Prevalence Of Human Papillomavirus And Co-existent Sexually Transmitted Infections Among Female

Background: human papillomavirus is one of the most common sexually transmitted infections in the world, with a higher prevalence among young adults at the onset of sexual activity, Methods: prospective cross-sectional study were performed among 162 women aged between 18 and 73 years. For the DNA/HPV isolation, samples were collected and placed in the HC2 DNA Collection buffer (QIAGEN, CA, USA), and frozen at -20°C until processed. DNA/HPV extraction were performed by using QIAamp DNA Mini and Blood kit (QIAGEN, CA, USA) according to manufacturer instructions. Total DNA was isolated, eluted in 100 mL AE buffer and stored at 80˚C. Extracted DNA was quantified using a NanoVue unit (GE Healthcare Life Sciences, Little Chalfont, UK). Statistical analysis was performed using IBM SPSS® software version 23. Data were initially subjected to descriptive analysis, plus mean and standard deviation. Results: among the participants, 61.7% had DNA / HPV and 66.7% were users of illicit drugs and 59.3% were non-users, making them statistically significant. Among DNA/HPV positive users there was a higher proportion of sexually transmitted infections (STIs) (27.9%) compared to non-users (9.27%) (p> 0.05). Conclusion: the vulnerability of women to STIs and the high influence caused by the socioeconomic context in the course of these infections, the importance of public policies that establish appropriate strategies for their prevention, early diagnosis and treatment is emphasized, so that there is. The Research Ethics Committee of the University Hospital of the Federal approved the project under the number CAAE and informed consent was obtained from all subjects.

Illicit drug users are exposed to additive and intoxicating effects of drugs, which alter judgment and inhibition, often causing impulsive and unsafe sexual behaviors such as Before the questionnaire administration, willing participants were given all the necessary information about the study, before they signed the informed consent form. A structured standardized questionnaire was administered to obtain detailed data on sociodemographic characteristics, and sexual, reproductive and gynecologic history. These data included age, literacy, marital status, ethnicity, age at first intercourse, parity, lifetime number of sexual partners, methods of contraception and history of IST infections.
We define drug users in this chapter as those who are addicted to the use of opiates (e.g., heroin), cocaine (e.g., freebase and crack), and methamphetamine (meth), and marijuana.

Detection of HPV
Presence from DNA/HPV was detected using nested polymerase chain reaction (PCR) with the primer sets PGMY09/11 (first round PCR) and GP+5/GP+6 (second round PCR); these primers amplify a segment of the L1 gene and evaluated by amplification of the human βglobin gene.
The first round of amplification was carried out in a 25 µL reaction volume by using 5µL DNA, 8.7 µL water, 2.5 µL 10X PCR buffer (10 mM Tris-HCl, pH 8.5, 50 mM KCl), 1.5 mM MgCl2, 10 mM each dNTP, 30 µM each primer (MY09 and MY11), and 0.5 µL Platinum Taq DNA polymerase (Invitrogen). Amplification was performed according to the following protocol: 35 cycles at 94°C for 30 seconds, 51.5°C for 30 seconds, 72°C for 30 seconds, followed by a final step at 72°C for 7 minutes. The second amplification was also carried out in a 25 µL reaction volume by using 5 µL amplified DNA, 9.7 µL water, 2.5 µL 10X PCR buffer, 1.5 mM MgCl2, 10 mM of each dNTP, 30µM of each primer (GP5+ and GP6+), and 0.5 µL Platinum Taq DNA polymerase. Amplification was performed as follows: 94°C for 5 minutes, followed by 45 cycles at 94°C for 45 seconds, 40°C for 60 seconds, and 72°C for 60 seconds, and a final step at 72°C for 10 minutes.
Amplification products were evaluated by electrophoresis on a 1.5% agarose gel in 1X TBE buffer for 30 minutes at 5 V/cm in a horizontal unit (Life Technologies, Carlsbad, CA, USA).

Data Analysis
Statistical analysis was performed using IBM SPSS® software version 23. Data were initially subjected to descriptive analysis, plus mean and standard deviation. The Kolmogorov-Smirnov test was used to verify the normality of data. The Student t-test was used to evaluate associations between groups of the independent variables with normal distribution. The results were considered statistically significant when p<0.05.

Results
The study group consisted of 162 women, divided into two groups: users of illicit drugs and non-users of illicit drugs, with a mean age of 34.3 years, with illicit drug users in age group from 18 to 30 years (45%).
With regard to sociodemographic data, it was verified that among the drug users 64.81% completed the average level; 61.10% were self-described with brown skin color and 57.40% were single. As far as sexual behavior is concerned, 70.37% of drug users are: first coitus between 15 and 19 years; 53.7% had more than 7 sexual partners so far; 74.07% and 83.33% practice oral and anal sex, respectively. The study participants are predominantly non-smokers (68.51% among users and 90% among non-users) and make steady use of alcoholic beverages, which exceeds the World Health Organization's recommendations (proportionally 2 doses per day or drink for 2 days). Regarding condom use, 75.92% of drug users say they do not use it while 62.03% of non-users use this barrier method in (Table 1). The results of the preventive tests (   Table 4 shows the co-infections in women with DNA / HPV positive, where HPV is frequently associated with another infectious agent in both groups. In both users and nonusers, the percentage of co-infections is similar (61.1% and 58.33%, respectively -p <0.05). This data configures that both groups are exposed to more than one type of IST in their relationship environments.

Discussion
As predicted by Goodman (2015) and Wolday (2018), the high prevalence of HPV is related to socioeconomic, demographic, and sexual behavior. According to Dev et al., (2006) and As a significant difference among users of illicit drugs, it was found that 70.37% had the first coitus between 15 and 19 years; 53.7% had more than 7 sexual partners so far; 74.07% practice oral sex and 83.33% anal sex.
Regarding age, Queiroz, Cano and Zaia (2007) report that HPV infection has a higher incidence among women in the age group between 20 and 40 years, since in this age group, sexual practice is more frequent. They also emphasize that it is in this age group that the disease presents its most latent form, and that because of this, its identification becomes more difficult, a fact that facilitates the transmission. According to the National Cancer Institute (INCA), it is proven that 50% to 80% of women with active sex life will have some type of infection caused by one or more types of HPV at some point. It reports that most of these infections will be transient, due to the immune system fighting them, especially among younger ones. However, it emphasizes that although the immune system develops antibodies, they will not always be sufficient to fight and eliminate viruses (INCA, 2019).
In the words of Simões and Zanusso Júnior (2019, 104) it is had that: […] Human Papilloma Virus (HPV) infection is the main risk factor for cervical cancer.
Other factors have been identified as at risk, such as socioeconomic and environmental and lifestyle, which include early onset of sexual activity, plurality of sexual partners, smoking, inadequate hygiene habits and prolonged use of oral contraceptives. In the early stages cervical cancer is asymptomatic, and the discovery of the disease is done through the result of cytopathological examination (Papanicolaou) that should be done regularly. According to Caiaffa et al. (2006), in the late 1980s and mid-1990s injecting drug users (IDUs) were most responsible for the country's HIV epidemic.
In this way, it is perceived that drug users constitute a population that must be constantly vigilant, since the contagion of the various STIs occurs, in the great majority, among those who live a disorderly life and without great concern for hygiene and health. In addition, the transmission of HPV occurs in various ways, either by contact between the sex organs, in anal intercourse that can lead to viral infections and neoplasias, and even through oral

Conclusion
In this study, we identified a higher probability of positive HPV associated with other STIs for the following women: single, brown, middle school, alcohol-consuming, and multiple partners.
In this context and in view of the vulnerability of women to STIs and the high influence  Group and the participating Health Units.