Prevalence of HSV-1, HSV-2, EBV, and HHV-8 Co-Infections Among HPV-Positive Women: A Cross-Sectional Study from Iran

Interactions between human papillomavirus (HPV) and co-infecting herpesviruses remain incompletely understood. This study assessed the prevalence of HSV-1, HSV-2, Epstein-Barr virus (EBV), and HHV-8 among HPV-positive women in Iran, and evaluated associations with HPV genotypic risk groups and genotype multiplicity.

This cross-sectional study analyzed 303 residual cervical cytology samples from HPV-positive women. Herpesviruses were detected using multiplex real-time PCR. Associations between herpesvirus positivity and HPV variables were examined using Logistic regression, Fisher's Exact Test and nonparametric statistics.

Co-infection of HPV with herpesviruses were detected in 20 of 303 samples (6.6%; 95% CI: 4.1-10.0), including HSV-1 in 2 samples (0.7%), HSV-2 in 10 samples (3.3%), EBV in 8 samples (2.6%), and HHV-8 in none of the samples. No significant associations were found between herpesvirus positivity and HPV risk group or HPV genotype multiplicity (p>0.05). Multivariable models did not identify independent predictors; analyses were limited by the low number of herpesvirus-positive cases and wide confidence intervals.

Co-infection of HPV with herpesviruses were uncommon among HPV-positive women and were not measurably associated with HPV genotype patterns. The low event frequency and cytology-based sampling likely contributed to nondetection of associations. Studies using tissue-based sampling, HPV-herpesvirus viral load, and high-grade lesions are needed to clarify potential viral synergism.