Women With SLE Show Higher Rates of HPV Infection and Cervical Lesions

Women with systemic lupus erythematosus (SLE) face a significantly elevated risk of human papillomavirus (HPV) infection and cervical precancerous lesions compared to the general population, according to recent research. This increased susceptibility underscores the necessitate for enhanced screening and preventive care in this vulnerable group.

Understanding the Link Between SLE and HPV-Related Complications

Systemic lupus erythematosus is an autoimmune disease in which the immune system mistakenly attacks healthy tissue. This dysregulation, often exacerbated by immunosuppressive treatments used to manage SLE, impairs the body’s ability to clear HPV infections effectively. Women with SLE are more likely to experience persistent HPV infection, which can progress to cervical dysplasia and precancerous changes.

A systematic review of 33 studies found that 15 out of 18 studies analyzing cervical cytology reported a higher frequency of squamous intraepithelial lesions in women with SLE compared to healthy controls. Three studies specifically noted an increased prevalence of high-grade squamous intraepithelial lesions (HSIL), which are more likely to advance to cancer if untreated.

Further supporting these findings, a nationwide cohort study from Denmark published in 2025 revealed that women with SLE had a standardized incidence ratio (SIR) of 2.3 for cervical precancer — meaning they experienced more than twice the rate of cervical precancerous lesions compared to the general population. The risk was even higher for other anogenital precancers, with SIRs of 4.3 for vaginal and anal precancers, and 3.7 for vulvar precancers.

HPV Infection Rates Are Significantly Higher in SLE Patients

Molecular testing confirms that women with SLE have a higher frequency of detectable HPV infection. Immunosuppression, whether due to the disease itself or medications such as corticosteroids, azathioprine, or mycophenolate mofetil, reduces immune surveillance and allows HPV to persist longer in cervical tissue.

Five studies in the systematic review identified a direct association between cervical abnormalities and prior use of immunosuppressive drugs, reinforcing the role of treatment-related immune suppression in increasing HPV-related risks.

Cervical Cancer Risk: A Nuanced Picture

While the risk of HPV infection and precancerous lesions is clearly elevated, the relationship between SLE and invasive cervical cancer is more complex. The same Danish nationwide study found no statistically significant increase in cervical cancer incidence overall (SIR not significantly elevated), while trends were observed for oropharyngeal and anal cancers.

But, experts caution that the absence of a significant increase in cervical cancer may reflect effective screening practices or longer latency periods for cancer development. Given the clear rise in precancerous lesions, ongoing vigilance remains essential.

Clinical Implications and Recommendations

Due to their increased risk of HPV persistence and cervical dysplasia, women with SLE should be considered a high-risk population for cervical cancer prevention. Current guidelines from rheumatology and gynecology experts recommend:

• More frequent cervical cancer screening (e.g., Pap smears and HPV co-testing) than the general population.
• Adherence to HPV vaccination guidelines, ideally prior to immunosuppression initiation when possible.
• Regular gynecological evaluations, especially for women on long-term immunosuppressive therapy.
• Patient education about the importance of follow-up and symptom reporting.

Healthcare providers are encouraged to integrate cervical cancer screening into routine SLE management, treating it as a critical component of comprehensive care.

Key Takeaways

• Women with SLE have higher rates of HPV infection and cervical precancerous lesions than the general population.
• Immunosuppression increases the risk of persistent HPV and progression to dysplasia.
• While cervical cancer rates are not uniformly elevated, precancer rates are significantly increased — warranting closer monitoring.
• Proactive screening, vaccination, and patient education are essential preventive strategies.

By recognizing SLE as a risk factor for HPV-related cervical disease, clinicians can improve early detection and reduce the burden of preventable gynecologic complications in this population.