Need for gender-neutral HPV vaccination: Lessons from a retrospective epidemiologic investigation of HPV infections among outpatients presenting to a tertiary dermatology hospital in central China from 2017 to 2024

• Genital warts were predominantly observed in both male and female cases. • Positive rate of HPV was significantly higher in male than that in female. • Multi-genotype infections were observed in 39.6% of cases, particularly among young, single individuals. • High proportion of asymptomatic HR-HPV infections poses challenge for early intervention. • HPV6 was the most dominant genotype with 46.2% co-infected cases observed in the cohort. This study aimed to analyze human papillomavirus (HPV) prevalence, genotype distribution, and associated clinical characteristics among outpatient individuals attending a tertiary dermatology hospital in Central China, to inform public health strategies. A retrospective analysis was conducted on electronic health records of 3,001 outpatients from 2017 to 2024. HPV genotyping was performed using a flow fluorescent hybridization assay detecting 27 genotypes (17 high-risk [HR], 10 low-risk [LR]). The overall HPV positivity rate was 31.4%, significantly higher in males than females (34.8% vs. 28.9%, p<0.001). The predominant HR-HPV genotypes were HPV16 (20.9%), HPV52 (20.1%), and HPV51 (13.8%); LR-HPV infections were mainly HPV6 (51.1%), HPV11 (22.8%), and HPV43 (14.4%). Multi-genotype infections occurred in 39.6% of cases, notably among young, single individuals. Genital warts were the primary clinical manifestation. Asymptomatic presentation was significantly more prevalent in HR-HPV versus LR-HPV infections (p<0.001). Cases were geographically concentrated near the hospital, indicating healthcare access disparities. The findings highlight high HPV prevalence and significant co-infection rates in Central China, emphasizing the risk of hidden HR-HPV transmission. Implementing gender-neutral vaccination (covering prevalent genotypes like 6, 11, 16, 18, 52, 58) and enhancing screening (e.g., colposcopy, self-sampling in rural areas) are crucial public health priorities.