Prevalence and potential implications of HPV infection in transgender women with gender reaffirming genital surgery: a systematic literature review and meta-analysis

Background Human papillomavirus (HPV) is a common infection of the anogenital tract. Although most infections clear, persistent infections with oncogenic types can predispose to cancer. While the natural history of anogenital HPV infection in cisgendered women is relatively well understood, there are significant knowledge gaps regarding HPV prevalence and clinical implications of genital HPV infection in transgender women (TGW) with neovagina(s).

Methods A systematic review, including meta-analysis, of studies available in the literature with data on HPV prevalence in TGW with neovaginas was performed. Additionally, a narrative analysis of the clinical manifestations of genital HPV infections in TGW with neovagina(s) was performed.

Results 21 studies were included; six focused on the prevalence of HPV in TGW, and data were pooled in a meta-analysis of prevalence; 15 were case reports/series, which were included in a narrative analysis of clinical implications. The meta-analysis showed the prevalence of genital HPV in TGW with neovaginas was 15% (95% CI 9% to 21%). The most frequently detected HPV type was HPV 16. 18 TGW were included in case reports/series and the median age was 42; 12 presented with condylomata acuminata and six had squamous carcinoma.

Conclusion Data on genital HPV prevalence in TGW with neovaginas are sparse, with many studies having small denominators. We report higher HPV prevalence compared with cisgendered women. Symptomatic genital HPV infection in TGW with neovaginas was largely associated with benign condylomata, although some carcinoma was detected. Future longitudinal studies are required to elucidate the clinical impact of genital HPV infection and examine its implications in TGW with neovaginas in order to inform prevention and management strategies.