Clearance of high-risk human papillomavirus in patients with cervical intraepithelial neoplasia 2-3 after the loop electrosurgical excision procedure with negative resection margins.

OBJECTIVE: This study aims to evaluate the longitudinal clearance rates of high-risk human papillomavirus (hr-HPV) and the incidence of clinical recurrence (defined by abnormal cytology or histologically confirmed cervical intraepithelial neoplasia; CIN) at 6 and 18 months post-loop electrosurgical excision procedure (LEEP), characterizing the mathematical boundaries within the complete cohort. METHODS: A retrospective cohort study was conducted at Siriraj Hospital, Mahidol University. We evaluated the clinical records of 145 patients diagnosed with CIN 2-3 who underwent LEEP between January 2021 and December 2024, analyzing clearance and clinical outcomes over an 18-month surveillance window. RESULTS: The baseline prevalence of hr-HPV was 99.3% (n = 144/145). At 6 months post-LEEP, the type-specific viral clearance rate was 74.3% (n = 107/144). At 18 months, complete hr-HPV negativity was 75.8% (47/62) among the evaluable subcohort, representing a conservative baseline minimum of 32.6% (47/144) when accounting for complete attrition bounds. The overall recurrence rate of CIN or cytological abnormalities was 11.1% (16/144). Notably, 15 of 16 recurrences were detected at the 6-month interval, of which 73.3% (11/15) demonstrated concurrent hr-HPV positivity (P = 0.0001). CONCLUSION: Loop electrosurgical excision procedure facilitates significant viral clearance, but persistent hr-HPV serves as a potent biomarker for clinical recurrence. Implementing mandatory HPV-based testing at the 6-month follow-up window optimizes risk stratification, providing critical data to guide surveillance in the presence of follow-up limitations.