Age-specific HPV prevalence and genotype distribution in a highly vaccinated population

To examine age-specific patterns of human papillomavirus (HPV) infection and genotype distribution in the context of widespread HPV vaccination and to compare cohorts with differing vaccination exposure.

We conducted a cross-sectional study using routine HPV testing data from women undergoing HPV testing in the Comunidad Valenciana (Spain) between 2019 and 2024. HPV prevalence and genotype distribution were analyzed by age group. Women aged ≤30 years were considered a post-vaccination proxy cohort, whereas those aged >30 years represented a pre-vaccination cohort. Differences between groups were assessed using chi-square tests, logistic regression, and tests for linear trend. High-risk (HR) HPV genotypes were evaluated separately.

A total of 5,885 women were included. Overall HPV prevalence was 39.8%, and 24.2% of women were infected with at least one HR genotype. HPV prevalence peaked among women aged 20-29 years (57.9%) and declined with increasing age (p for trend <0.001). HPV and HR-HPV prevalence were higher in the post-vaccination cohort than in the pre-vaccination cohort (57.0% vs. 36.8% and 38.2% vs. 21.8%, respectively; p<0.001). Despite higher overall prevalence, the post-vaccination cohort showed a lower relative contribution of HPV16 and a more heterogeneous genotype distribution.

HPV prevalence showed a clear age-related gradient, with higher prevalence among younger women. The post-vaccination proxy cohort had higher overall HPV prevalence but a lower relative contribution of HPV16 and a more heterogeneous genotype distribution than the pre-vaccination cohort. These findings highlight the importance of considering age and genotype distribution when evaluating HPV epidemiology in highly vaccinated populations.