The Use of Native Flora/Herbal Products in Human Papilloma Virus (HPV) Infection: A Global Perspective Study

1. Introduction

In South Africa and other Sub-Sahara countries, cervical cancer (CC) is the most prevalent type of cancer disease suffered by women, with 20.2 million women at risk and 12.983 cases diagnosed annually [1]. Management of CC requires access to health care systems. Due to the stage of progression, the affected persons by this disease would require surgery, radiotherapy, and chemotherapy in order to increase their chances of survival. However, if CC is left unmanaged death may result [2].

In Low Middle-Income Countries (LMICs), the unaffordability of therapeutic resources and negligence of palliative care are among the factors hampering the fight against CC. Most women often consult health care providers at an advanced stage of cervical cancer due to financial hardship. The partial resources available for treatment are not adequate to provide effective surgical, radiotherapy, and chemotherapeutic services [2].

Studies [3, 4] have shown that among HIV positive women, there is consistent higher incidence of human papilloma virus (HPV) infection (the major cause of CC), persistent HPV infection with high-risk types, multiple types of HPV, and cervical cancer precursors (CIN or SIL). An estimate as high as 20–40% has been made for the prevalence of CIN in HIV-positive women. Many studies have shown that HIV-positive women are more likely to have persistent HPV infections than HIV-negative women [3]. South Africa is among countries in the world with a very high HIV prevalence. Zhang et al. [3] in their study recorded nearly half (41/83, 43%) of HIV-infected women co-infected with carcinogenic HPV genotypes [3]. Similarly, Temmerman et al. [4] reported a five-fold increased risk of high-grade SIL among 513 HIV-positive women in a family planning clinic in Kenya. Other reports from the region show that women with HIV develop cervical cancer at an earlier age than women who are HIV-negative [4]. Statistically, cervical cancer in South Africa is at a prevalence of 22.8 and 27 per 100,000 women when compared with the global average of 15.8. A total of 5743 new cases are encountered annually with an approximately 3000 mortalities. About 99% of these mortalities are associated with HPV, HPV strains 16 and 18 being responsible for 70% of the cases [1, 5].

Currently, in most of these sub-Sahara African countries, a vaccination program is either ongoing [1] or not yet incorporated into the eradication/screening policy [6, 7]. In South Africa, there is a vaccination of Cervarix®, which is provided for protection against HPV-16 and HPV-18 strains [1]. However, this vaccination program is either expensive, not efficient, or not within easy reach for all that need it. Furthermore, not much effort has been observed in HPV eradication and cervical cancer status in spite of the vaccination efforts in all the locations where it is operating.

Traditional medicines or herbal medicines have always been recorded as an important component of the health care system of the African people [8]. Medicinal plants/extracts involved in this practice are becoming a worldwide topic, drawing an impact on world health. They are still being administered by traditional practitioners in some parts of the health care system, especially in the rural areas of developing countries [9, 10] for the treatment of various illnesses, including viral infection, cancer, osteoarthritis, asthma, heart disease, tuberculosis, swollen ankles, bone fracture, malaria, convulsion, piles, hypertension, typhoid fever, diabetes, and anemia [8, 11, 12]. Additionally, extracted compounds of medicinal plants are being employed as inputs in toxicology, phytochemicals, pharmaceuticals, and other chemical industries [8, 13]. Furthermore, [14] has shown that medicinal plants are a source of bioactive agents employed in the preparation of synthetic medicine, therefore, function in the discovery of drugs like antiviral, antidiabetic, anticancer, antifungal, antiasthma, antibacterial, anti-HIV, and antimalarial [14]. This study evaluates how people see the use of native floral-derived products and bio-therapeutics in the management of HPV infection.

2. Materials and methods

3. Results

3.1 Demographical characteristics

Demographically, gender (Figure 1a), race (Figure 1b), age group (Figure 1c), and country of residence (Figure 1d) were the characteristics used. Under gender, 93 females and 21 males participated in the study questionnaire. 3 of the participants preferred not to say. The number of females that participated was statistically significant (P-Value = 0.001347 < 5%) compared to the number of males (Figure 1a). Data under race (Figure 1b) indicated participation of races from Black/African (96), White/Caucasian (6), Asian/Asian America (6), Hispanic/Latino (0), American India (0), Native Hawaiian, or other Pacific Islander (0). Other races not included in the list indicated a total score of 9.0. Black/African participants showed the highest score of 96, which is statistically significant compared to participants from other race groups. Figure 1c depicts the age group of participants, which ranged from 18 years to 65 and above. Participants from 18 to 24 were 3, 25–34 (6), 35–44 (18), 45–54 (72), 55–64 (15), and 65 and above were 3 participants. Age group 45–54 indicated the highest group of age that participated in the survey with 72 people that responded, followed by age group 35–44 with 18 respondents. In order to know people’s notions using location on the use of plant extracts for the treatment of HPV, participants’ countries of residence were requested in the survey. The number of participants residing in Nigeria was 51, in South Africa was 12, and those residing in other countries were 51 similar to those in Nigeria (Figure 1d).

3.2 Knowledge of HPV infection and the type of cancers it can cause

HPV infection is the most sexually transmitted infection (STI). There are over 100 types of HPV and more than 40 can infect humans [15]. HPV is known to be the cause of 70% of cervical cancer and other cancers such as vulva cancer, Papillomas/Carcinomas, vagina, penis, and oropharynx cancers. Additionally, 630,000 cases of HPV-related cancers are diagnosed each year [1, 16, 17, 18].

For the above reasons, it was necessary to ascertain the knowledge of participants about HPV infection and other cancers it can cause. Data realized from this survey question (Figure 2) indicates that 78 participants are aware of HPV infection and other types of cancers it can cause while 24 participants are ignorant of this. 9 participants are not sure (maybe) of their level of awareness to this. This shows that most people are aware of HPV infection and other types of cancer.

3.3 Knowledge of relative suffering or have suffered from any HPV-related cancers

As cervical cancer had earlier been indicated as the second most prevalent type of cancer suffered by women in developing countries [19] and with the nature of HPV infection as indicated in [15], we tried to have the knowledge of participants with relatives suffering or have suffered HPV-related cancers. On the question, do you have a family member, friend, or relative suffering or has suffered from cancer that HPV is one of its causes? Data from this survey question indicated that only 15 people have either friends, relatives, or family members suffering or have suffered HPV-related cancer while 93 (P-Value = 0.000 < 5%) people have not had such experience and 3 were not sure (Figure 3). This figure shows that although most participants are aware of HPV infection as well as other types of cancer, they do not have many relatives affected by HPV-related cancer. Financial burden of these HPV cancers sickness was also included in the survey question. Results indicated that 15 participants showed bad financial effects/burdens on them due to these HPV cancers while 39 showed neutral burden over the HPV cancer sickness. No participant indicated the financial burden to have a good effect (figure not shown).

3.4 Use of herbal products for any purpose

Question to find out if participants have in any way used herbal or plant medicinal products for any purpose showed that 63 participants know and have used herbal products for one purpose or the other. A total of 43 participants indicated that they have never employed herbal products for any purpose while 6 participants were not sure if they have (Figure 4). The majority of participants demonstrated that they have already used herbal products for their health.

3.5 Awareness of some herbal products being used effectively either singly or in combination for the treatment of different ailments

Currently, many herbal products or medicinal plant extracts have been showcased for the treatments of different sicknesses [8, 10]. This study also evaluated the level of awareness of participants regarding the single-use or a combination of herbal products for the treatment of different diseases effectively. Data from participants’ responses showed that 96 participants were aware of the effective use of herbal products for the treatment/management of different ailments. This value was highly significant (P-Value = 0.000 < 5%) compared to the number of participants (3) that declared ignorant of the use of herbal products. 12 participants responded maybe to this effect (Figure 5).

3.6 Future use of herbal products for HPV management/treatment

Readiness of the participants to patronize/support the use of any native flora/herbal discovered for the management/treatment of HPV infection was evaluated. Data from this showed that 93 participants indicated their interest in the future use of herbal products. 3 participants did not approve the future use of herbal products while 18 participants’ opinions were uncertain (Figure 6). Most participants were willing to use any future herbal products that may be produced to manage HPV. This is in agreement with previous observation where most participants indicated that they have previously used herbal products to improve their health.

4. Discussion

The higher incidence of HPV infection, especially in HIV-positive women, and the higher prevalence of cervical cancer in LMICs call for urgent attention. Despite all the efforts of the government to ameliorate HPV infection through immunization and cervical cancer screening measures, yet not much has been achieved in HPV infection level and reduction in CC prevalence, especially in sub-Sahara Africa [1, 3, 6].

HPV is known to be the most sexually transmitted infection and 40 types of HPV can infect humans. HPV is also implicated in the proliferation of not only CC but other types of cancers [1, 16]. Therefore, eradication or ameliorating of HPV infection becomes imperative and necessary.

Currently, the importance of medicinal plant extracts has been showcased severally in the literature due to their involvement in the production of different drugs, herbal products, and bio-therapeutics for the treatment/management of different diseases.

This study evaluated people’s notions of future use of herbal products for the treatment/management of HPV infection. Table 1 exhibits some of the medicinal plants/active compounds evaluated for antiviral/inhibition of HPV by previous studies with Figure 7 depicting photographs of some of the plants listed in Table 1.

In this study, demographically, the number of females (93) that participated was highly statistically significant (Figure 1a) compared to the number of males (21). The reason may be perhaps due to CC cancer being discussed here is one of the women gynecological cancers or questionnaire was more distributed among women online groups. However, HPV infection affects both females and males and can cause other cancers rather than CC. Similar incidence also occurred in the age group (Figure 1c) where ages from 35 to 44, 45–54, and 55–64 were the age group that participated. The score value from the age group 45–54 was very high and statically significant compared to other age groups. This is perhaps due to the screening stage of cervical cancer falling in these age groups. Again, the survey questionnaire was mostly distributed among women groups than men groups. For the race, Africans was the most participated (Figure 1b). This could be a result of influence due to location and execution of study questionnaire. However, studies have observed that traditional medicine/herbal products are being practiced and used mostly by poor African black communities for their wellbeing [11, 23].

It is quite interesting that a high number of participants (78) already have the knowledge of HPV infection and its impact on the associating types of cancer (Figure 2). Only few participants (15) revealed that their relatives had experienced a type of cancer disease due to HPV infection. Consequently, the number of participants recorded with financial burdens was small/few (Figure 3).

Additionally, many participants (63) indicated that they have used herbal products for different purposes. However, 43 participants showed that they have never used herbal products for any purpose. This study impressively indicated that almost all the participants (96) know that herbal products can be effectively used singly or in combination for the treatment of diseases (Figure 5). This number is highly statistically significant (P-Value = 0.000 < 5%) compared to those without awareness. Furthermore, Figure 6 of this study indicated the willingness of the participants to support or patronize the use of any native flora/herbal product discovered for the management/treatment of HPV infection.

5. Conclusion

Knowing people’s reaction over the therapeutic capacity of these herbal products will not only help in the production of herbal products for HPV infection and reduce the prevalence of cervical cancer/other HPV implicated cancers but it will be of economic importance to agriculture and health sector. It will also address the gap of unemployment and good propagation of medicinal plants species that are on the verge of being wiped off. The knowledge will also attract more research in the field of agriculture, biomedical sciences, pharmaceuticals, chemistry, biotechnology, etc. This study could perhaps serve as a common interaction between people’s notions and the use of medicinal plant extracts and herbal products for the treatment of HPV infection and other related diseases.

For future work, we intend to work on already identified medicinal plants found to have antiviral effects with HPV up to the prototype stage and further.

Challenges encountered: Study should have the survey for a longer period of time so as to get more people involved and a more generalizable result. Our current study is for a short period of time and with a small population. Our survey was not widely distributed and the links sometimes were not easily accessed. Some of the survey questions were not completely answered so many questionnaires were eliminated.

Acknowledgments

The authors like to thank the Foundation for women’s health promotion and welfare initiatives (FWHPWI) members for assisting in the filling and dissemination of the online survey questionnaire links to the public, and Prof David Katerere and group, Department of Pharmaceutical Sciences, Faculty of Science, Tshwane University of Technology for their encouragement.

Conflict of interest

No conflict of interest.