**5. Conclusions**

In summary, this study describes the detection rates of the most common HR HPVs (16, 31, 33, and 51) and E6/E7 mRNA HR HPV expression in 365 Serbian women who showed normal and abnormal cytological findings. Those HR HPV genotypes are oncogenically active in more than half of the examined cases, and the detected oncogenic activity has predictive potential in diagnosing high-grade cervical intraepithelial lesions. According to the constructed predictive model, the oncogenic activity of HPV 16 and age are risk factors with the strongest predictive values for developing those lesions. Thus, our data indicate that mRNA testing may be more relevant than HPV DNA for assessing lesion grade and diagnosing and monitoring women at risk of progressive cervical disease. This way, the mRNA test as a tool for better risk stratification of HPV infection could overcome unnecessary examinations, increased costs, and patient anxiety. However, further follow-up studies are needed to determine the clinical utility of the mRNA HR HPV test.

**Supplementary Materials:** The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/diagnostics13050917/s1. Figure S1: Dispersion of Ct values of E6/E7 mRNA HR HPVs. Table S1: Analysis of HR HPV DNA 16's influence on the diagnosis of HSIL; Table S2: Analysis of total E6/E7 mRNA HR HPV's influence on the diagnosis of HSIL; Table S3: Analysis of E6/E7 mRNA HR HPV 16's influence on the diagnosis of HSIL; Table S4: Analysis of the influence of age on the diagnosis of HSIL.

**Author Contributions:** Conceptualization, N.N., V.G. and V.P; methodology, N.N., N.S., A.M. and T.P.; validation, N.N., N.S. and B.B.; formal analysis, N.N., N.S., M.S. and B.B.; investigation, N.N., A.M., N.S. and B.B.; data curation, N.N., V.G., N.S., D.M. and M.S.; writing—original draft preparation, N.N., B.B. and V.P.; writing—review and editing, V.P., T.P. and A.M.; supervision, V.P. and A.M. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The study was conducted in accordance with the Declaration of Helsinki and approved by the Committee for the Ethics of Clinical Trials on Humans of the Faculty of Medicine of the University of Novi Sad (number: 01-39/136/1, date 2 March 2017) and the Ethics Committee of the Institute of Public Health of Vojvodina (number: 01-252/3, date 13 February 2017).

**Informed Consent Statement:** All of the women provided written consent for the use of the biological specimens for research purposes.

**Data Availability Statement:** The data that support the findings of this study are available from the corresponding author upon reasonable request.

**Acknowledgments:** The authors are grateful to the personnel of the Department of Gynecology, Community Health Centre Novi Sad, Serbia, and the Oncology Institute of Vojvodina, Serbia, for their contribution to this study.

**Conflicts of Interest:** The authors declare no conflict of interest.
