High-risk human papillomavirus co-infection with other sexually transmitted infections and its association with cervical precancerous lesions in Ethiopian women: A cross-sectional study

Abstract

• High prevalence of high-risk human papillomavirus and STIs shows a major public health burden. • Over 40% of hrHPV positive women had non-HPV STI co-infections. • Human papillomavirus and STI co-infections are linked to cervical precancerous lesions. • Findings support integrated HPV and STI screening, early diagnosis, and expanded HPV vaccination To determine the prevalence of high-risk human papillomavirus (hrHPV) and other sexually transmitted infection (STI) co-infections and assess their association with cervical cytological abnormalities among Ethiopian women aged 30–65 years. A facility-based cross-sectional study was conducted from May 2024 to March 2025 among 735 women attending 11 public health facilities found in six regions of Ethiopia. Cervical cytology, serological, and molecular tests were performed to detect hrHPV, Human Immunodeficiency virus (HIV), Syphilis, Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), Hepatitis B and C viruses. Descriptive statistics and logistic regression models were executed. Overall, 37.6% (95% CI: 34.1 - 41.1%) of women had at least one type of STI; hrHPV was detected in 16.2%, HIV in 18.6%, syphilis in 5.0%, and CT in 3.7%. Cytological abnormalities were present in 5.7% of women, with 40.5% hrHPV-positive. Among hrHPV-positive women, 42.1% had ≥1 STI co-infection, most commonly HIV (24.5%), syphilis (5.0%), and CT (4.2%). hrHPV/STI co-infection was strongly associated with cervical abnormalities (AOR=5.85, 95% CI: 2.68–12.74, p<0.001). Co-infections of hrHPV and other non-HPV STIs are common and strongly associated with cervical precancerous lesions. Integrating STI screening into cervical cancer prevention programs may improve early detection and reduce disease progression in Ethiopia.