Objective: To describe the long-term clinical outcomes of women diagnosed with human papillomavirus type 31 (HPV 31) infection and to assess its potential implications for genotype-specific cervical cancer risk stratification in a real-world screening setting.
Methods: This retrospective cohort study analyzed 106,450 women screened for cervical cancer at the Afyonkarahisar Cancer Early Diagnosis, Screening, and Education Center (KETEM) between 2015 and 2025. Among 3313 HPV-positive women, 147 cases with confirmed HPV 31 infection and complete follow-up data were included. Clinical outcomes, cytology results, and histopathological findings were compared across three groups: isolated HPV 31, HPV 31 co-infected with HPV 16/18, and HPV 31 co-infected with other high-risk genotypes.
Results: Biopsies were performed in 66 women (44.9%) due to abnormal cytology or HPV 16/18 co-infection. CIN2+ lesions were detected in 15 patients (22.7% of those biopsied; 10.2% of the entire cohort). The CIN2+ detection rate was 6.0% in isolated HPV 31 infections and 44.4% in women co-infected with HPV 16/18 (p = 0.0006). Notably, 13.9% of cytology-negative women were diagnosed with CIN2+ on histopathology. Two invasive cancers occurred in women with isolated HPV 31 infection and negative cytology at baseline.
Conclusion: HPV 31 infection demonstrated measurable oncogenic potential, particularly in cytology-negative women and those with HPV 16/18 co-infection. While isolated HPV 31 positivity alone may not warrant immediate colposcopy, these findings support the need for genotype-specific risk stratification in cervical cancer screening. Further multicenter and prospective studies are required to confirm these results.
Keywords: HPV 31; cervical cancer; genotype‐specific screening; human papillomavirus; risk stratification.
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