The Impact of COVID-19 Vaccination on HR-HPV Persistence and Cervical Cytology Outcomes: A Retrospective Study

Mustafa Şahin,1 Tufan Arslanca2 1Department of Gynecologic Oncology, Konya City Hospital, Konya, Türkiye; 2Department of Gynecologic Oncology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, TürkiyeCorrespondence: Mustafa Şahin, Department of Gynecologic Oncology, Konya City Hospital, Istiklal District, Adana Ring Road Avenue No: 135/1, Karatay, Konya, 42020, Türkiye, Tel +90 05458585420, Email mustafasahin1163@gmail.comPurpose: This study investigates the potential impact of coronavirus disease 2019 (COVID-19) vaccination on the persistence of high-risk human papillomavirus (HR-HPV) and cervical cytopathological outcomes. While targeted vaccines like the HPV vaccine are established modifiers of viral clearance, the influence of non-targeted systemic platforms and whether they exert any “bystander” immune effect on HR-HPV remains under-explored.Methods: In this retrospective study, clinical data were obtained from the colposcopy database and electronic health records of a tertiary care center in Turkey. A total of 1,435 HR-HPV positive women were analyzed over a mean follow-up period of 18.4 months. Participants were divided into COVID-19 vaccinated (n=723) and unvaccinated (n=712) groups. To isolate the specific impact of systemic immunization, individuals with prior COVID-19 infection, HPV vaccination, or cervical surgical procedures were excluded. Statistical analyses were performed using SPSS v22.0. HR-HPV persistence and cytological progression were compared using Pearson’s Chi-square and Fisher’s exact tests. Selection bias was ruled out via attrition analysis, and vaccination influence was assessed using multivariate logistic regression adjusted for age and follow-up duration.Results: At the 18.4-month follow-up, the estimated prevalence of HR-HPV persistence showed no statistically significant difference between the COVID-19 vaccinated and unvaccinated groups (p=0.600; 95% CI: − 2.91 to 5.11). Persistence status for highly oncogenic genotypes appeared comparable for HPV-16 (p=0.922; 95% CI: − 9.0 to 10.0) and HPV-18 (p=0.927; 95% CI: − 15.8 to 14.4). Multivariable logistic regression analysis confirmed that vaccination status (aOR=1.108; 95% CI: 0.75– 1.63) was not an independent risk factor for persistence. Furthermore, the prevalence of cervical precancerous lesions, including abnormal cytology (p=0.095) and biopsy-confirmed findings such as LSIL and HSIL (p=0.315; 95% CI: − 8.8 to 19.4), remained similar across both cohorts. While HR-HPV related cervical cancers remain a significant global burden with high estimated incidence, our data demonstrated that systemic COVID-19 vaccination does not increase the risk of cytological progression or interfere with the natural clearance of high-risk genotypes.Conclusion: Systemic COVID-19 vaccination does not appear to influence the natural history of HR-HPV. Our findings suggest a state of immune compartmentalization where systemic immunization remains independent of localized cervical dynamics. Unlike targeted mucosal vaccines, these platforms maintain a neutral effect on viral clearance.Keywords: COVID-19 vaccination, high risk HPV in women, HPV persistence, cervical cytology, mucosal immunity