Cervical Cytology and Age in HPV-Infected Women in North Macedonia: A Cross-Sectional Study.

OBJECTIVE

HPV infection is a key etiological factor in cervical epithelial alterations and neoplasia. Its prevalence and cytological impact vary with age, co-infections, and screening practices. This study investigated the association between HPV infection, age, and cervical cytological findings in women from North Macedonia.

MATERIALS AND

METHODS

This cross-sectional study included 300 women aged 26-66 years, who were screened over a 13-month period (June 2023-July 2024). The participants were divided into two age groups (26-36 and 37-66 years). All participants underwent Pap testing, HPV screening, and microbiological evaluation. Ordinal regression analysis was used to examine the associations between age, microbial factors, and HPV positivity.

RESULTS

HPV prevalence was higher in the 37-66 group (12.33%) than in the 26-36 group (6.0%). However, younger age showed a stronger statistical association with HPV positivity (OR=2.10; P<0.1). Cytological abnormalities, particularly LSIL/CIN I, were more prevalent in HPV-positive participants. The use of conventional Pap smears was associated with lower HPV detection (OR=0.16; P<0.05). Co-infection with Candida spp. and atrophic inflammation were inversely associated with HPV positivity.

CONCLUSION

This study confirmed the association between HPV infection and cytological changes, particularly in younger age groups. These results highlight the importance of age-tailored screening approaches and support the continued use of conventional Pap smears as cost-effective tools. Integrating virological and microbiological assessments may further refine cervical cancer prevention strategies, particularly in transitional healthcare systems across the Western Balkans.