Endometriosis, High-Risk HPV Infection, and Colposcopic Abnormalities in HPV-Positive Women: A Cross-Sectional Study

Abstract Background Endometriosis is a chronic inflammatory gynecological disorder that may influence local immune responses and alter the clinical behavior of human papillomavirus (HPV) infection. Although HPV infection is a major cause of cervical epithelial abnormalities, the relationship between endometriosis and colposcopic findings among HPV-positive women remains insufficiently understood. This study aimed to evaluate the association between endometriosis, HPV risk typing, and colposcopic findings in women with confirmed HPV infection. Methods This cross-sectional study was conducted at Arash Women Hospital, Tehran University of Medical Sciences, between 2024 and 2025. HPV-positive women were classified according to the presence or absence of endometriosis. Demographic, reproductive, cytological, pathological, HPV genotyping, and colposcopic data were collected from clinical records, structured interviews, laboratory reports, and standardized colposcopic examinations. HPV types were categorized as high-risk or low-risk, and colposcopic findings were classified as normal, aceto-white changes, or coarse mosaicism. Statistical analyses included chi-square tests, independent-samples t-tests, odds ratios with 95% confidence intervals, and multivariable logistic regression. Results A total of 800 HPV-positive women were included. High-risk HPV was significantly more frequent among women with endometriosis than controls (73.3% vs. 40.5%; OR = 4.02, 95% CI: 2.99–5.42; p < 0.001). Abnormal colposcopy was also more common in the endometriosis group (69.5% vs. 17.8%; OR = 10.56, 95% CI: 7.57–14.74; p < 0.001). After adjustment, endometriosis remained independently associated with abnormal colposcopy (adjusted OR = 10.47; p < 0.001). Pap smear and biopsy pathology did not differ significantly between groups. Conclusion Endometriosis was associated with high-risk HPV infection and abnormal colposcopic findings among HPV-positive women, supporting individualized cervical surveillance in this population. Clinical Trial Registration Not applicable.