Psychological and economic burden of high-risk human papillomavirus infection of the female genital tract in Liuzhou, China

We examined how anxiety influences treatment choices and economic burden in patients with high‑risk human papillomavirus (HR‑HPV) infection. A total of 412 h‑HPV‑positive outpatients were grouped by treatment preference: observation, interferon, loop electrosurgical excision procedure (LEEP), or focused ultrasound (FUS). Data on anxiety (SAS), quality of life (QoL), costs, and 12‑month HPV clearance were collected. Propensity score matching balanced baseline characteristics. The 12‑month clearance rates were 38.7–39.5% (observation), 58.6% (interferon), 82.9% (LEEP), and 80.6% (FUS) (all P < 0.05). FUS was associated with the greatest observed anxiety reduction among the active treatment groups. Higher baseline anxiety increased the likelihood of choosing active treatment, especially interferon (OR = 1.403) and LEEP (OR = 1.102). Multivariable regression showed baseline anxiety was not independently associated with clearance (OR = 0.983, P = 0.382), while active treatment was significantly associated with clearance (OR = 3.491, P < 0.001). Baseline QoL independently predicted clearance (higher QoL, lower HIP score, associated with greater odds). Low income favoured active treatment, while lower education reduced LEEP/FUS choice. FUS had the most favourable cost‑effectiveness ratio (73.83 CNY per 1% clearance increase). Anxiety drives treatment decisions but does not directly enhance viral clearance. Individualized management should integrate psychological, socioeconomic, fertility and follow‑up considerations.