High-risk human papillomavirus co-infection with other sexually transmitted infections and its association with cervical precancerous lesions in Ethiopian women: A cross-sectional study.

Objectives: This study aimed to determine the prevalence of high-risk human papillomavirus (hrHPV) and other sexually transmitted infection (STI) co-infections and assess their association with cervical cytological abnormalities among Ethiopian women aged 30-65 years. Methods: A facility-based cross-sectional study was conducted from May 2024 to March 2025 among 735 women attending 11 public health facilities found in six regions of Ethiopia. Cervical cytology, serological, and molecular tests were performed to detect hrHPV, HIV, syphilis, Results: Overall, 37.6% (95% confidence interval: 34.1-41.1%) of women had at least one type of STI; hrHPV was detected in 16.2%, HIV in 18.6%, syphilis in 5.0%, and CT in 3.7%. Cytological abnormalities were present in 5.7% of women, with 40.5% hrHPV positive. Among women positive for hrHPV, 42.1% had one or more STI co-infection, most commonly HIV (24.5%), syphilis (5.0%), and CT (4.2%). hrHPV/STI co-infection was strongly associated with cervical abnormalities (adjusted odds ratio = 5.85, 95% confidence interval: 2.68-12.74, Conclusion: Co-infections of hrHPV and other non-HPV STIs are common and strongly associated with cervical precancerous lesions. Integrating STI screening into cervical cancer prevention programs may improve early detection and reduce disease progression in Ethiopia.