Epidemiology and genotype distribution of cervical high-risk human papillomavirus infection among women in Punjab, India: A large-scale retrospective analysis

Abstract

The study aimed to determine the prevalence and genotype of high-risk human papillomavirus (HPV) among women in Punjab region and to assess the association between single/multiple HPV infections and cervical intraepithelial neoplasia (CIN). The study involved retrospective analysis of electronic health records for individuals, for which cervical samples were tested for HPV DNA using a real-time polymerase chain reaction assay (Seegene assay) between January 2023 and July 2025. The study included females participating in out-campus screening camps and those attending the department of preventive oncology for routine screening and consenting to undergo HPV testing. Overall HPV prevalence in the study population was 13.8% (544/3919). The most common genotypes were HPV-16 (35.7%), HPV-18 (14%), and HPV-66 (11%). Single genotype infections were most frequent (66.5%). The peak prevalence occurred in women of age group 36–40 years. Multiple HPV infections were significantly associated with higher CIN 2/3 lesions (χ 2 = 4.6; P = 0.032; odds ratio [OR] = 2.8). HPV-16 women had higher, though nonsignificant odds of developing high-grade CIN (OR = 1.96; P = 0.09). HPV-66-positive women had lower odds of developing high-grade CIN, though statistically nonsignificant (OR = 0.47; P = 0.33). There is substantial HPV burden in local population with HPV-16 and HPV-18 as the dominant genotypes. The unexpected high frequency of HPV-66 genotype warrants further molecular and epidemiological investigations. The study findings reinforce the need for implementing systematic large-scale HPV vaccination and HPV screening and molecular testing programs in India to achieve the World Health Organization’s cervical cancer elimination goals.