Universal colposcopy in HPV-positive women with negative Cytology: Lesion Prevalence and Predictive Factors

Abstract

Introduction: In women with human papillomavirus (HPV) infection and negative cytology, the identification of occult cervical lesions represents a clinical challenge. Studies report that up to 30% of cervical intraepithelial neoplasias (CIN) may go undetected in this group. Objective: To evaluate predictive factors for cervical lesions and the diagnostic performance of universal colposcopy in HPV-positive/cytology-negative women from Santa Clara, Cuba (2020-2024). Methods: Prospective cohort of 174 women aged 25-64 years. HPV genotyping (Cobas® 4800), universal colposcopy with targeted biopsy, and coinfection testing were performed. Statistical analysis included logistic regression (crude OR) and evaluation of diagnostic performance (sensitivity, specificity). English: Results: Prevalence of lesions: 55.2% (96/174; 74 CIN1, 18 CIN2, 4 CIN3). Significant predictive factors were HPV18: OR 3.43 (95%CI: 1.29-9.16), smoking: OR 3.52 (95%CI: 1.92-6.45), postcoital bleeding: OR 3.29 (95%CI: 1.78-6.08). The diagnostic yield of colposcopy shows a sensitivity of 90.6%, with 9.4% false negatives. Cytology, with a sensitivity of 94.8% and specificity of 20.5%. Conclusions: The high prevalence of lesions in more than half of the sample justifies universal colposcopy in HPV positive women with negative cytology. HPV18 genotype, smoking, and postcoital bleeding are key predictors for prioritizing follow-up. A triage algorithm based on HPV16/18 genotyping and risk factors is proposed.