Introduction/Background*The distribution of human papillomavirus (HPV) varies geographically, and each country is making its own screening and vaccination program. This study questioned the need for colposcopy for HPV types other than HPV 16 and 18, and the need for cytology incorporated into HPV testing.

Methodology 1043 consecutive patients referred from August 2017 to November 2019 for colposcopy are included in the study. For statistical analysis, logistic regression analysis, ANOVA and Pearson’s correlation was used. The value of p <0.05 was considered statistically significant.

Result(s)*HPV 16 was the most common HPV type referred, followed by HPV 18, 52, 51 and 31, respectively. HPV 16 tends to be positive in younger patients than other HPV types (p <0.05). For all HPV positive patients with cytological abnormality, only HSIL cytology increased the risk of CIN 2+ lesions (OR:5.7, 1.1-29.6 95%CI) (p<0.05). 19% of the CIN 2+ lesions were detected in patients without HPV 16 and 18 infection (cytology and double other high-risk HPV positivity). Only HPV 16 (OR: 1.25, 0.9-2.2 95% CI) and HPV 33 (OR:2.76; 1,18-6.49 95% CI) (p<0.05) had prediction for CIN 2+ lesions. In patients with only a cytological abnormality or double other hr HPV positivity but without HPV 16 and 18 infection, we detected 159 (19%) CIN 2+ lesions.

Conclusion*HPV 33 may be implemented in high-risk HPV screening protocols for direct colposcopy referral among HPV 16 and HPV 18 in specific regions. If we had been opted HPV-based screening for only HPV 16 and 18 without cytology, 19% of all CIN 2+ lesions would have been missed. HPV based screening only with HPV 16 and 18 does not seem to be feasible. Nonavalent vaccines may be considered for vaccination for this specific sub-population.