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April 2023, Volume 73, Issue 4

Letter to the Editor

HPV: take the test, not the risk. Be wise, immunize

Moniba Tehrim  ( Karachi Medical and Dental College, Karachi, Pakistan )
Beena Kumari  ( Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan )
Areeba Memon  ( Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan )

Madam, Human Papilloma Virus (HPV) is the most common sexually transmitted infection inflicting nearly 570,000 women and 60,000 men each year, thus accounting for a considerable healthcare burden. HPV causes several significant pathologies including genital and epidermal warts, laryngeal papillomatosis, and a long list of cancers involving the cervix, anus, oropharynx, vulva, vagina, and penis.

Among the listed pathologies, cervical cancer constitutes the most significant burden as the second most common malignancy in terms of incidence and mortality in developing countries, including Pakistan,1 where the incidence of cervical cancer is as high as 20 women falling prey to it daily.2 World Health Organization (WHO) predicts an alarming mortality rate of half a million women by 2030, with developing countries accounting for 98% of these figures.2 Despite these warning statistics, cervical cancer remains a largely ignored and understudied domain in Pakistan.

Some risk factors for acquiring an HPV infection include early age of sexual activity, having multiple sexual partners or having a high-risk sexual partner(s), weakened immune system, low socioeconomic status, and skin-to-skin contact. However, preventive steps have significantly reduced incidence in developed countries, and middle to low-income countries like Pakistan lag behind. The barriers include educational unawareness about the knowledge, screening, and preventive strategies for HPV,3 the stigma attached to sexual topics, the exorbitant price of screening tests and vaccines, unavailability of these resources, and societal and parental and misconceptions attached to such subjects.4 Ineffective healthcare facilities and unsatisfactory approach of healthcare professionals add to the list.3 Owing to these barriers, an already developing country like Pakistan is collapsing under the overall disease burden, obliging us to develop better executive plans to counter the situation.

Some of the strategies employed by developed nations that have succeeded at curbing some of the disease burdens are the utilization of regular Pap smears to screen women at an early treatable stage and exercising well-framed vaccination policies under the WHO guidelines, with available vaccines such as Gardasil, Gardasil-9 and Cervarix, at the national level. Strategies to customize the cost of these for developing nations to be able to endorse them, as well as awareness directed at both genders via social media campaigns and television to address the loopholes.4 Further, healthcare workers should be diligent in raising awareness and making appropriate patient recommendations to promote increased acceptance.5


Disclaimer: None.


Conflict of interest: None.


Funding disclosure: None.




Submission completion date: 20-08-2022


Acceptance date: 02-11-2022




1.      Portnoy A, Abbas K, Sweet S, Kim JJ, Jit M. Projections of human papillomavirus (HPV) vaccination impact in Ethiopia, India, Nigeria and Pakistan: a comparative modelling study. BMJ Glob Health 2021; 6: e006940.

2.      Batool SA, Sajjad S, Malik H. Cervical cancer in Pakistan: A review. J Pak Med Assoc 2017; 67: 1074-7.

3.      Riaz L, Manazir S, Jawed F, Arshad Ali S, Riaz R. Knowledge, Perception, and Prevention Practices Related to Human Papillomavirus-based Cervical Cancer and Its Socioeconomic Correlates Among Women in Karachi, Pakistan. Cureus 2020; 12: e7183.

4.      Shaikh MY, Hussaini MF, Narmeen M, Effendi R, Paryani NS, Ahmed A, et al. Knowledge, Attitude, and Barriers Towards Human Papillomavirus (HPV) Vaccination Among Youths of Karachi, Pakistan. Cureus 2019; 11: e6134.

5.      Ali SF, Ayub S, Manzoor NF, Azim S, Afif M, Akhtar N, et al. Knowledge and awareness about cervical cancer and its prevention amongst interns and nursing staff in Tertiary Care Hospitals in Karachi, Pakistan. PLoS One 2010; 5: e11059.

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