Background: Endometriosis is a chronic gynecological condition characterized by ectopic endometrial tissue, which may influence host immune response and alter the clinical course of concurrent infections such as human papillomavirus (HPV). However, the impact of endometriosis on colposcopic findings in HPV-positive women remains understudied. Objective: To evaluate the effect of endometriosis on colposcopy findings and HPV genotype distribution among HPV-infected women. Methods: In this cross-sectional study conducted at Arash Women Hospital (2024–2025), 801 HPV-positive women were enrolled and stratified into two groups: 400 women with confirmed endometriosis and 401 controls without endometriosis. Data on demographics, reproductive history, HPV genotyping (high-risk vs. low-risk), and colposcopic findings (normal, aceto-white changes, coarse mosaicism) were collected and analyzed. Statistical comparisons were made using chi-square and t-tests. Results: Women with endometriosis were more likely to exhibit abnormal colposcopic findings, including aceto-white changes (38.5%) and coarse mosaicism (31.0%), compared to controls (10.0% and 7.8%, respectively; p < 0.0001). Normal colposcopic patterns were significantly more common in the control group (82.2% vs. 30.5%). Additionally, high-risk HPV genotypes were more prevalent in the endometriosis group (73.2% vs. 40.5%; p < 0.0001), despite no significant differences in age or BMI between groups. Conclusions: Endometriosis in HPV-positive women is associated with a higher prevalence of high-risk HPV genotypes and a greater frequency of abnormal colposcopic findings. These results support the need for personalized colposcopic surveillance and risk-based HPV screening protocols in this population.
