The prevalence of different HPV genotypes is changing after HPV vaccination. The associated risks are needed for optimizing cervical cancer screening.

To estimate HPV type-specific prevalence, OR, and PPV for cervical cytological abnormalities, we determined 41 different HPV genotypes in cervical samples from a population-based sample of 8351 women before the HPV vaccination era.

Prevalence of HPV16 was 4.9%, with the PPV for high-grade cytology 11.2%, and OR 11.9. Carcinogenic HPVs included in the nonavalent vaccine had a population prevalence of 14.4%, with PPV of 8.0% and OR 23.7 for high-grade cytology. HPV types currently included in most screening tests but not vaccinated had a joint prevalence of 8.5% with PPV of 4.4% and OR of 2.9 for high-grade cytology. The other 27 non-carcinogenic genotypes had a prevalence of 11.8%, PPV of 2.9%, and OR 1.5 for high-grade cytology.

The study concluded that HPV screening tests in the post-vaccination era might perform better if restricted to the HPV types in the nonavalent vaccine. Screening for all 14 HPV types might result in a suboptimal balance of harms and benefits.