Where does HPV most often establish infection in the female reproductive system?

Human Papillomavirus (HPV) primarily establishes infection in the transformation zone of the cervix, which is a key area where the squamous epithelium transitions into columnar epithelium. This transformation zone is particularly susceptible to HPV infection because it is a region of high cellular turnover and is often the site of metaplastic changes due to hormonal influences.

Infection typically begins in the basal layers of the epithelium where HPV can integrate its viral DNA into the host genome, potentially leading to dysplastic changes and, if the infection persists, to cervical cancer. The transformation zone is where most cervical pre-cancerous lesions develop, making it crucial for screening and management of HPV-related diseases.

The cervix as an overall structure is important for HPV infection, but it's specifically within the transformation zone that the virus establishes itself most effectively due to its unique histological characteristics and the prevalence of high-risk HPV types in that area. Other locations within the female reproductive system, such as the ovaries and endometrium, are not typical sites for initial HPV infection and are more aligned with other pathologies.