Prevalence and clinical correlates of human papillomavirus infection: A study of 7,601 women attending a tertiary referral center in Greece

Objectives: This study aimed to analyze the prevalence, genotype distribution, and infection burden of human papillomavirus (HPV) as well as their association with cytological findings, among 7,601 women attending a tertiary referral center in Athens, Greece. Materials and Methods: This retrospective, single-center cross-sectional study analyzed cervical samples from women attending a specific institution (2019-2024) that underwent polymerase chain reaction-based HPV genotyping, while cytological findings were classified according to the Bethesda system. Statistical analyses assessed the relationships between HPV types, infection burden, cytological outcomes, and age groups. Results: Overall HPV prevalence was 31%, including 18.4% single and 12.6% multiple infections. The most frequent HPV genotypes detected were HPV-42, HPV-51, HPV-16, HPV-53, and HPV-54. Multiple infections were more common in younger women, while single infections predominated with increasing age. Cytological results showed 82.3% normal, 15.9% low-grade squamous intraepithelial lesions (LSILs), 1.3% atypical squamous cells of undetermined significance (ASC-US), and 0.5% high-grade squamous intraepithelial lesions (HSILs). HPV types 16, 18, 31, 33, 42, and 51 were strongly associated with LSIL and/or HSIL. Women with multiple HPV infections had higher odds of ASC-US and LSIL compared to those with single infections; however, the opposite pattern was observed for HSIL. Age was inversely associated with ASC-US and LSIL but not with HSIL. Conclusion: These findings highlight the importance of HPV genotype and infection burden in cervical disease risk in this patient cohort and underscore the need for targeted screening and vaccination strategies tailored to the local epidemiology.