Evaluation of Genital Lesions and HPV Genotype Diversity in 130 Iranian Women: Highlighting the Diagnostic Superiority of HPV PCR and Colposcopy over Conventional Cytology

Background: Human Papillomavirus (HPV) infection is a major health concern worldwide that can cause serious diseases and represents the leading cause of cervical cancer. Pap smear cytology has low sensitivity for detecting high-risk genotypes. We evaluated 130 Iranian women to demonstrate the clinical superiority of molecular HPV PCR and colposcopy over conventional cytology in accordance with ESMED guidelines. Methods: A retrospective evaluation of 130 female patients referred to Maad Pathobiology Laboratory was conducted using anonymized secondary data involving simultaneous Pap smear cytology, multiplex Real-Time PCR (32 mucosal HPV genotypes), and colposcopy-directed punch biopsy. Results: 100% of participants were HPV-positive (64.6% single, 35.4% coinfections). High-Risk genotypes predominated: HPV 16 (27.7%) and HPV 18 (14.6%). Histology revealed LSIL/CIN I in 51.5%, Benign in 25.4%, Chronic Endocervicitis in 13.8%, and HSIL/CIN II/III in 9.2%. Pap smear misclassified 41.8% of high-risk cases as normal/inflammatory and underreported 33.3% of HSIL/CIN II+ lesions (p < 0.001). Conclusion: Molecular HPV PCR and colposcopy are far more trustworthy than Pap smear cytology and should be prioritized in routine clinical practice based on ESMED guidelines.