The aims of this study are: a) to describe the clinical profile of female patients with recurrent urinary tract infections and urethral human papillomavirus (HPV); b) to describe the characteristics of urinalysis in patients with urethral HPV and the coinfection with urinary bacteria and fungi; c) to determine the HPV genotype distribution in patients with urethral syndrome of viral origin.

Retrospective observational study of 138 women with recurrent urinary tract infections and urethral syndrome. 
Intervention: All patients underwent a specific sample collection with a special swab for viral PCR studies. HPV was positive in 66 patients (Group HPV) and negative in 72 patients (Group Non-VHP).
Variables: Age, follow-up time, body mass index (BMI), predominant sign or symptom, therapeutic protocol, concomitant disorders, HPV genotype.
Descriptive statistics and multivariate analysis with logistic regression.

Mean age of the sample was 44.13 years (SD 16.16, median 41.00); patients in Group HPV were younger (mean age 39,09 years, SD 12.9, range 29-63). Mean BMI was 22.64 kg/m2 (SD 1.41, median 22.65, range 19.15-24.38). Mean follow-up time was 1957.35 days (SD 1532. 61, median 1712,00, range 28-5421). 
Predominant signs/symptoms in patients with HPV infection were (Table 1): wart/papilloma (n=42; 63.64%); urinary tract infection (n=36; 54.55%); urethral pain (n=24;36.36%); paraesthesia (n=24;36.36%); dyspareunia (n=6;9.09%). The HPV genotypes identified are shown in Table 2, as well as the risk of developing cervical cancer for each genotype.
Most common concomitant disorders: depression (n=12;18.18%), urinary incontinence (n=12;18.18%), high blood pressure (n=6;9.09%), hypotyroidism (n=6;9.09%), smoking habit (n=6;9.09%).  
Abnormal urinalysis was found in 25% of patients in Group Non-HVP and in 54.54% of Group HPV, being the most common finding in Group HPV leukocyturia in 27.27%, higher than in Group Non-HPV (p=0.0061). Most common bacteria found in urine cultures in Group HPV were Escherichia coli (81.81%), Klebsiella pneumonaie (45.45%), Enterobacter cloacae (18.18 %) and Streptococcus agalactaie (18.18%).
Most common treatment protocols in patients in Group HPV were: combined treatment (hyaluronic acid, chondroitin sulfate, mirabegron, aciclovir, botulinum toxin: n=30;45.45%); polybacterial sublingual vaccine (n=30;45.45%); continuous dose antibiotics (n=18; 27.27%); watchful waiting and on-demand treatment (n=12;18.18%); excision-electrocoagulation (n=6;9.09%). In multivariate analysis, a positive trend between HPV diagnosis and antibiogram sensitivity to nitrofurantoin was found with a correlation coefficient 0.664, p=0.0001.

HPV is related with recurrent urinary tract infection in women, and it appears more frequently in younger patients. There was a more frequent diagnosis of HPV in patients with dysuria and dyspareunia. 
Given the high proportion of high-risk HPV genotypes found in our series, it is of upmost importance to undergo more studies in order to establish diagnosis and treatment protocols for patients with recurrent urinary tract infections and urethral syndrome. Furthermore, it is worth studying the prognostic significance of HPV findings in the female urethra to define a follow-up protocol for a correct oncological control of these patients.

Urethral HPV infection is a chronic, infra-diagnosed entity of difficult treatment and unknown clinical significance. It is characteristic of young women with long-term symptoms, being more frequent the dyspareunia and less characteristic spontaneous pain. Sensitivity to nitrofurantoin is a key factor, whereas there is no influence of the concomitancy of episodes of bacterial urinary tract infection. The high incidence of high-risk genotypes for cervical cancer suggests the need of deeper investigation of the pathological meaning of urethral HPV.