Prevalence and genotype distribution of human papillomavirus (HPV) in an at-risk and suspected population in Iran

Invasive cervical cancer is primarily caused by human papillomaviruses (HPV). In developing countries, HPV and viral hepatitis together are responsible for a quarter of all cancers. Valid regional data on the distribution of HPV types in men and women affected and unaffected by cervical cancer is vital for predicting the effectiveness of current vaccines and enhancing screening programs. This study was conducted to examine the prevalence and genotypes of HPV in suspected and at-risk populations of men and women in a center in Tehran. This study was conducted from September 2023 to September 2024, during which 121 male and 93 female sexually active subjects were investigated to detect HPV and determine the high-risk and low-risk HPV strains. Pap smear samples were histologically examined, and then, HPV detection and genotype identification were performed using the INNO-LiPA HPV Genotyping Extra II Amp genotype via specific primers MY09 and MY11. Overall HPV prevalence was 28%, of which 43.4% of individuals were infected with high-risk HPV genotypes. The most common high-risk genotypes among both male and female subjects were HPV16 and HPV31. The remaining high-risk genotypes identified among infected women were HPV18, HPV35, HPV39, and HPV58, with a prevalence of 8.3% each. No significant differences were observed between men and women in the distribution of high-risk (χ² (6) = 4.85, P = 0.505) or low-risk HPV genotypes (χ² (3) = 2.24, P = 0.168, Fisher’s exact test); nor between gender and cytological findings in HPV-positive participants with abnormalities (χ² (2) = 3.56, P = 0.094). Also, Atypical squamous cells of undetermined significance (ASC-US) and Low grade squamous intraepithelial lesion (LSIL) were more common in women with OR = 0.52 and 0.50, respectively, while High grade squamous intraepithelial lesion (HSIL) were more frequent in men with OR = 4.67; 95% CI: 0.82-26.48, P = 0.087. This study presents sex-disaggregated data on HPV genotype distribution and associated cytological abnormalities in an at-risk Iranian population. These findings inform vaccine policy, emphasize the importance of including men in prevention strategies, and, given the high prevalence of high-risk HPV vaccine strains observed, will improve forecasts of vaccine impact on cervical cancer and aid in developing enhanced screening procedures.