Cervical cytological abnormalities and human papillomavirus status in HPV-vaccinated and unvaccinated women: a cross-sectional study

To investigate the association between HPV vaccination status and cervical cytological findings, HPV prevalence, and genotype distribution among Iranian women, providing real-world evidence from a population with limited epidemiological data.

A cross-sectional study was conducted from March 2023 to February 2024 among 216 women aged 30-65 years attending a tertiary gynecology clinic in Babol, Iran. Participants underwent liquid-based cytology and HPV DNA genotyping. Demographic and clinical data were collected using structured questionnaires and medical records. Comparisons between vaccinated and unvaccinated women were performed using appropriate statistical tests.

Overall HPV prevalence was 39.8%. HPV infection was less frequent among vaccinated women (33.3%) than unvaccinated women (42.9%), although the difference was not statistically significant (P = 0.18). Vaccine-targeted HPV types 16 and 18 were not detected in vaccinated women. The distribution of high-risk HPV genotypes differed significantly between vaccinated and unvaccinated participants (P < 0.001), with non-vaccine high-risk genotypes predominating among HPV-positive vaccinated women. No significant association was observed between HPV vaccination status and abnormal cervical cytology.

HPV vaccination was associated with the absence of vaccine-targeted HPV types 16 and 18 and with differences in HPV genotype distribution. However, non-vaccine high-risk HPV types remained common among vaccinated women, supporting the continued importance of cervical cancer screening alongside HPV vaccination. These findings provide novel epidemiological data on HPV genotype distribution among vaccinated and unvaccinated Iranian women and may help inform future HPV prevention strategies.