Concurrent cervical and extra cervical HPV-related lesions: an observational study

Purpose This prospective observational study aims to determine the prevalence of concurrent Human Papillomavirus (HPV) infections in different anatomical sites in patients with a cervical HPV (cHPV) infection. Methods Patients with cHPV infection referred to the Gynecological HPV Unit of Policlinico Umberto I, Sapienza, University of Rome were recruited. Inclusion criteria were: women >= 25 and < 80 years old; positive cHPV-DNA test; signed informed consent. The exclusion criteria were: (I) pregnancy; (II) previously treated cancer in the investigated sites (cervical, oral and anal districts); and (III) any cancer under active treatment. All enrolled patients underwent gynecological examination, Pap-smear, colposcopy and, if appropriate, biopsies. Recruited patients were addressed to proctological (High Resolution Anoscopy-HRA/ HPV DNA/ Pap smear), otorhinolaryngological (laryngoscopy and biopsy when appropriate) and odontostomatological evaluation (clinical examination and biopsy when appropriate) in the corresponding Departments of Policlinico Umberto I involved in the multidisciplinary unit. Results From March 2022 to December 2023, 150 patients were enrolled in the study. The cervical Pap test was abnormal in 101 patients (67.3%); 46 patients (30.5%) reported a cervical intraepithelial neoplasia Grade 2 + (CIN2 +) after cervical biopsies. Anal HPV (aHPV) test was positive in 77 patients of 150 (51.3%), 93 patients underwent HRA reporting anal high grade squamous intraepithelial lesion (aHSIL) in 39% and anal low grade squamous intraepithelial lesion (aLSIL) in 46.9% of 64 patients subjected to biopsies. Eighty-one women (54%) refused odontostomatological examination. HPV related oral and laryngeal lesions were detected in 8 of 69 and 10 of 150 patients respectively. Cervical/anal coinfection was frequent (67%) and mostly observed in CIN2 + patients (p < 0.05), regardless of age, immunosuppressive conditions or smoking habits. Cervical/otorhinolaryngological and cervical/odontostomatological coinfection were rare (6.7% and 2.9% respectively). Conclusions In CIN2 + patients the risk of aHPV coinfection is non-negligible; these findings prompt us to consider anal brushing in these patients. On the other hand, data regarding oral and laryngeal HPV lesions do not support its routine evaluation. Future and larger studies are needed to consolidate these hypotheses of our exploratory study, paving the way to multidisciplinary guidelines for future practice.