Knowledge, attitudes and practices regarding Human Papillomavirus in women from the distance Law program
DOI:
https://doi.org/10.54753/rsh.v2i1.2459Keywords:
Human papillomavirus, cervical cancer, university students, screening, preventionAbstract
Human papillomavirus (HPV) is the most common sexually transmitted infection, and its persistence is associated with precancerous lesions and cervical cancer. The objective was to analyze knowledge, attitudes, and practices (KAP) regarding HPV among women in the distance-learning Law program at the National University of Loja. We conducted an observational, quantitative, descriptive, cross-sectional study in a random sample of 225 women (population: 625). Information was collected using a KAP questionnaire validated by expert judgment (Cronbach’s alpha = 0.82) and administered online. Data were processed in IBM SPSS v25 and presented as frequencies and percentages. The protocol was approved by the CEISH-UNL ethics committee. Overall, 79.1% showed high knowledge; however, the diagnosis and treatment dimension was at a medium level in 97.3%. Regarding attitudes and practices, 100% were classified as positive: 94.7% would accept a Pap smear or HPV test, and 89.3% expressed willingness to be vaccinated. Specific barriers persist, including misconceptions about prevention and inconsistent condom use. We conclude that general knowledge is adequate, but there are applied gaps in diagnosis and treatment that justify targeted educational interventions (triage algorithms, screening indications, and management of abnormal results) and organizational actions to facilitate access to vaccination and screening (reminders, self-sampling, and “see-and-treat” pathways). These findings provide evidence to strengthen HPV prevention in the university setting.References
[1] Administración de Alimentos y Medicamentos. (2024). Prueba de VPH cobas para el sistema 4800 – P100020/S055. https://www.fda.gov/medical-devices/recently-approved-devices/cobas-hpv-test-4800-system-p100020s055
[2] Al Raisi, M., Al Yahyai, T., & Al Kindi, R. (2022). Knowledge and attitude regarding cervical cancer and human papillomavirus in Oman. Sultan Qaboos University Medical Journal, 22(4), 493–500. https://doi.org/10.18295/squmj.9.2021.140
[3] Albayat, S. S., Mundodan, J. M., Elmardi, K., Hasnain, S., Khogali, H., Baaboura, R., Al-Romaihi, H. E., AlKubaisi, N. J., & Bougmiza, M. I. (2024). Knowledge, attitude, and practices regarding human papilloma virus vaccination among physicians in Qatar. Women’s Health, 20, 17455057241227360. https://doi.org/10.1177/17455057241227360
[4] AlMesbah, N., Maatoug, J., Selim, N., & Bougmiza, I. (2024). Human papillomavirus prevalence and genotypes in Gulf Cooperation Council countries: A scoping review 2017–2024. Qatar Medical Journal, 2024(3), 33. https://doi.org/10.5339/qmj.2024.33
[5] Almonte, M., Albero, G., Molano, M., Carcamo, C., García, P. J., & Pérez, G. (2008). Risk factors for human papillomavirus exposure and co-factors for cervical cancer in Latin America and the Caribbean. Vaccine, 26(Suppl. 11), L16–L36. https://doi.org/10.1016/j.vaccine.2008.06.008
[6] Arbyn, M., Smith, S. B., Temin, S., Sultana, F., Castle, P., & Collaboration on Self-Sampling and HPV Testing. (2018). Detecting cervical precancer and reaching underscreened women by using HPV testing on self samples: Updated meta-analyses. BMJ, 363, k4823. https://doi.org/10.1136/bmj.k4823
[7] Arrossi, S., Thouyaret, L., & Paul, L. (2015). Prevención del cáncer cervicouterino: Recomendaciones para el tamizaje, seguimiento y tratamiento de mujeres en el marco de programas de tamizaje basados en el test de VPH: Actualización 2015. https://repositorio.cedes.org/handle/123456789/4318
[8] Asociación Médica Mundial. (2024). Declaración de Helsinki de la AMM: Principios éticos para las investigaciones médicas con participantes humanos. https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
[9] Ayora Apolo, D. C., & Guzmán Cruz, M. M. (2017). Conocimientos, actitudes y prácticas de prevención del virus del papiloma humano en estudiantes de colegios nocturnos. Enfermería Investiga, 2(4), 127–131. https://dialnet.unirioja.es/servlet/articulo?codigo=6233759
[10] Bedell, S. L., Goldstein, L. S., Goldstein, A. R., & Goldstein, A. T. (2020). Cervical cancer screening: Past, present, and future. Sexual Medicine Reviews, 8(1), 28–37. https://doi.org/10.1016/j.sxmr.2019.09.005
[11] Brewer, N. T., Hall, M. E., Malo, T. L., Gilkey, M. B., Quinn, B., & Lathren, C. (2017). Announcements versus conversations to improve HPV vaccination coverage: A randomized trial. Pediatrics, 139(1), e20161764. https://doi.org/10.1542/peds.2016-1764
[12] Bruni, L., Serrano, B., Bosch, X., & Castellsagué, X. (2015). Human papillomavirus vaccine: Efficacy and safety. Enfermedades Infecciosas y Microbiología Clínica, 33(5), 342–354. https://doi.org/10.1016/j.eimc.2015.03.018
[13] Centers for Disease Control and Prevention. (2023, February 27). Infección por el virus del papiloma humano (VPH): Guía de tratamiento de las ITS. https://www.cdc.gov/std/treatment-guidelines/hpv-cancer.htm
[14] Centers for Disease Control and Prevention. (2025, May 7). Chapter 11: Human papillomavirus. Epidemiology and prevention of vaccine-preventable diseases. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-11-human-papillomavirus.html
[15] Chávez, S. N. A. (2024). Conocimientos, actitudes y prácticas sobre el VPH y el método de screening de Papanicolaou. Revista UNO, 4(6), 28–39. https://doi.org/10.62349/revistauno.v.4i6.24
[16] Clarke, M. A., Deshmukh, A. A., Suk, R., Roberts, J., Gilson, R., Jay, N., Stier, E. A., & Wentzensen, N. (2022). A systematic review and meta-analysis of cytology and HPV-related biomarkers for anal cancer screening among different risk groups. International Journal of Cancer, 151(11), 1889–1901. https://doi.org/10.1002/ijc.34199
[17] Costa, S., Verberckmoes, B., Castle, P. E., & Arbyn, M. (2023). Offering HPV self-sampling kits: An updated meta-analysis of the effectiveness of strategies to increase participation in cervical cancer screening. British Journal of Cancer, 128(5), 805–813. https://doi.org/10.1038/s41416-022-02094-w
[18] Degarege, A., & Madhivanan, P. (2024). Methodological assessment of a review of knowledge, attitude and practice about human papilloma virus vaccination in India. Asian Pacific Journal of Cancer Prevention, 25(6), 1857–1859. https://doi.org/10.31557/APJCP.2024.25.6.1857
[19] Díaz, N. del C. G., Correa, D. C. V., Castañeda, P. M. R., & Gálvez-Díaz, S. (2023). Conocimientos de los estudiantes peruanos de enfermería sobre el virus del papiloma humano. Enfermería Global, 22(3), 407–427. https://doi.org/10.6018/eglobal.547161
[20] Dirección Nacional de Registros Públicos. (2021). Ley de Protección de Datos Personales. https://www.registrospublicos.gob.ec/programas-servicios/servicios/proyecto-de-ley-de-proteccion-de-datos/
[21] Eva, F. N., Khan, M. A. S., Islam, T., Monisha, U. K., Meem, N.-E.-S., Hossain, M. A., Goutam, A., Zerin, T., Alam, N., Nath, R., Sifat, S., Sultana, S., Sultana, M. S., Saha, S. K., Sarker, N. E., Rahman, M. L., Nabi, M. H., & Hawlader, M. D. H. (2024). Awareness of HPV vaccine and its socio-demographic determinants among the parents of eligible daughters in Bangladesh: A nationwide study. Heliyon, 10(10), e30897. https://doi.org/10.1016/j.heliyon.2024.e30897
[22] Falcón-Córdova, D., & Carrero, Y. (2021). Situación actual de la infección por Virus del Papiloma Humano (VPH) asociado a lesiones cervicales en mujeres del Ecuador: Revisión sistemática. Kasmera, 49(1), e49133050. https://doi.org/10.5281/zenodo.4587242
[23] Galvão, M. P. S. P., de Araújo, T. M. E., & da Rocha, S. S. (2022). Knowledge, attitudes, and practices of adolescents regarding human papillomavirus. Revista de Saúde Pública. https://doi.org/10.11606/s1518-8787.2022056003639
[24] Gottschlich, A., Payne, B. A., Trawin, J., Albert, A., Jeronimo, J., Mitchell-Foster, S., Mithani, N., Namugosa, R., Naguti, P., Orem, J., Rawat, A., Simelela, P. N., Singer, J., Smith, L. W., van Niekerk, D., Nakisige, C., & Ogilvie, G. (2023). Experiences with thermal ablation for cervical precancer treatment after self-collection HPV-based screening in the ASPIRE Mayuge randomized trial. International Journal of Cancer, 152(8), 1630–1639. https://doi.org/10.1002/ijc.34369
[25] Graham, S. V. (2017). The human papillomavirus replication cycle, and its links to cancer progression: A comprehensive review. Clinical Science, 131(17), 2201–2221. https://doi.org/10.1042/CS20160786
[26] Guerrero Romero, A. A. (2020). Conocimientos, actitudes y prácticas sobre el virus del papiloma humano y su vacuna en adolescentes de bachillerato de la Unidad Educativa Rumiñahui, Ambato 2019 [Tesis de grado, UCACUE]. https://dspace.ucacue.edu.ec/handle/ucacue/8336
[27] Guzmán Barajas, L. V., & Zapata Vargas, L. M. (2022). Conocimientos, actitudes y prácticas sobre el papiloma humano (VPH) y su vacuna en jóvenes universitarios de la FUCS [Repositorio institucional]. https://repositorio.fucsalud.edu.co/handle/001/3155
[28] Institutional Repository for Information Sharing. (2016). Integrating HPV testing in cervical cancer screening program: A manual for program managers. https://iris.paho.org/handle/10665.2/31393
[29] Instituto Nacional del Cáncer. (2013, January 3). Exámenes de detección del cáncer de cuello uterino (PDQ®). https://www.cancer.gov/espanol/tipos/cuello-uterino/pro/deteccion-cuello-uterino-pdq
[30] Instituto Nacional del Cáncer. (2025, April 18). Detección del cáncer de cuello uterino (PDQ®). https://www.cancer.gov/types/cervical/hp/cervical-screening-pdq
[31] Isa Modibbo, F., Dareng, E., Bamisaye, P., Jedy-Agba, E., Adewole, A., Oyeneyin, L., Olaniyan, O., & Adebamowo, C. (2016). Qualitative study of barriers to cervical cancer screening among Nigerian women. BMJ Open, 6(1), e008533. https://doi.org/10.1136/bmjopen-2015-008533
[32] Kombe Kombe, A. J., Li, B., Zahid, A., Mengist, H. M., Bounda, G.-A., Zhou, Y., & Jin, T. (2021). Epidemiology and burden of human papillomavirus and related diseases, molecular pathogenesis, and vaccine evaluation. Frontiers in Public Health, 8, 552028. https://doi.org/10.3389/fpubh.2020.552028
[33] Kore, V. B., & Anjankar, A. (2023). A comprehensive review of treatment approaches for cutaneous and genital warts. Cureus, 15(10), e47685. https://doi.org/10.7759/cureus.47685
[34] Lam, J. U. H., Rebolj, M., Dugué, P.-A., Bonde, J., von Euler-Chelpin, M., & Lynge, E. (2014). Condom use in prevention of human papillomavirus infections and cervical neoplasia: Systematic review of longitudinal studies. Journal of Medical Screening, 21(1), 38–50. https://doi.org/10.1177/0969141314522454
[35] Lechner, M., Liu, J., Masterson, L., & Fenton, T. R. (2022). HPV-associated oropharyngeal cancer: Epidemiology, molecular biology and clinical management. Nature Reviews Clinical Oncology, 19(5), 306–327. https://doi.org/10.1038/s41571-022-00603-7
[36] Lott, B. E., Trejo, M. J., Baum, C., McClelland, D. J., Adsul, P., Madhivanan, P., Carvajal, S., Ernst, K., & Ehiri, J. (2020). Interventions to increase uptake of cervical screening in sub-Saharan Africa: A scoping review using the integrated behavioral model. BMC Public Health, 20(1), 654. https://doi.org/10.1186/s12889-020-08777-4
[37] Luria, L., & Cardoza-Favarato, G. (2025). Human papillomavirus. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK448132/
[38] Manini, I., & Montomoli, E. (2018). Epidemiology and prevention of human papillomavirus. Annali di Igiene: Medicina Preventiva e di Comunità, 30(4 Suppl 1), 28–32. https://doi.org/10.7416/ai.2018.2231
[39] Markowitz, L. E., Naleway, A. L., Klein, N. P., Lewis, R. M., Crane, B., Querec, T. D., Hsiao, A., Aukes, L., Timbol, J., Weinmann, S., Liu, G., Steinau, M., & Unger, E. R. (2020). Human papillomavirus vaccine effectiveness against HPV infection: Evaluation of one, two, and three doses. The Journal of Infectious Diseases, 221(6), 910–918. https://doi.org/10.1093/infdis/jiz555
[40] Medina, M. L., Medina, M. G., & Merino, L. A. (2018). Principales conductas de riesgo sobre papilomavirus humano en universitarios argentinos. Avances en Odontoestomatología, 34(6), 311–319. https://scielo.isciii.es/scielo.php?script=sci_abstract&pid=S0213-12852018000600005
[41] Mejía, L., Muñoz, D., Trueba, G., Tinoco, L., & Zapata, S. (2016). Prevalence of human papillomavirus types in cervical cancerous and precancerous lesions of Ecuadorian women. Journal of Medical Virology, 88(1), 144–152. https://doi.org/10.1002/jmv.24310
[42] Mekonnen, B. A., Anagaw, Y. K., Kassahun, B. A., & Worku, M. C. (2024). Evaluation of female university students’ knowledge, attitudes, and practices toward human papillomavirus infection and vaccination: Multicenter cross-sectional study. BMC Women’s Health, 24, 437. https://doi.org/10.1186/s12905-024-03279-6
[43] Ministerio de Salud Pública. (2024a). 258 mujeres de pueblos y nacionalidades del Ecuador fueron tamizadas para detección y prevención de VPH. https://www.salud.gob.ec/258-mujeres-de-pueblos-y-nacionalidades-del-ecuador-fueron-tamizadas-para-deteccion-y-prevencion-de-vph/
[44] Ministerio de Salud Pública. (2024b). Semana de vacunación de las Américas pondrá énfasis en prevenir el cáncer de cuello uterino. https://www.salud.gob.ec/2024-semana-de-vacunacion-de-las-americas-pondra-enfasis-en-prevenir-el-cancer-de-cuello-uterino/
[45] Ministerio de Salud Público. (2017). Estrategia nacional para la atención integral del cáncer en el Ecuador. https://www.iccp-portal.org/resources/estrategia-nacional-para-la-atencion-integral-del-cancer-en-el-ecuador
[46] Mouchet, J., Salvo, F., Raschi, E., Poluzzi, E., Antonazzo, I. C., De Ponti, F., & Bégaud, B. (2018). Human papillomavirus vaccine and demyelinating diseases: A systematic review and meta-analysis. Pharmacological Research, 132, 108–118. https://doi.org/10.1016/j.phrs.2018.04.007
[47] National Cancer Institute. (2019a, March 1). Human papillomavirus. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer
[48] National Cancer Institute. (2019b, March 1). VPH y cáncer. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer
[49] National Cancer Institute. (2020, September 18). New ACS cervical cancer screening guideline. https://www.cancer.gov/news-events/cancer-currents-blog/2020/cervical-cancer-screening-hpv-test-guideline
[50] National Cancer Institute. (2025, April 18). Cervical cancer screening (PDQ®). https://www.cancer.gov/types/cervical/hp/cervical-screening-pdq
[51] National Health Service. (2019, March 19). Human papillomavirus (HPV). https://www.nhs.uk/conditions/human-papilloma-virus-hpv/
[52] Ogden, S. N., Leskinen, E. A., Sarma, E. A., Wainwright, J. V., & Rendle, K. A. (2021). Effects of message framing on cervical cancer screening knowledge and intentions related to primary HPV testing. Cancer Prevention Research, 14(9), 839–844. https://doi.org/10.1158/1940-6207.CAPR-20-0622
[53] Oliveira, G. R. de, Siqueira, J. D., Finger-Jardim, F., Vieira, V. C., Silva, R. L., Gonçalves, C. V., Soares, E. A., Martinez, A. M. B. de, & Soares, M. A. (2017). Characterisation of complete high- and low-risk human papillomavirus genomes isolated from cervical specimens in southern Brazil. Memórias do Instituto Oswaldo Cruz, 112(10), 728–731. https://doi.org/10.1590/0074-02760170121
[54] Organización Mundial de la Salud. (2022). La OMS actualiza las recomendaciones sobre el calendario de vacunación contra el VPH. https://www.who.int/es/news/item/20-12-2022-WHO-updates-recommendations-on-HPV-vaccination-schedule
[55] Organización Panamericana de la Salud. (2022). Vacuna contra el virus del papiloma humano (VPH). https://www.paho.org/es/vacuna-contra-virus-papiloma-humano-vph
[56] Organización Panamericana de la Salud. (2025, October 6). Recomendaciones para el uso de la vacuna contra el virus del papiloma humano (VPH). https://www.paho.org/es/documentos/recomendaciones-para-uso-vacuna-contra-virus-papiloma-humano-vph
[57] Pal, D., Sahoo, B. K., Taywade, M., & Maji, S. (2024). Evidence of knowledge, attitude, and practice regarding human papilloma virus vaccination at the community level in India: A systematic review and meta-analysis. Asian Pacific Journal of Cancer Prevention, 25(3), 793–800. https://doi.org/10.31557/APJCP.2024.25.3.793
[58] Pierce Campbell, C. M., Lin, H.-Y., Fulp, W., Papenfuss, M. R., Salmerón, J. J., Quiterio, M. M., Lazcano-Ponce, E., Villa, L. L., & Giuliano, A. R. (2013). Consistent condom use reduces the genital human papillomavirus burden among high-risk men: The HPV infection in men study. The Journal of Infectious Diseases, 208(3), 373–384. https://doi.org/10.1093/infdis/jit191
[59] Pity, I. S., Abdo, H. M., & Goreal, A. A. (2019). Human papillomavirus genotyping among different cervical smears in Duhok/Iraq. Asian Pacific Journal of Cancer Prevention, 20(7), 2059–2064. https://doi.org/10.31557/APJCP.2019.20.7.2059
[60] Prendiville, W., & Sankaranarayanan, R. (2017). The role of colposcopy in cervical precancer. In Colposcopy and treatment of cervical precancer. International Agency for Research on Cancer. https://www.ncbi.nlm.nih.gov/books/NBK568372/
[61] Przybylski, M., Pruski, D., Millert-Kalinska, S., Zmaczynski, A., Baran, R., Horbaczewska, A., Jach, R., & Zaborowska, L. (2022). Remission of HPV infection after LEEP-conization—A retrospective study. Ginekologia Polska. https://doi.org/10.5603/GP.a2021.0164
[62] Purdy, N. L., Katz, M. L., & Reiter, P. L. (2025). Women’s acceptability of HPV self-collection in a healthcare setting following FDA approval in the United States. Women & Health, 65(7), 606–617. https://doi.org/10.1080/03630242.2025.2550649
[63] Ramathuba, D. U., & Ngambi, D. (2018). Knowledge and attitudes of women towards human papilloma virus and HPV vaccine in Thulamela Municipality of Vhembe District in Limpopo Province, South Africa. African Journal of Reproductive Health, 22(3), 111–119. https://doi.org/10.29063/ajrh2018/v22i3.12
[64] Sakrawal, K., Meena, G., Gupta, A., Malav, K., & Grover, S. (2023). Knowledge, attitude, and practice about cervical cancer among adult women in rural Jaipur: An observational analysis. Journal of Family Medicine and Primary Care, 12(10), 2379–2384. https://doi.org/10.4103/jfmpc.jfmpc_933_23
[65] Shaikh, M. Y., Hussaini, M. F., Narmeen, M., Effendi, R., Paryani, N. S., Ahmed, A., Khan, M., & Obaid, H. (2019). Knowledge, attitude, and barriers towards human papillomavirus (HPV) vaccination among youths of Karachi, Pakistan. Cureus, 11(11), e6134. https://doi.org/10.7759/cureus.6134
[66] Smulian, E. A., Mitchell, K. R., & Stokley, S. (2016). Interventions to increase HPV vaccination coverage: A systematic review. Human Vaccines & Immunotherapeutics, 12(6), 1566–1588. https://doi.org/10.1080/21645515.2015.1125055
[67] Sozib, S. I., Smail, L., & Jassim, G. A. (2025). Knowledge, attitudes, and practices regarding HPV infection, cervical cancer, and HPV vaccination among Emirati women. Future Oncology. https://doi.org/10.1080/14796694.2025.2575519
[68] Staley, H., Shiraz, A., Shreeve, N., Bryant, A., Martin-Hirsch, P. P., & Gajjar, K. (2021). Interventions targeted at women to encourage the uptake of cervical screening. Cochrane Database of Systematic Reviews, (9), CD002834. https://doi.org/10.1002/14651858.CD002834.pub3
[69] Steben, M., & Garland, S. M. (2014). Genital warts. Best Practice & Research Clinical Obstetrics & Gynaecology, 28(7), 1063–1073. https://doi.org/10.1016/j.bpobgyn.2014.07.002
[70] Szymonowicz, K. A., & Chen, J. (2020). Biological and clinical aspects of HPV-related cancers. Cancer Biology & Medicine, 17(4), 864–878. https://doi.org/10.20892/j.issn.2095-3941.2020.0370
[71] Tesfaye, Z. T., Bhagavathula, A. S., Gebreyohannes, E. A., & Tegegn, H. G. (2019). Knowledge and awareness of cervical cancer and human papillomavirus among female students in an Ethiopian university: A cross-sectional study. International Journal of Preventive Medicine, 10, 198. https://doi.org/10.4103/ijpvm.IJPVM_181_17
[72] Universidad Nacional de Loja. (2023a). CEISH. https://unl.edu.ec/ceish
[73] Universidad Nacional de Loja. (2023b). Unidad de Educación a Distancia y en Línea. https://www.unl.edu.ec/oferta_academica/unidad-de-educacion-distancia
[74] Vaccarella, S., Bruni, L., & Seoud, M. (2013). Burden of human papillomavirus infections and related diseases in the extended Middle East and North Africa region. Vaccine, 31(Suppl. 6), G32–G44. https://doi.org/10.1016/j.vaccine.2012.06.098
[75] Valdez Castillo, E. G. (2015). Relación entre el nivel de conocimiento y las actitudes preventivas sobre la infección por virus del papiloma humano en usuarias del centro de salud “Chancas de Andahuaylas” de Santa Anita, primer semestre del 2015 [Tesis de licenciatura].
[76] World Health Organization. (2021). WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention (2nd ed.). https://www.who.int/publications/i/item/9789240040434
[77] World Health Organization. (2024a). Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
[78] World Health Organization. (2024b). Cervical cancer elimination day of action. https://www.who.int/southeastasia/news/detail/17-11-2024-cervical-cancer-elimination-day-of-action
[79] World Health Organization. (2024c). Human papillomavirus and cancer. https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer
[80] Zang, L., & Hu, Y. (2021). Risk factors associated with HPV persistence after conization in high-grade squamous intraepithelial lesion. Archives of Gynecology and Obstetrics, 304(6), 1409–1416. https://doi.org/10.1007/s00404-021-06217-1
[81] Zhang, J.-M., Zhao, Q.-M., & Zhang, L.-M. (2017). Assessment of the knowledge, attitude and practices about human papilloma virus vaccine among the nurses working in a tertiary hospital in China: A cross-sectional descriptive study. Journal of the Pakistan Medical Association, 67(2), 209–213.
[82] Zhao, X.-L., Hu, S.-Y., Zhang, Q., Dong, L., Feng, R.-M., Han, R., & Zhao, F.-H. (2017). High-risk human papillomavirus genotype distribution and attribution to cervical cancer and precancerous lesions in a rural Chinese population. Journal of Gynecologic Oncology, 28(4), e30. https://doi.org/10.3802/jgo.2017.28.e30
[83] Zhu, P., Qi, R.-Q., Yang, Y., Huo, W., Zhang, Y., He, L., Wang, G., Xu, J., Zhang, F., Yang, R., Tu, P., Ma, L., Liu, Q., Li, Y., Gu, H., Cheng, B., Chen, X., Chen, A., Xiao, S., … Gao, X.-H. (2022). Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). Journal of Evidence-Based Medicine, 15(3), 284–301. https://doi.org/10.1111/jebm.12494
