Abstract
BACKGROUND: Condyloma acuminata (CA) is primarily caused by low-risk human papillomavirus (LR-HPV); however, high-risk HPV (HR-HPV) co-infection is increasingly reported and cannot be reliably distinguished based on clinical appearance alone. Histopathological assessment and selected immunohistochemical markers may help identify lesions with greater biological risk. OBJECTIVE: To evaluate the association between histopathological features, p16 and p62 expression, and HR-HPV co-infection in anogenital CA. METHODS: This cross-sectional study included 81 histopathologically confirmed CA cases. Semi-quantitative scoring was applied to lesion morphology, keratinization patterns, koilocytosis, atypical mitoses, and lymphocytic infiltration. p16 and p62 expression were assessed immunohistochemically. HPV genotyping was performed using real-time PCR. Variables significant in bivariate analysis were entered into multivariate logistic regression. RESULTS: HR-HPV co-infection was detected in 59.3% of cases, with HPV-16 as the most frequent genotype. Hyperkeratosis (aOR = 4.29; p = 0.039) and atypical mitotic activity (aOR = 14.29; p < 0.001) were independently associated with HR-HPV co-infection. Parakeratosis and koilocytosis showed inverse associations. p16 and p62 were not independent predictors, although p16 block positivity correlated with high p62 expression (p < 0.001). CONCLUSION: Certain histopathological features, particularly atypical mitoses and hyperkeratosis, are associated with HR-HPV co-infection in anogenital CA. Routine histopathological evaluation may therefore provide practical clues to identify lesions that warrant closer clinical attention, while p16 and p62 offer complementary biological information.