HPV Infection in Women with ASC-US in Eastern Marmara, Türkiye: Genotype Prevalence and Clinical Implications.

Abstract

Purpose: This study aimed to retrospectively evaluate the distribution of human papillomavirus (HPV) genotypes, age-specific prevalence, and their association with histopathological outcomes in women with cervical cytology results reported as atypical squamous cells of undetermined significance (ASC-US) and concurrent high-risk HPV (hr-HPV) positivity.

Patients and methods: Among 39,189 records screened between October 2019 and October 2024, 705 patients with ASC-US and hr-HPV positivity were included. HPV genotyping was performed using real-time PCR, cytological evaluation followed the Bethesda System, and colposcopic biopsies were classified according to the Lower Anogenital Squamous Terminology (LAST) guidelines.

Results: HPV-16 (25.6%), HPV-51 (7%), and HPV-31 (6.5%) were the most prevalent genotypes, detected in 28.2% (n=199) of hr-HPV-positive cases. HPV-16 demonstrated the strongest association with high-grade lesions, accounting for 47.6% of cervical intraepithelial neoplasia grade 2 or worse (CIN2+). Multiple HPV infections correlated with an elevated risk of CIN2+. Age-stratified analysis revealed HPV-16 predominance in women aged 40-49 years, whereas HPV-51 was more frequent in those ≥60 years.

Conclusion: In ASC-US cases, HPV-16 is the predominant genotype and a significant predictor of high-grade cervical lesions. The unexpectedly high prevalence of HPV-51 and HPV-31 in this Turkish cohort underscores the importance of tailoring screening algorithms to regional genotype distributions. Furthermore, the observed age-specific variations in genotype prevalence highlight the need for age-adjusted management strategies.