Human Papillomavirus in the Neovagina of Transgender Women in Thailand: Prevalence, Diversity, and Associated Risk Factors

Background Transgender women (TGW) face unique sexual health challenges, including neovagina complications, with limited research on sexually transmitted disease prevalence and risk factors. This study aimed to investigate the prevalence, genotype diversity, and associated risk factors of human papillomavirus (HPV) infection in the neovagina of TGW in Thailand. Cisgender women (CGW) are included to provide contextual insights. Methods We conducted a cross-sectional study from April to October 2023, recruiting 63 TGW from gender care clinics and community health centers, and 25 CGW from routine gynecological checkups. Samples were collected via Papanicolaou test from the neovagina of TGW and the cervix of CGW for HPV testing. Participants completed questionnaires on sociodemographic characteristics, sexual behaviors, and health-related factors. Univariate Poisson regression was used to explore associations with HPV infection. Results Among TGW, 66.7% had any HPV type, with 41.3% being high-risk and 36.5% having multiple infections. In CGW, 24% had any HPV type and 20% had high-risk HPV. About 34.9% of TGW had 9-valent HPV vaccine-preventable types. Inconsistent condom use and syphilis exposure were associated with a higher risk of any HPV infection (risk ratio [RR] of 1.59 [95% confidence interval {CI}, 1.07-2.35] and RR of 1.57 [95% CI, 1.29-1.90]) and lack of awareness linked to high-risk infection (RR, 1.84 [95% CI, 1.04-3.24]) among TGW. Conversely, CGW showed vaginal and pelvic symptoms as the only risk factor. Conclusion This novel study of HPV prevalence in TGW neovaginas reveals a high burden of both high- and low-risk types, underscoring the urgent need for tailored prevention, education, vaccination, and screening.