Contemporary global prevalence and genotype distribution of human papillomavirus among female sex workers, 2015–2025: an updated systematic review and meta-analysis

Abstract Background Female sex workers experience disproportionate exposure to human papillomavirus (HPV), but estimates of HPV prevalence and genotype distribution vary according to geography, specimen type, diagnostic method, and genotype coverage. This updated systematic review and meta-analysis synthesized contemporary evidence published between February 2015 and December 2025. Methods PubMed/MEDLINE, Scopus, and Web of Science were systematically searched without language restrictions. Two reviewers independently screened records, extracted data, and critically appraised included studies using the JBI checklist for prevalence studies. One independent estimate was retained per study population for the primary analysis to avoid double-counting. Overall and type-specific HPV prevalence estimates were synthesized using random-effects generalized linear mixed models with logit transformation. Heterogeneity, prediction intervals, subgroup patterns, and sensitivity analyses were examined. The review was not prospectively registered. Results Thirty-six independent study/population estimates from 23 countries included 12,193 female sex workers, of whom 5,586 were HPV positive. The pooled HPV prevalence was 39.0% (95% confidence interval, 30.0%-48.9%), with very high heterogeneity (I²=97.6%) and a wide prediction interval (5.0%-88.6%). Prevalence varied across World Bank geographic regions, country income groups, diagnostic methods, and specimen types. Among genotypes assessed in at least 10 studies, HPV-52 had the highest pooled prevalence, followed by HPV-53 and HPV-16; HPV-58, HPV-35, and HPV-66 each had a pooled prevalence of 5.8%. Sensitivity analyses did not materially change the overall interpretation. Conclusions The available contemporary evidence indicates a substantial overall burden of HPV among female sex workers, although prevalence varies markedly across populations and settings. The broad genotype distribution includes both vaccine-targeted and non-vaccine types and underscores the relevance of vaccination, cervical cancer screening, and integrated STI/HIV prevention services for this population.