HPV genotype distribution and cervical lesions in colposcopy-referred women in Western China: a cross-sectional study

HPV genotype distribution and sociodemographic patterns of cervical lesion severity remain under-characterized for colposcopy-referred populations in multiethnic western China. This evidence gap impedes precision triage for clinical populations selected through screening thresholds.

To delineate HPV genotype composition and examine sociodemographic profiles associated with biopsy-confirmed cervical lesion grades within a single-center hospital-based colposcopy-referred population in Xinjiang.

Cross-sectional analysis of 2,934 patients who underwent colposcopy with complete biopsy data at People's Hospital of Xinjiang Uygur Autonomous Region (January 2018-June 2025). Associations were evaluated using chi-square tests with standardized residual analysis. Multivariable binary logistic regression identified sociodemographic determinants of high-grade lesions (CIN2+), while restricted cubic splines characterized non-linear age effects. Joint logistic classifiers combining HPV16/18 positivity with ordinal TCT results were constructed, and pairwise AUC comparisons were performed using the DeLong test.

Within the referral population, high-grade lesions (CIN2+) constituted 44.2% of biopsy specimens. HPV16 accounted for 46.0% of HPV-positive detections, increasing to 70.4% among cervical cancer specimens. HPV52 (9.2%) and HPV58 (8.5%) formed a secondary genotype cluster. For CIN3+, the joint classifier significantly outperformed HPV16/18 or TCT alone (AUC 0.712), whereas for CIN2 + the incremental gain was marginal. Age distribution exhibited a dominant bimodal pattern (peaks at ~ 35 and ~ 51 years), with high-grade precancerous lesions concentrated among patients < 40 years and invasive cancer among those ≥ 50 years. After multivariable adjustment, illiteracy (aOR 2.83, 95% CI 1.58-5.07) and physical-labor occupation (aOR 0.54 vs. mental labor) remained independently associated with CIN2+.

In this Xinjiang colposcopy-referred population, HPV16 predominates among high-grade lesions, while HPV52/58 constitute a consequential secondary cluster. These findings support a three-tiered conceptual framework for refining triage: genotype-informed cytology allocation, sociodemographic risk weighting alongside virological data, and intensified surveillance for postmenopausal women with abnormal screening history. Prospective external validation is required before operationalization.