Distribution of human papillomavirus in cervical, vaginal and vulvar lesions: a single-center retrospective study from Shanxi, China

Abstract

Unlike the well-studied cervical cancer caused by human papillomavirus (HPV), there is a lack of epidemiological data on HPV, which covers the entire lower genital tract and has regional characteristics. This study investigated the HPV distribution in cervical, vaginal and vulvar lesions to provide a reference for their integrated management. This cross-sectional study was designed using the data from the Second Hospital of Shanxi Medical University between January 2014 and December 2023. Study participants underwent colposcopy and targeted biopsy. Pathological diagnosis of cervical, vaginal and vulvar lesions were performed. Participants were divided into different groups according to pathological diagnosis. The clinical characteristics and HPV infection status were analyzed. The attributable risk percentage (AR%) was computed. The sensitivity and specificity of cervical cytology examination, HPV testing and co-testing were calculated. We extracted fourfold table data for each testing method and computed the indicators via standard formulas. Among 19,740 study participants, 5.55% (1095/19740) were pathologically diagnosed with squamous cell carcinoma (SCC), vaginal squamous cell carcinoma (VaSCC) or vulvar squamous cell carcinoma (VSCC). 74.00% (810/1095) of SCC, VaSCC or VSCC were infected with one type of high-risk HPV (HR-HPV), and 8.60% (94/1095) with two types. The most common HR-HPV genotypes were HPV16, 18, 58, 33, and 52. The top three combinations of dual HR-HPV infection were HPV16 + 58, HPV16 + 18, and HPV16 + 52. The positive rate of HPV genotypes covered by nine-valent vaccines was 85.00%. The top five HR-HPV genotypes with the highest AR% were HPV16 (78.2%), 18 (5.0%), 58 (4.2%), 33 (3.0%) and 52 (2.5%). The sensitivity and specificity of combined screening were 71.05% and 67.67% respectively. The HPV positive rates were high in cervical, vaginal, or vulvar intraepithelial neoplasia and squamous cell carcinoma, predominantly involving single-genotype HR-HPV. Six common HPV genotypes included HPV16, 18, 52, 58, 33 and 31, which were associated with high-grade squamous intraepithelial lesions and squamous cell carcinoma of the cervix, vagina, or vulva.