Distribution of high-risk human papillomavirus genotypes and associated risk factors among women with normal and abnormal cervical cytology in Lagos, Nigeria

Cervical cancer is the fourth most common cancer in women worldwide and is primarily driven by persistent infection with high-risk human papillomavirus (HR-HPV) genotypes. This study aimed to determine HR-HPV genotype distribution and associated risk factors in women with normal and abnormal cervical cytology in Lagos, Nigeria. A total of 165 sexually active women were recruited from a tertiary gynecology referral clinic between July 2017 and June 2018. Cervical cytology was assessed using Pap smears, whereas HR-HPV was detected and genotyped using nested and multiplex polymerase chain reaction (PCR) targeting 18 HR-HPV genotypes (13 established and 5 probable high-risk types). Sociodemographic and clinical data were collected via questionnaires and analyzed using SPSS version 21. Associations between HR-HPV prevalence and risk factors were evaluated using chi-square and logistic regression analyses. Factors independently associated with HR-HPV infection were subsequently identified using multivariable logistic regression with Firth’s penalized-likelihood method. Among the 165 participants, 93 (56.4%) were positive for at least one of the 13 established high-risk HPV genotypes, while 116 (70.3%) were positive for at least one of the 18 tested established or probable high-risk HPV genotypes, with HPV-35 emerging as the predominant genotype (43.6%), followed by HPV-82 (20.0%), and HPV-73 (9.1%). Among women with abnormal cytology (21.8%), HPV-35 was the most frequent genotype across all cytological grades. Dual and multiple HR-HPV infections were common, occurring in 34.5% of all participants. History of sexually transmitted infection was significantly associated with HR-HPV infection (OR, 2.97; 95% CI 1.43–6.17; P = 0.003); later sexual debut (≥ 21 years) and a higher number of lifetime sexual partners showed elevated but not statistically significant odds ratios. After multivariable adjustment, condom use (adjusted odds ratio [AOR], 0.19; 95% CI 0.08–0.45; P < 0.001) and history of sexually transmitted infection (AOR, 3.27; 95% CI 1.47–7.25; P = 0.004) remained independently associated with HR-HPV infection, whereas age, educational status, and marital status did not. This study revealed a high burden of HR-HPV among women in Lagos, with a predominance of genotypes not covered by current HPV vaccines. These findings underscore the urgent need for region-specific vaccine strategies, the integration of molecular diagnostics into routine screening, and targeted public health interventions to reduce HPV disease.