Molecular detection of sexually transmitted and commensal urogenital pathogens in a large Greek cohort: prevalence, co-detection, and cervical cytology associations.

OBJECTIVES: To describe the detection frequency and demographic distribution of a broad panel of urogenital pathogens in a large Greek cohort, to characterize pathogen co-detection patterns, and to examine their association with cervical cytology. METHODS: We retrospectively analysed molecular test results from 7,513 women whose cervical samples were submitted to a tertiary cytopathology laboratory (2021-2025). Sixteen molecular targets were tested on one of two multiplex platforms, applied to non-overlapping subsets of the cohort. Cytology was classified per the Bethesda System and was documented for 6052 women (80.6%). Logistic regression identified predictors of pathogen detection and of abnormal cytology, adjusting for age group and assay platform. RESULTS: At least one pathogen was detected in 37.9% of women, peaking at 55.5% in those aged ≤ 24 years. The composite was dominated by conditionally pathogenic and commensal organisms, principally Ureaplasma parvum (24.5%); established sexually transmitted pathogens accounted for no more than 8.4%. T. vaginalis and M. hominis were strongly co-detected (OR = 19.38; p < 0.001). Among women with documented cytology, detection of any pathogen was independently associated with abnormal cytology (adjusted OR = 1.63; p < 0.001), with three independent predictors: C. trachomatis (OR = 2.12), U. parvum (OR = 1.86) and U. urealyticum (OR = 1.85). In HPV-positive women with documented cytology (n = 1,323), overall co-detection was not significant (OR = 1.26), while M. hominis showed an inverse association (OR = 0.50; p = 0.013). CONCLUSIONS: Most molecular detections in this cohort reflected conditionally pathogenic or commensal organisms rather than established sexually transmitted pathogens, and detection was concentrated in women under 25. C. trachomatis, U. parvum and U. urealyticum were independently associated with abnormal cytology, whereas within the HPV-positive subgroup no pathogen increased risk and M. hominis showed an unexplained inverse association. These data support age-targeted C. trachomatis screening but do not justify extending routine cervical-screening panels to the full spectrum of organisms tested.