A pilot study for high-risk HPV genotypes in Liberia: A post conflict country endemic for urogenital schistosomiasis

Background Cervical cancer remains a leading cause of female cancer mortality in Liberia and sub-Saharan Africa, with high-risk human papillomavirus (hr-HPV) infection as the primary driver. The continent has the highest incidence and mortality rate globally with Liberia ranking amongst the top 20 countries with the highest burden of cervical cancer. Urogenital schistosomiasis (UGS), including female genital schistosomiasis (FGS), is highly prevalent in many HPV-endemic settings and has been hypothesized to increase susceptibility to HPV infection through genital mucosal damage and immune modulation, however co-infection data are limited especially in west Africa. This study assessed HPV prevalence and its association with UGS/FGS in schistosomiasis endemic populations in Liberia. As most cases of cervical cancer and precancerous cervical lesions are attributable to hr-HPV (High Risk-HPV) types 16 and 18 globally, these high-risk HPV genotypes were the primary targets of the study. Methods A cross-sectional pilot study was conducted in four rural counties (Nimba, Maryland, Bong, and Lofa) in Liberia. Women aged 18–45 were recruited via community health centres, excluding pregnant or menstruating participants. Sociodemographic and clinical data were collected using a structured questionnaire. Urine samples were tested for S. haematobium via microscopy and qPCR. Cervical and vaginal swabs were collected to detect hr-HPV 16/18 DNA and participants were examined for FGS lesions. Laboratory analyses were performed at the Liverpool School of Tropical Medicine. Results Among 298 women, 22 tested positive for hr-HPV (7.38%; 95% CI: 4.93–10.92), including two cases of hr-HPV–UGS co-infection (0.67%; 95% CI: 0.18–2.41) detected in Nimba and Bong County. hr-HPV prevalence was highest in Nimba (13/79) (16.46%;95% CI: 9.88–26.15) and Bong (6/75) (8.00%;95% CI: 3.72–16.37),UGS prevalence was identical to hr-HPV prevalence amongst participants 22/298 7.4% (95% CI: 4.9–10.9) HPV18 infections outnumbered HPV16, largely driven by cases in Nimba (15/22) 65.2% (95% CI 44.9–81.2) . Conclusion High-risk HPV is present across all counties endemic for urogenital schistosomiasis in Liberia. The distribution of hr-HPV prevalence closely reflects the pattern of UGS prevalence across counties, with concentration in Nimba and Bong, while hr-HPV–UGS co-infection is rare. These findings highlight the need for targeted screening, public awareness campaigns, and expanded HPV vaccination to reduce cervical cancer burden in Liberia. Integration of cervical cancer, sexually transmitted infection, and schistosomiasis programs may improve early detection and prevention.