Association of High-risk Human Papillomavirus Titer and Pathogenic Co-infections with Cervical Tissue Cytopathology

Human papillomaviruses (HPV) are one of the first viral organisms acknowledged to causing carcinogenesis. Among gynecologic cancers, Pap smear represents a gold standard diagnostic procedure for precancerous cervical lesions. It is efficiently interpreted through a standardized reporting system; The Bethesda System, which aids in distinguishing squamous categories from other entities. Co-infections with other sexually transmitted infections (STIs) could exacerbate cervical lesion severity caused by initial HPV infection as co-infections can lead to distinct reprogramming of host cells and genome integrity. The intricate pathways and effect of the unique cellular microenvironment that HPV and co-infecting STIs create that cause local inflammation and eventually cervical lesion progression will be reviewed in this manuscript. Besides, it is also crucial to consider HPV viral load and distinguish its correlation with cervical lesion severity. Varying amounts of viral titer and its impact on cervical lesions could indicate a mutagenic transformation of the human host cells and HPV. Thus, this review aims to discuss the correlation of co-infections and viral titer on cervical lesion severity and its progression to cancer. Based on these factors, clear clinical reasoning with more effective treatment plans and specific diagnostics can be achieved.