Prevalence of sexually transmitted infections and association between high-risk HPV and cytopathological abnormalities in women residing in the Lower São Francisco region, Northeastern Brazil

Abstract

Genital pathogen proliferation constitutes a significant public health challenge due to its repercussions on reproductive wellbeing and the high frequency of asymptomatic or polymicrobial presentations. Objective: To evaluate the prevalence and distribution patterns of genital microorganisms — highlighting infections by Ureaplasma spp., Mycoplasma spp., Trichomonas vaginalis, and Human Papillomavirus (HPV) — as well as to identify associated factors. Methodology: Cross-sectional, quantitative, and analytical study involving 151 women receiving care in Primary Health Care within the Baixo São Francisco region, Alagoas, Brazil. Participants completed a sociodemographic questionnaire and underwent liquid-based cytology screening alongside molecular detection using qPCR. Bivariate associations were assessed via Pearson’s Chi-square test (p < 0.05), and associations with sociodemographic and clinical variables were estimated through Multivariate Poisson Regression with robust variance (PRa; 95%CI). Results: Overall pathogen prevalence reached 41.06% (n = 62). HPV-DNA was identified in 19.2% of participants (n = 29/151), categorized as high oncogenic risk in 12.6% (n = 19), low risk in 4.0% (n = 6), and multiple/mixed genotype infections in 2.6% (n = 4). Among the 62 women positive for non-viral agents, Ureaplasma parvum was the predominant microorganism (85.5%; n = 53), followed by Mycoplasma hominis (24.2%; n = 15), Ureaplasma urealyticum (8.1%; n = 5), and Trichomonas vaginalis (1.6%; n = 1). Regarding infection profiles, 82.3% (n = 51) exhibited single infections, 16.1% (n = 10) dual co-infections, and 1.6% (n = 1) triple co-infections. Vaginal discharge emerged as the primary clinical complaint (68.4%), whereas 12.3% remained asymptomatic. Detailed analysis of co-infected cases (n = 24) revealed Ureaplasma spp. co-occurrence in 54.2%. Multivariate Poisson regression revealed no statistically significant association with individual sociodemographic determinants. Conclusion: Findings underscore the elevated occurrence of Ureaplasma parvum and its strong co-infection rates with HPV within a socially vulnerable, homogeneous group, demonstrating the necessity of expanded molecular screening to optimize diagnostic precision and clinical management.