Diverse non-vaccine high-risk HPV genotypes in rural Kerala: implications for cervical cancer prevention in an underserved population

BACKGROUND: The distribution of high-risk human papillomavirus (hrHPV) genotypes varies across populations and directly influences cervical cancer prevention strategies. Data from underserved rural populations remain limited. METHODS: A community-based screening study was conducted among 358 women from rural and tribal regions of Kerala, India. High-risk HPV was detected using real-time PCR, and non-16/18 genotypes were identified through L1 gene sequencing and phylogenetic analysis. RESULTS: The prevalence of hrHPV infection was 2.23% (8/358). Detected genotypes included HPV16, HPV31, HPV35, HPV45, HPV66, and HPV70. All detected infections were due to high-risk HPV genotypes, of which three were non-vaccine high-risk types. Phylogenetic analysis demonstrated close similarity with globally circulating strains. CONCLUSIONS: Despite low prevalence, the presence of diverse non-vaccine hrHPV genotypes highlights a potential gap between circulating strains and current vaccine coverage. These findings highlight the importance of continued region-specific HPV surveillance in underserved populations and provide baseline epidemiological data for future studies evaluating cervical cancer prevention strategies.