Abstract C157: The impact of HPV status and history of other STIs on cervical lesion severity in a cohort of pregnant women living in Puerto Rico

Abstract

Human papillomavirus (HPV), a known causative agent of cervical cancer, has a lifetime prevalence of 80%. Pregnancy-related immune changes and other sexually transmitted infections (STIs) such as chlamydia, gonorrhea, herpes simplex virus 2, human immunodeficiency virus, and bacterial vaginosis may influence HPV persistence and cervical dysplasia. To the best of our knowledge, no study has examined these predictors together in pregnant women living in Puerto Rico. We hypothesized that high-risk HPV (hr-HPV) genotypes and STI history would be associated with more severe cervical lesions in this population. This retrospective sub-analysis included 126 pregnant women recruited at two clinics located in San Juan, Puerto Rico between 2016 and 2024. Patients completed a questionnaire self-reporting history of STIs and other relevant risk factors. Cervicovaginal samples were HPV typed using SPF10-LiPA25 or Atila AmpFire systems, and cytology was evaluated using a liquid-based method. Colposcopy was indicated for patients with cytology ≥ ASC-US and/or a positive HPV result; cervical lesion grade was determined by clinician consensus using cytology and/or pathology results. Associations between HPV status, history of other STIs, and cervical lesion severity were assessed using Fisher's exact test and binary/ordinal logistic regression, adjusting for age and pregnancy trimester. HPV prevalence was 59.5% with HPV-52 and HPV-16 being the most prevalent genotypes. HPV-positive women had 5.61 times the odds of abnormal cervical lesions compared to HPV-negative women (95% CI: 2.41-13.06). HPV-16/18 positive women showed 6.73 times the odds of severe lesions compared to HPV-negative women (95% CI: 2.44-18.54). Past medical history of STIs was 38.1%, with chlamydia the most reported STI (17.5%). History of other STIs was not independently associated with lesion severity (adjusted OR=1.57, 95% CI: 0.65-3.79). Elevated vaginal pH was independently associated with increased lesion severity (OR=4.63, 95% CI: 1.71-12.51), and HPV vaccination was protective against high-grade cervical lesions (OR=0.26, 95% CI: 0.08-0.81). HPV status, but not past medical history of STIs, independently predicted cervical lesion severity in our cohort of pregnant patients, with HPV-16/18 showing the strongest association. Elevated vaginal pH was independently associated with lesion severity, suggesting vaginal dysbiosis as an additional, modifiable risk factor. HPV vaccination showed a protective association against high-grade cervical lesions, reinforcing its role as a critical prevention strategy for reproductive-age and pregnant women. These findings address a key gap in the literature on HPV and cervical dysplasia in pregnant women in Puerto Rico and support incorporating HPV genotyping and vaginal pH assessment into cervical lesion screening during pregnancy, while reinforcing the value of HPV vaccination in reducing lesion risk. Julieann M. Colón-Sarriera, Andrea Cortés-Nazario, Filipa Godoy-Vitorino, Josefina Romaguera. The impact of HPV status and history of other STIs on cervical lesion severity in a cohort of pregnant women living in Puerto Rico [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr C157.