Abstract
BACKGROUND: The relationship between high-risk human papillomavirus (HR-HPV) infection outcomes and cervical lesion recurrence after conization is well documented. However, the temporal dynamics of human papillomavirus (HPV) status post-conization, especially in postmenopausal women, remain unclear. METHODS: This retrospective cohort study consecutively enrolled 598 patients who underwent conization, all of whom had baseline HR-HPV positivity and histologically confirmed cervical intraepithelial neoplasia (CIN) 2-3. All patients had at least one follow - up HPV test after surgery. Temporal changes in HPV status following conization and their association with menopause were analyzed using Generalized Additive Mixed Models (GAMM). RESULTS: Among the 598 patients, GAMM analysis revealed a significant decrease in HPV positivity risk over time. Adjusting for confounders, the overall risk of HPV positivity decreased by 59% every 4 months within the first 24 months post-conization (OR: 0.41, 95% CI: 0.35-0.47). After 24 months, the risk continued to decline by 7% every 4 months (OR: 0.93, 95% CI: 0.81-1.06). Menopause status significantly influenced these temporal changes; postmenopausal patients had a 45% increased risk of HPV positivity every 4 months after conization compared to premenopausal patients (OR: 1.45, 95% CI: 1.13-1.85), particularly within the first 24 months (p = 0.0032). CONCLUSIONS: In patients undergoing conization, longitudinal HPV infection status changes were independently associated with menopause. The risk of HPV positivity decreased significantly in the first 24 months post-surgery, with a more pronounced decline in premenopausal patients, informing HPV testing strategies post-conization.