The human papillomavirus (HPV) infection is a leading cause of sexually transmitted infections. HPV is primarily transmitted through sexual contact, making it the most common sexually transmitted infection globally. While other non-sexual transmission routes have been suggested in literature, including vertical transmission and contact with contaminated surfaces, sexual activity remains the predominant route of transmission for HPV (1). While some women may experience HPV infections that resolve spontaneously without treatment, others may develop complications such as cervical cancer, which can be fatal if not treated promptly, particularly if diagnosed at an advanced stage (2). Human papillomavirus (HPV) comprises over 200 types, causing genital warts, as well as various cancers, including those affecting the throat, cervix, and anus (3). Cervical cancer prevention primarily depends on screening and vaccination. HPV screening is used to detect the presence of high-risk HPV types that are associated with cervical cancer. However, it does not measure the severity or stage of the disease. Instead, it helps to identify individuals who may require further diagnostic procedures such as colposcopy or biopsy (4, 42). The World Health Organisation and the South African Department of Health advocate for routine cervical screening, including cytology and HPV DNA testing, depending on availability and infrastructure. These methods aim to detect abnormal cervical changes early, thus improving the prognosis through timely intervention (4, 5). In rural areas like Vhembe district in Limpopo province, uptake remains low due to limited awareness, cultural barriers, and poor access to healthcare (6). The Centres for Disease Control and Prevention emphasise HPV infection screening significance in sexually transmitted infections, with differing levels of severity among HPV types. Although some infections may resolve spontaneously, others can lead to complications such as cervical cancer, underscoring the importance of HPV infection screening services for women’s health due to daily exposure to its transmission routes (7). It was stated that HPV infection signs and symptoms that persist without disappearing on their own, HPV becomes necessary to determine the type of the virus, whether is high risk HPV type or not. As HPV infections remain to be a global contributor to cervical cancer with significant regional variation. HPV is responsible for approximately 90% of cervical cancers diagnosed in women, which is a leading cause of cancer-related morbidity and mortality. In addition to cervical cancer, HPV is also linked to a significant proportion of other anogenital cancers (such as vaginal, vulvar, anal cancers) and some oropharyngeal cancers. However, HPV is not associated with breast cancer, which is another common cancer among women (3). A study was done in Asia on knowledge about human papillomavirus and cervical cancer prevention among nurses, it was revealed that the majority 39.5% of respondents were uncertain whether HPV vaccination has major side effects or not and this finding suggest insufficient awareness regarding HPV vaccination (8). A supporting study was also conducted in Israel among nurses, majority 60.5% of the respondents, were not aware of the different body regions that can be affected by HPV and this finding concludes that training of nurses on HPV infection is very crucial (9). A cross-sectional study of knowledge, attitudes, barriers and practices of cervical cancer screening among nurses in selected hospitals in the Eastern Cape Province, South Africa, it was stated that only 16.0% nurses showed awareness that HPV vaccines is highly recommended to girls less than 16 years and 84.0% of nurses believed that HPV vaccine is highly recommended to girls above 16 years (10). This lack of knowledge was also marked on the study done at Nelson Mandela Bay clinics, where the majority of nurses, 63.64%, stated that condoms are not protective measures against HPV infection transmission (11). A continent-wide cross-sectional survey among healthcare providers from 23 African countries (including South Africa) found that only 9.9% of providers answered key HPV vaccine knowledge questions correctly, and most reported a lack of training in counselling or recommending HPV vaccination (12). Since the national rollout of South Africa’s HPV vaccination programme in 2014, efforts have largely focused on school-based delivery to Grade 4 girls, achieving high coverage but with limited emphasis on structured training of nurses, the key frontline implementers of vaccination and screening (13, 14). A 2022 narrative review highlighted that despite improving uptake rates, formal capacity-building efforts targeting healthcare workers, especially nurses, remain under-documented, which could compromise providers’ ability to promote HPV prevention services effectively (14). A South African regional audit conducted in 2023 revealed widespread poor knowledge and limited engagement in screening activities among nurses in the Eastern Cape, with negative attitudes towards HPV vaccination also reported, underscoring urgent needs for system-level interventions (10).

In South Africa, provincial data revealed that Limpopo province is one of the provinces with the highest HPV infection prevalence rate at 59% following Gauteng with 64% and Eastern cape with 63% (15). A study revealed that over 84,000 women screened for HPV infection in Limpopo 19.6% were found to have abnormal cells in the cervix. Furthermore, women who were HIV positive were found to have high prevalence of HPV infection at 31.8% compared to HIV negative women at 9.2% (16). Similar results were reported from the study conducted in Eastern cape among women, where high risk HPV infection prevalence was reported at 28.5% with high rates among HIV. positive women at 40.6 and 21.4% among HIV negative women. The study also points out several behavioural risk factors contributing to this high prevalence, including having more than three lifetime sexual partners, unprotected sexual activity and unusual virginal discharge (17). These results highlight the need for targeted interventions in provinces like Limpopo, where challenges such as inadequate access to healthcare, high HIV rates, and insufficient cervical cancer screening contribute to an increased risk of HPV-related health issues. In South Africa, a national school-based HPV vaccination programme was introduced in 2014, targeting girls aged 9–14 before sexual debut. Two vaccines are used: the bivalent vaccine (effective against high-risk HPV types 16 and 18 linked to cervical cancer) and the quadrivalent vaccine (effective against types 6 and 11, which cause genital warts). These vaccines also offer protection against other cancer-related HPV types. The programme aims to reduce HPV prevalence and cancer risk, with the WHO recommending two doses administered 6 months apart (18). In 2017, the South African Department of Health introduced primary HPV DNA testing as part of the national cervical cancer screening strategy, aiming to improve early detection of high-risk HPV types in women (19). Nurses are often the first point of contact for patients in public healthcare facilities and are responsible for implementing these services. However, if nurses lack adequate knowledge and training on HPV, its transmission, and prevention strategies, including the importance of HPV testing the success of these programmes may be compromised. Therefore, this study aimed to determine the awareness about HPV infection screening and vaccination among nurses in Vhembe district of Limpopo Province, South Africa. The population for this study were nurses with expertise in health promotion, patient education and delivery of preventative health care services. Nurses’ knowledge and attitude play a role in influencing the public’s seeking health behaviour and trust in medical intervention. Addressing gaps in awareness is important as insufficient awareness among nurses can undermine the National Department of Health’s effort in the reduction of HPV infections and cervical cancer rate. The findings of this study can therefore inform public health policy and contribute to the design of targeted educational interventions and training for healthcare professionals.

The data were collected from 115 respondents. Descriptive analysis was conducted to acquire the percentages and frequency distribution of socio-demographic data, involving aspects such as occupation, age, gender, HPV infection screening, and HPV infection workshop/training. As well as inferential statistics analyses. In this study, the researcher returned to the selected clinics and gave the questionnaire back to the respondents on two different occasions to determine whether the results would be the same. In this research study, Cronbach’s alpha coefficient was 0.638, which was deemed acceptable as the correlation coefficient approached 1 (one). A summary of this socio-demographic data was compiled and presented in Table 1 and Supplementary Table S1 with supplementary analysis without male data and Table 2 represent general awareness regarding HPV infection, with Supplementary Table S2 representing supplementary analysis without male data. Only variables that demonstrated a statistically significant positive correlation with HPV infection screening and vaccination practices were included in the correlation analysis presented in Table 3 and non-significant variables were disregarded. Only variables with statistically significant relationships were included i non-significant variables were omitted.

According to the results of this study, nurses showed a low level of awareness and understanding regarding the human papillomavirus. Limited HPV infection awareness among nurses can impact patients/women negatively. The more nurses know about HPV infections, the more patients/women are also aware of HPV infections and able to take preventive measures against HPV infections.

The findings revealed that the respondents in the study were predominantly females, with males’ representation being minimal. The high level of female nurses may be due to the belief and attitude of male nurses that they will be called ‘sisters’ as their female counterparts are called in the profession. However, they can be referred to as ‘professional nurse Mushasha” instead of “sister Mushasha.” In a study conducted in urban India, it was found that of 318 respondents, 71 were men and 247 were women (24). Another study in South Africa also found mostly female healthcare workers. This study looked at the knowledge of HPV in Nelson Mandela Bay clinics. Just like in this current study, there were many more women 106 than males 9 in that South African study (25). The study participants represented a wide age range, with the majority falling between the ages of 46 and 55. Younger and older age groups were less represented. The results of this research study concur with those found in another study conducted by Ma et al. (26), which found that the average age of the respondents was 21 years old.

A greater proportion of RNs participated in the study compared to RENs and RANs, suggesting that the perspectives captured are more representative of the RN category. The results of this study are in line with the findings of the study carried out at the Nelson Mandela Bay Clinic in the Eastern Cape, South Africa. The study results revealed that among the 110 nurses who participated in the study, 79 were RNs. However, the RENs numbered more than the RANs (25). The study revealed that just over half of the respondents had undergone HPV infection screening, indicating moderate uptake. However, a substantial portion had never been screened, underscoring the need to improve screening coverage among the target population. A study carried out in China on HPV infection screening and vaccination among university students found that 98.4% of respondents had done HPV infection screening, and 1.6% of students had never done HPV infection screening (26). These findings validated the findings of this study. The findings revealed a significant gap in HPV infection screening training among respondents, with the majority indicating they had never received such training. Only a small number reported having been trained within the past 2 years, highlighting the need for ongoing professional development in this area. The findings of a study, which examined the perspectives of primary health care professionals (HCPs) on the introduction of cancer screening services in a tribal region of Maharashtra, India, confirmed the outcomes of this study, in that most of the respondents never received training in cancer (27).

The findings revealed a widespread misconception among respondents, with most not recognising the link between HPV and cervical cancer. This highlights a critical gap in knowledge that may hinder effective prevention and early detection efforts. In this study, the results contradicted the outcomes of the study carried out in Western China, which reported that 53.4% of the 1,109 respondents were aware that HPV could cause cancer of the cervix, and 46.6% were unaware of which diseases were caused by HPV (28). The findings of this study demonstrated that the majority of the nurses knew that being sexually involved with multiple partners increased susceptibility to HPV infection. These findings support those found in a study conducted by Cocchio et al. (29), it was revealed that of 9,188 respondents, the majority, 83.3%, were aware and had high levels of knowledge that having multiple sexual partners increased the risk of contracting HPV infection.

The study showed that while the majority of respondents understood that HPV infection is transmitted through sexual contact, including anal, oral, and vaginal sex, a notable proportion remained unaware of these transmission routes. This highlights ongoing gaps in knowledge that need to be addressed through targeted education, unlike a previous study in Limpopo Province, where most people, 85.1%, did not know how HPV infection spreads. In that study, some mistakenly thought that kissing, 3.2% or unprotected sex, 2.1%, could transmit HPV infection. Furthermore, 9.60% of the respondents stated that sexual intercourse is the main mode of HPV infection transmission (30). The study revealed that most participants were aware that HPV infection can remain undetected for years, suggesting a fair level of understanding regarding the virus’s asymptomatic nature. However, a small portion still lacked this awareness, indicating a need for continued education. The results align with a study conducted in the United Kingdom; the study found a similar awareness among Health Care Professionals (HCPs), 634 of 643 knew HPV infection can go undetected for a long time. Just like in this current study, only a small number of 9 were unaware of this fact (31). The study found that 40.0% of the respondents knew that HPV infection may not always show symptoms. On the contrary, 60.0% were unaware of this. There is a significant negative correlation between gender and knowledge regarding the manifestation of HPV infection signs and symptoms, with a Pearson correlation coefficient of −0.225 and a p-value of 0.016. This further suggests that men may ignore obvious signs and symptoms of HPV infection and never consult to receive treatment. Moreover, women who are mostly seen going to clinics to consult, which means that any signs and symptoms of HPV infection are likely to consult to receive treatment. The findings are similar to another study in Al Qunfudhah, both studies found that most respondents were unaware that HPV infection can be symptomless. In this current study, 60% were unaware, and the Al Qunfudhah study found 65% unaware (32). Participants were divided in their beliefs about how common HPV infections are, reflecting uncertainty or gaps in knowledge about their widespread nature. Lack of knowledge is seen to lower nursing categories (assistance and auxiliary nurses). Another significant relationship was found between profession and HPV infection rarity, indicated by a p-value of 0.035 and a Pearson’s correlation coefficient of −0.196. This suggests that nurses of a higher category, such as registered nurses, may possess sufficient awareness about HPV infection compared to enrolled nurses. This may influence registered nurses to protect themselves from being infected by HPV infection compared to enrolled nurses due to the level of education they have. The results of this study contradicted those found by Rahman et al. (33), who stated that the majority of the respondents were aware that HPV infections are common, while 32.3% were unaware that HPV infections are not rare.

The study found that most respondents were aware of the existence of multiple HPV types. Notably, awareness was higher among nurses with over 5 years of experience and those who had received HPV infection screening training, suggesting that both experience and targeted education play a crucial role in improving HPV-related knowledge. The conclusions of this research contrast with those of the earlier study on Moroccan women’s knowledge, perception, and willingness to receive the HPV vaccine. The study found that few women were aware of HPV and its different types. 131 respondents had better awareness, while 759 respondents had no awareness about HPV and its types (34). The findings revealed that a considerable number of nurses lacked awareness that men are also at risk of contracting HPV. This knowledge gap highlights the need for inclusive HPV infection education that addresses both male and female vulnerability to the virus. A significant negative correlation was found between age and knowledge regarding the gender at risk of HPV infection, with a p-value of 0.031 and a Pearson correlation coefficient of −0.201. Older individuals with a high level of knowledge are likely to understand that both men and women are at risk of contracting HPV infection and are likely to take preventative measures against HPV.

There was a lack of knowledge about HPV infections related to the awareness of HPV, its infections, and prevention. Seyfettinoglu & Hark (35) conducted a study on physician attitudes on HPV vaccination of their son; the results contradict the findings of this study by indicating that 100% of respondents were aware that men can also be diagnosed with HPV infection. The study revealed that while most respondents were aware that condom use can reduce the risk of contracting HPV infection, a significant portion still lacked this knowledge. This suggests the need for more comprehensive education on preventive measures against HPV infection transmission. Women who think they are at low risk of contracting HPV infection are not likely to use preventative measures that can prevent them from contracting HPV infection. The conclusions support those of a previous study, which reported that among 670 respondents, 408 were informed that the protective role in the use of condoms in sexual activity reduced the risk of being infected by HPV. Furthermore, 262 respondents were unaware that the use of condoms can protect against HPV infection or not (36).

The findings also revealed that while just over half of the respondents were aware that HPV infection can be transmitted through direct skin-to-skin contact in the genital area, a substantial proportion lacked this knowledge. This gap highlights the need for clearer communication about the modes of HPV infection transmission in healthcare training. Women’s beliefs and attitudes also play a role in how they look at certain diseases and how they can affect them. The results of this study concurred with those of a study conducted by Tian et al. (37), which indicated that a substantial proportion of respondents 296 demonstrated awareness of HPV infection transmission through skin-to-skin contact, while 140 respondents expressed uncertainty about the transmission mode. The results revealed generally low awareness among nurses regarding the link between HPV and the development of genital warts. Only a small proportion demonstrated a high level of understanding, indicating a need for improved training on the clinical manifestations of HPV. Insufficient knowledge of HPV infections can result in women being ignorant of the severity of the disease and how it can affect their lives and health (36), which corroborates the results of the study, which indicated that of the 670 respondents in the study, 592 were aware and aware that genital warts are caused by HPV. Few respondents, 78, had no understanding of the complications of HPV infections. Furthermore, it was indicated that the lack of knowledge was linked to the fact that the undergraduate courses were not related to health sciences.

The findings revealed mixed understanding among respondents regarding the treatment of HPV-related infections. While some believed that antibiotics could be used, nearly half lacked awareness or held misconceptions about appropriate treatment approaches. This highlights the need for clearer education on the management of viral infections caused by HPV. A woman who is aware of HPV and its infection, or has a history of having HPV infection, or has a family member who suffers from HPV infection, may identify these as cues to action, which can lead to understanding that antibiotics cannot be used to treat HPV infection. Sypie & Zielonka (38) supported the results of this study, indicating that among 302 respondents, 216 were aware that HPV infection signs and symptoms cannot be treated with anti-infectives. 86 respondents were unaware that anti-infectives cannot be used to treat HPV infection. This study found that parents with higher HPV infection knowledge, more education, and those living in large cities were more likely to know about HPV vaccination. These parents were also more likely to support the vaccine, view it as safe and effective, and be willing to vaccinate their children. The study identified a notable knowledge gap among nurses regarding the relationship between HPV and HIV/AIDS. While many nurses demonstrated correct understanding, a significant number of participants mistakenly believed that HPV causes HIV/AIDS. This highlights the need for clearer differentiation between the two viruses in educational programmes. This lack of awareness about HPV infection can cause women to have misconceptions about the virus, its causes, effects, and prevention methods. These misconceptions might negatively impact their attitudes towards HPV infection and screening programmes (6), which corroborates the findings of this research study by stating that 211 of the 227 respondents showed a high level of awareness that HPV cannot cause HIV/AIDS, and 29 respondents showed a low level of awareness that HPV is not responsible for causing HIV/AIDS. The level of HPV knowledge concerning HPV infection among HCPs in New Zealand was observed to be inadequate and incomplete, showing a lack of training. In this study, 68.7% of nurses showed a high level of awareness that sexually active people are at high risk of contracting HPV infection in their lives. The study identified a significant knowledge gap about HPV among nurses. This lack of awareness about HPV infection can lead women to have misconceptions about the virus, including their risk of infection. Women who underestimate their risk of HPV infection may be less likely to take preventive measures such as condoms, potentially increasing their exposure to the virus. Tanaka et al. (39) conducted a study, which contradicted the findings of this study. Of 152 pregnant adolescents, 48 respondents were aware that sexually active people are at high risk of contracting HPV and may develop HPV infection in their lifetime. It was indicated that girls with a low level of knowledge and education are engaged in risky sexual behaviour.

The findings demonstrated that most nurses were aware of the link between early sexual activity and an increased risk of acquiring HPV infection. However, a small proportion remained unaware, suggesting the need to reinforce this aspect in sexual health education. Women’s belief that there is no possibility of being infected with HPV may lead them to engage in early sexual intercourse. A significant negative relationship was observed between age and knowledge about the risk of engaging in sexual intercourse at a younger age, with a Pearson correlation coefficient of −0.218 and a p-value of 0.020. As people grow, they understand the risks of contracting HPV due to lived experiences, and they are more likely to take preventative measures against HPV infection, such as using condoms and having one sexual partner. Chanprasertpinyo & Rerkswattavorn (40) conducted a study, and the results differ from the results of this study, in that of 521 respondents, 273 were aware that engaging in sexual intercourse increased the risk of contracting HPV infection, while 248 were unaware that engaging in sexual activity at a young age increased the probability of acquiring HPV. The study highlighted that peer pressure among adolescents contributes to early participation in sexual activity, increasing the risk of HPV infection transmission. Furthermore, it revealed that the majority of respondents, 79.1%, did not know that HPV infections do not always require treatment. The study found that majority of the respondents, did not know that HPV infections can clear up on their own. This suggests a lack of education from healthcare providers, which could impact women’s understanding of HPV and the importance of prevention. George et al. (41) confirm the finding of this study by indicating that only 146 were aware of HPV infection and its vaccines. Furthermore, 12 respondents were aware that HPV does not always require treatment, and 134 respondents were unaware that HPV infections does not always require treatment. It was indicated that a lack of awareness and knowledge was identified among the respondents, the majority of whom lacked awareness that they were at the age where they should know about HPV, HPV vaccination, and prevention to limit HPV infections.

The study findings underscore a concerning lack of awareness among registered nurses about HPV screening and vaccination. This knowledge gap highlights a potential shortfall in healthcare provision, as nurses play a crucial role in patient education and preventive care. Consequently, it is imperative to implement HPV infection training programmes aimed at newly qualified nurses and experienced physicians to enhance their understanding and proficiency in managing HPV-related issues. By improving nurses’ knowledge through targeted education initiatives, healthcare facilities can ensure that patients receive complete and accurate information on HPV, its risks, and preventive measures. Failure to address this limited understanding of HPV infections among nurses may not only compromises patient care but also perpetuates inadequate awareness and understanding of HPV infections within the broader community. Thus, investing in ongoing education and training for nurses is essential to improve public health outcomes and combat the spread of HPV infections.