Among Tunisian women, cervical cancer (CC) ranks second most prevalent after breast for gynaecological cancer [1]. With a poor efficiency of pap screening preventive strategy, an incidence of 3,8% (342 new cases in 2020) and about 200 deaths per year, CC represents a major health issue in Tunisia. Human Papillomavirus (HPV) infection is the etiological agent for the development of precancerous and cancerous lesions of the cervix [2]. It is known that most HPV infections are self-limited, and the data show that 90% of infections are cleared within a few years, but approximately 10% of low squamous intraepithelial lesions (LSIL) progress to High grade squamous intraepithelial lesion (HSIL) [3], [4], [5].

Currently, about 200 different HPV types have been identified [6, 7]. According to their oncogenic potential, they have been subdivided into Low-risk (LR-HPV) and High-risk (HR-HPV), of which 40 infect anogenital region. Approximately 15 to 18 of these HPV strains have been classified as HR-HPV genotypes which are responsible of cervical neoplasia and cancers. The most common HR-HPV genotypes are HPV16 and HPV18 and are incriminated in about 70% of all cervical cancer cases [8].

There is wide consensus that women with high-grade cytological lesions detected at cervical cancer screening need further diagnostic work-up. However, follow-up guidelines in cases of minor cytological abnormalities vary between countries and include cytological surveillance, triage using HPV DNA or RNA testing or referral for colposcopy [9, 10]. Therefore, intensive research has been conducted over recent years to elaborate improved management procedures. Women with minor cervical cytological lesions such as atypical squamous cells of undetermined significance (ASC-US) or LSIL have a small but significantly increased risk of developing CC compared to women with normal smears. Reviews of the natural history of cervical epithelial atypia or low-grade squamous lesions indicate that the 2-years cumulative risk of invasive CC is in the range of 0.10–0.25% [3, 11]. Therefore, careful management of these lesions is warranted and the challenge is to discriminate accurately between those having underlain or incipient cancer precursors and those that can be released safely to routine screening 3 or 5 years later.

In Tunisia, the management of patients with a minor cytological abnormality is essentially based on the colposcopy examination. Although WHO guidelines recommend to integrate HPV testing in cervical cancer screening [12, 13], it is rarely used and not yet implemented as a screening tool in Tunisia..

In this context, this study aimed to evaluate the prevalence and the distribution of HR HPV among women with LSIL or ASC-US, in order to point out the importance of HPV testing in the triage of women with LSIL in Tunisia and to optimize current and future screening programs.