doi: 10.4103/joc.joc_42_22. Epub 2022 Nov 11. PMID: 36605868; PMCID: PMC9809425.
  16. Liao G, Jiang X, She B, Tang H, Wang Z, Zhou H, Ma Y, Xu W, Xu H, Chen W, Ji J, Xi M, Chen T. Multi-Infection Patterns and Co-infection Preference of 27 Human Papillomavirus Types Among 137,943 Gynecological Outpatients Across China. Front Oncol. 2020 Apr 7;10:449. doi: 10.3389/fonc.2020.00449. PMID: 32318343; PMCID: PMC7154087.
  17. Gallegos-Bolaños J, Rivera-Domínguez JA, Presno-Bernal JM, Cervantes-Villagrana RD. High prevalence of co-infection between human papillomavirus (HPV) 51 and 52 in Mexican population. BMC Cancer. 2017 Aug 8;17(1):531. doi: 10.1186/s12885-017-3519-7. PMID: 28789619; PMCID: PMC5549346.
  18. Beyazit F, Sılan F, Gencer M, Aydin B, Paksoy B, Unsal MA, Ozdemir O. The prevelance of human papillomavirus (HPV) genotypes detected by PCR in women with normal and abnormal cervico-vaginal cytology. Ginekol Pol. 2018;89(2):62-67. doi: 10.5603/GP.a2018.0011. PMID: 29512809.
  19. Maraqa B, Lataifeh I, Otay L, Badran O, Qutaiba Nouri Y, Issam I, Al Hussaini M. Prevalence of Abnormal Pap Smears: A Descriptive Study from a Cancer Center in a Low-Prevalence Community. Asian Pac J Cancer Prev. 2017 Nov 26;18(11):3117-3121. doi: 10.22034/APJCP.2017.18.11.3117. PMID: 29172288; PMCID: PMC5773800.
  20. Umakanthan S, Bukelo MM, Ghany S, Gay D, Gilkes T, Freeman J, Francis A, Francis K, Gajadhar G, Fraser J. The Correlation of Papanicolaou Smears and Clinical Features to Identify the Common Risk Factors for Cervical Cancer: A Retrospective and Descriptive Study from a Tertiary Care Hospital in Trinidad. Vaccines (Basel). 2023 Mar 18;11(3):697. doi: 10.3390/vaccines11030697. PMID: 36992281; PMCID: PMC10052654.
  21. Al-Lawati Z, Khamis FA, Al-Hamdani A, Al-Kalbani M, Ramadhan FA, Al-Rawahi TR, Al-Kobaisi MF. Prevalence of human papilloma virus in Oman: Genotypes 82 and 68 are dominating. Int J Infect Dis. 2020 Apr;93:22-27. doi: 10.1016/j.ijid.2019.12.038. Epub 2020 Jan 11. PMID: 31935539.
  22. Zang L, Hu Y. Risk factors associated with HPV persistence after conization in high-grade squamous intraepithelial lesion. Arch Gynecol Obstet. 2021 Dec;304(6):1409-1416. doi: 10.1007/s00404-021-06217-1. Epub 2021 Sep 5. PMID: 34482445.
  23. Akarolo-Anthony SN, Famooto AO, Dareng EO, Olaniyan OB, Offiong R, Wheeler CM, Adebamowo CA. Age-specific prevalence of human papilloma virus infection among Nigerian women. BMC Public Health. 2014 Jun 27;14:656. doi: 10.1186/1471-2458-14-656. PMID: 24972674; PMCID: PMC4094683.
  24. Kang LN, Castle PE, Zhao FH, Jeronimo J, Chen F, Bansil P, Li J, Chen W, Zhang X, Qiao YL. A prospective study of age trends of high-risk human papillomavirus infection in rural China. BMC Infect Dis. 2014 Feb 21;14:96. doi: 10.1186/1471-2334-14-96. PMID: 24559293; PMCID: PMC3936871.
  25. Mayer C, Mahdy H. Abnormal Papanicolaou Smear. 2023 Jan 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32809685.
  26. Clarke MA, Risley C, Stewart MW, Geisinger KR, Hiser LM, Morgan JC, Owens KJ, Ayyalasomayajula K, Rives RM, Jannela A, Grunes DE, Zhang L, Schiffman M, Wagner S, Boland J, Bass S, Wentzensen N. Age-specific prevalence of human papillomavirus and abnormal cytology at baseline in a diverse statewide prospective cohort of individuals undergoing cervical cancer screening in Mississippi. Cancer Med. 2021 Dec;10(23):8641-8650. doi: 10.1002/cam4.4340. Epub 2021 Nov 3. PMID: 34734483; PMCID: PMC8633239.
  27. Yan X, Shen L, Xiao Y, Wang Q, Li F, Qian Y. Prevalence, characteristics, and distribution of HPV genotypes in women from Zhejiang Province, 2016-2020. Virol J. 2021 Oct 20;18(1):208. doi: 10.1186/s12985-021-01676-z. PMID: 34670576; PMCID: PMC8527678.
  28. Findik S, Findik S, Abuoğlu S, Cihan FG, Ilter H, Iyisoy MS. Human papillomavirus (HPV) subtypes and their relationships with cervical smear results in cervical cancer screening: a community-based study from the central Anatolia region of Turkey. Int J Clin Exp Pathol. 2019 Apr 1;12(4):1391-1398. PMID: 31933954; PMCID: PMC6947064.
  29. Ozaydin-Yavuz G, Bilgili SG, Guducuoglu H, Yavuz IH, Elibuyuk-Aksac S, Karadag AS. Determinants of high-risk human papillomavirus infection in anogenital warts. Postepy Dermatol Alergol. 2019 Feb;36(1):76-81. doi: 10.5114/ada.2019.82915. Epub 2019 Feb 22. PMID: 30858783; PMCID: PMC6409869.

Download Article
Received December 12, 2023.
Accepted February 2, 2024.
©2024 International Medical Research and Development Corporation.