Prevalence and genotype distribution of human papillomavirus (HPV) in Tehran, Iran: a retrospective cross sectional study (2011-2024).

Abstract

Background: Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection in the world, particularly among young adults shortly after they become sexually active. Beyond its commonality, HPV is a significant public health concern due to its carcinogenic potential. Globally, HPV is responsible for a substantial number of cancer cases annually, including the vast majority of cervical cancers, as well as a notable proportion of other anogenital cancers. To convey the urgent need for comprehensive prevention strategies, this study aimed to assess HPV test positivity and genotype distribution among individuals referred for HPV testing in Tehran, Iran, over a 14-year period (2011-2024), providing the foundational data required to guide future national vaccination and screening programs.

Methods: This study examined the demographic characteristics of 6418 individuals (5988 women and 430 men) tested for HPV using data and samples collected from patients visiting a Saeed pathology and genetics laboratory between 2011 and 2024. HPV DNA was extracted from genital samples, (cervical/vaginal specimens for women, and penile/urethral swabs and urine for men) representative of both female and male individuals in Tehran, and analyzed for the presence of HPV. Genotyping was performed by real-time PCR (Cobas 4800 and Sansure G26) and Reverse Hybridization (INNO-LiPA and HPV Direct Flow Chip) methods for the identification of high-risk (HR) and low-risk (LR) HPV genotypes.

Result: Over the 14-year study period, HPV prevalence was assessed using four diagnostic methods (INNO-LIPA, HybriSpot, COBAS X480, and Sansure Kit), reflecting the evolution of available laboratory assays over time yielding positive detection rates of 55.7%, 61.5%, 17.2%, and 52.1%, respectively. The proportion of positive HPV test results varied across age groups, with the highest prevalence observed in the 20-30 year age group. Within the studied cohort, the HPV positivity rate was 40.8% among female patients and 63.3% among the smaller cohort of male patients. The most frequently detected genotypes overall were 6 (12.3%), 16 (7.1%), 52 (3.6%), and 31 (3.3%), in descending order. Notably, 74.4% (517) of patients reported were asymptomic and were referred for routine screening. Among HPV-positive individuals, 69.5% (163) were asymptomatic. Conversely, 23.0% (106) of HPV- negative individuals reported at least one clinical symptom. Positive HPV rates were 56.3% and 24.5% in single and married subjects, respectively.

Conclusion: This study contributes valuable insights into HPV prevalence and genotype distribution in samples collected over a 14-year period in Tehran. The high prevalence of HPV infection, particularly with high-risk Genotypes coupled with the highest prevalence observed in the 20-30 year age group and HPV-16 being common in younger ages, without clinical sign of infection, underscores the necessity for sustained vigilance in monitoring HPV prevalence, early detection through screening, and targeted prevention programs, and comprehensive cervical cancer prevention strategies.