# Distribution of HPV genotypes and comparison of cervico-vaginal cytologies in PCR-detected HPV-positive patients: a retrospective observational study

## TL;DR

This study analyzed HPV infection rates and cervical cell changes in women in Türkiye, finding that HPV-16 is most common and linked to severe lesions, highlighting the need for better screening and vaccination.

## Contribution

The study provides updated genotype-specific HPV prevalence data and age-related infection patterns in Türkiye, emphasizing the need for targeted interventions.

## Key findings

- HPV positivity showed a bimodal age distribution, with peaks in women under 30 and aged 40–49.
- HPV-16 was the most prevalent genotype and significantly associated with moderate-severe cervical lesions.
- Multiple HPV infections did not show significant differences in cytological outcomes compared to single infections.

## Abstract

This large-scale study aimed to determine the prevalence and genotype distribution of Human Papillomavirus (HPV) infection together with cervical cytological findings among women undergoing cervical screening in Türkiye. In Türkiye, HPV prevalence varies regionally, and vaccination rates remain low due to the absence of HPV vaccination in the national program.

A retrospective study of 4,648 women who underwent HPV testing and cervical cytology from January 2020 to March 2023. HPV genotype was determined by multiple PCR. Cytological findings were categorized based on the 2015 Bethesda System. Statistical analysis was conducted using the chi-square test and logistic regression to compare the association between positivity for HPV, age groups, types of infection, and cytological alterations.

17.7% (n = 825) of both groups were HPV positive, and 82.3% of the subjects (n = 3,823) were negative for HPV. HPV positivity had a bimodal distribution by age, with higher prevalence among women <30 years and those aged 40–49 (p = 0.0049). Women younger than 29 years had significantly higher odds of being HPV positive compared with the reference group (OR: 2.55; 95% CI: 1.86–3.49; p < 0.01). The most prevalent genotypes were HPV-16 (23.3%) followed by HPV-6 (13.3%), HPV-51 (6.3%), and HPV-59 (6.5%). Differences in cytological distributions between single and multiple infections were not significant (p = 0.41), though HPV-16 was significantly associated with moderate-severe lesions (HSIL, ICC) (p < 0.01).

The results indicate the requirement for age-optimized screening, ongoing genotype surveillance, and successful HPV vaccination programs. Cervical cancer represents a major health burden although it is largely preventable through vaccination. These findings highlight the urgent need for genotype-specific surveillance and reinforce the importance of implementing comprehensive HPV vaccination programs in Türkiye.