Diagnostic criteria for HPV infection classification: a comment on Wen et al

We read with great interest Wen et al.'s article on HPV infection in Huizhou men, commending this pioneering research as the first systematic analysis of HPV epidemiology in the region. The findings, including a 30.53% positivity rate and prevalent genotypes like HPV6, HPV52, HPV11, and HPV16, offer valuable insights for developing effective prevention strategies.

We are concerned, however, about the study's HPV classification methodology. Categorizing infections into "low-risk," "high-risk," and "mixed" (which includes any combination of high and low-risk genotypes) might obscure the true incidence of high-risk HPV infections. High-risk HPV types are strongly linked to malignant transformations. Hence, a single high-risk genotype poses a significant health risk, irrespective of low-risk co-infection. Grouping high-risk infections with low-risk types in the "mixed" category could therefore underestimate the proportion of patients with high-risk HPV.

For future research, we suggest presenting high-risk HPV prevalence by distinguishing between solely low-risk, solely high-risk, and high-risk mixed infections (multiple infections that include at least one high-risk genotype). This offers a more accurate understanding of the burden, aiding public health efforts, screening, and vaccination programs.