Features of the clinical course of endometriosis in papillomavirus infection

Aigul M. Khanova, Armine Robertovna Khachaturyan, Tatiana А. Khusnutdinova, Аlevtina M. Savicheva, Maria I. Yarmolinskaya
In: Journal of obstetrics and women's diseases · 2025 · vol. 73(6) , pp. 172–181 · doi:10.17816/jowd639963 · W4406924932
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Human papillomavirus, particularly high-risk genotypes, was found in 30% of endometriosis patients, associated with increased dyspareunia, pain, and vaginal dysbiosis.

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This retrospective study analyzed 185 outpatient records of women with genital endometriosis, dividing them into those with co-detected human papillomavirus (HPV; n=56) and those without (n=129), using complaints/anamnesis, objective examination, cytology, and molecular testing. HPV was detected in 30.3% of women with endometriosis, with the most common types reported as 31, 16, 18, 56, and 53; cervical cytology was largely NILM in both groups, with only a few LSIL cases in the HPV-positive group. Compared with HPV-negative endometriosis, the HPV-positive group had more dyspareunia (77 vs 42%), higher visual analogue pain scores (6.7 vs 5.9), and more impaired vaginal microbiocenosis, while the average endometriosis duration did not differ significantly (p=0.15). The paper’s main limitation is that it is retrospective and based on record review rather than prospective assessment of causal pathways. This paper is centrally about endometriosis — it characterizes the clinical course of genital endometriosis in relation to concurrent human papillomavirus infection.

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Abstract

Background: To date, the etiology and pathogenesis of endometriosis are still unclear and are determined by a number of factors (genetic, immunological and endocrine), including microbiological ones. Aim: The aim of this study was to characterize the clinical course of endometriosis in papillomavirus infection. Materials and methods: This retrospective analysis included 185 outpatient records of patients with genital endometriosis and comprised complaints, anamnesis data, objective examination, cytological and molecular biological examination results. All patients were divided into two study groups. Group 1 (main) consisted of patients with endometriosis and human papillomavirus (n = 56), and group 2 (comparison) included patients with endometriosis and no human papillomavirus (n = 129). Results: The frequency of human papillomavirus detection among patients with endometriosis was 30.3 (95% confidence interval 24–38)%. The most frequent types detected were 31 (20%), 16 (18%), 18 (18%), 56 (16%), and 53 (13%). The conclusion of cervical cytological examination: in group 1 was the following 54/56 patients had negative for intraepithelial lesion or malignancy (NILM) and 2/56 patients had low grade squamous intraepithelial lesion (LSIL), all patients in group 2 had NILM. The average duration of endometriosis was 8.2 ± 5.0 years for patients in group 1 and 9.4 ± 5.9 years for patients in group 2 (p = 0.15). We found differences between the study groups with respect to the following parameters: the average age of sexual debut was 17.82 ± 1.47 years and 18.53 ± 1.43 years for groups 1 and 2, respectively. Dyspareunia occurred in 77 (95% confidence interval 63–87)% of women in Groups 1 and in 42 (95% confidence interval 33–51)% in groups 2 (p 0.001). The average pain severity score according to the visual analogue scale was 6.7 ± 2.4 and 5.9 ± 2.8 points, respectively (p = 0.039). In group 1, impaired vaginal microbiocenosis was more common. Conclusions: Human papillomavirus was detected in every third woman with endometriosis, most often in genotypes of high carcinogenic risk. Among the features of the clinical course of endometriosis in the presence of human papillomavirus, more pronounced pain syndrome and symptoms of dyspareunia were noted. In the group of women with human papillomavirus, impaired vaginal microbiocenosis was more often observed.
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Abstract

Background: To date, the etiology and pathogenesis of endometriosis are still unclear and are determined by a number of factors (genetic, immunological and endocrine), including microbiological ones. Aim: The aim of this study was to characterize the clinical course of endometriosis in papillomavirus infection.

Materials and methods

This retrospective analysis included 185 outpatient records of patients with genital endometriosis and comprised complaints, anamnesis data, objective examination, cytological and molecular biological examination results. All patients were divided into two study groups. Group 1 (main) consisted of patients with endometriosis and human papillomavirus (n = 56), and group 2 (comparison) included patients with endometriosis and no human papillomavirus (n = 129).

Results

The frequency of human papillomavirus detection among patients with endometriosis was 30.3 (95% confidence interval 24–38)%. The most frequent types detected were 31 (20%), 16 (18%), 18 (18%), 56 (16%), and 53 (13%). The conclusion of cervical cytological examination: in group 1 was the following 54/56 patients had negative for intraepithelial lesion or malignancy (NILM) and 2/56 patients had low grade squamous intraepithelial lesion (LSIL), all patients in group 2 had NILM. The average duration of endometriosis was 8.2 ± 5.0 years for patients in group 1 and 9.4 ± 5.9 years for patients in group 2 (p = 0.15). We found differences between the study groups with respect to the following parameters: the average age of sexual debut was 17.82 ± 1.47 years and 18.53 ± 1.43 years for groups 1 and 2, respectively. Dyspareunia occurred in 77 (95% confidence interval 63–87)% of women in Groups 1 and in 42 (95% confidence interval 33–51)% in groups 2 (p < 0.001). The average pain severity score according to the visual analogue scale was 6.7 ± 2.4 and 5.9 ± 2.8 points, respectively (p = 0.039). In group 1, impaired vaginal microbiocenosis was more common.

Conclusions

Human papillomavirus was detected in every third woman with endometriosis, most often in genotypes of high carcinogenic risk. Among the features of the clinical course of endometriosis in the presence of human papillomavirus, more pronounced pain syndrome and symptoms of dyspareunia were noted. In the group of women with human papillomavirus, impaired vaginal microbiocenosis was more often observed. Full Text About the authors Aigul M. Khanova The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Author for correspondence. Email: [email protected] ORCID iD: 0000-0002-6438-5195 MD Russian Federation, Saint PetersburgArmine R. Khachaturian The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0003-2141-6307 SPIN-code: 2691-3910 MD, Cand. Sci. (Medicine) Russian Federation, Saint PetersburgTatiana A. Khusnutdinova The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-2742-2655 SPIN-code: 9533-9754 MD, Cand. Sci. (Medicine) Russian Federation, Saint PetersburgAlevtina M. Savicheva The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0003-3870-5930 SPIN-code: 8007-2630 MD, Dr. Sci. (Medicine), Professor, Honored Scientist of the Russian Federation Russian Federation, Saint PetersburgMaria I. Yarmolinskaya The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-6551-4147 SPIN-code: 3686-3605 MD, Dr. Sci. (Medicine), Professor, Professor of the Russian Academy of Sciences Russian Federation, Saint PetersburgReferences - Bulun SE, Yilmaz BD, Sison C, et al. Endometriosis. 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