Abstract
BACKGROUND: Human papillomavirus (HPV) is a prevalent sexually transmitted virus associated with various oral lesions. While oral HPV infections are common, there is a lack of comprehensive data on its prevalence in regions like Iran. This study aims to assess the prevalence of oral HPV infection in the Iranian population, comparing healthy individuals to those with oral lesions, including oral squamous cell carcinoma (OSCC), oral potentially malignant disorders (OPMDs), and benign lesions. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search was performed across PubMed, Scopus, and Web of Science, supplemented by manual search using google scholar and observational studies (case-control, cross-sectional, and case series) were included if they reported the prevalence of oral HPV infection in Iran. Data synthesis performed to calculate pooled prevalence rates, subgroup analyses by lesion type, and HPV subtype distribution. RESULTS: Of 85 screened studies, 48 were included in the qualitative synthesis, with 36 focused on lesion-bearing patients and 19 on healthy individuals. The overall prevalence of oral HPV infection was 18.3%, with a higher prevalence in lesion-bearing patients (27.1%) compared to healthy individuals (8.2%). The highest prevalence was observed in patients with OSCC (22.7%) and OPMDs (31.2%). HPV-16 was the most common subtype in both groups. A meta-regression analysis revealed a significant association between female sex and HPV detection. Comparative analysis showed significantly higher odds of HPV detection in individuals with oral lesions (OR = 4.78). CONCLUSIONS: Oral HPV infection is significantly more prevalent in individuals with oral lesions, especially for HPV-16 and HPV-18. This highlights the importance of HPV in oral health and underscores the need for multidisciplinary efforts to optimize interventions and reduce HPV-related oral disease burden, particularly in regions like Iran. TRIAL REGISTRATION: This study is registered with PROSPERO (Registration No. CRD42025641087).