The prevalence of human papillomavirus (HPV) genotype and cervical dysplasia in women older than 64 years, who are outside the Chinese cervical cancer screening age, has not been extensively studied. Here we conducted a retrospective analysis of women from a tertiary hospital in Guangzhou, aiming to provide meaningful advice for cervical cancer prevention and control in Guangzhou, China. In this study, the age-specific prevalence of any HPV genotypes showed a U-shaped pattern, and the second peak was observed among women >64 years, which was 19.27%. The top six HR HPV genotypes were HPV 16, HPV 52, HPV 58, HPV 31, HPV 33, and HPV 18. The persistence rate of any HPV in 24 months among women > 64 years was 33.33%, which was higher than that of women among <25 years age group (20.75%), and 25-64 years age group (20.46%). For HPV-positive women aged >64 years, the proportion of cervical cancer (16.47%) was obviously higher than that in women aged 25-64 years (2.41%) ( P<0.001). The infection of HPV 58 was the greatest risk factor for the occurrence of HSIL+ (OR 3.556; 95% CI, 1.107-11.415; P=0.032) in women aged >64 years, with HPV+/NILM. In conclusion, the burden of HPV infection in women >64 years is heavy in Guangzhou. Re-evaluate cervical cancer screening strategies for women after age 64 is needed. And HPV 16/18/52/58 genotype model may be an alternative triage strategy to discover HSIL+ among women aged >64 years, with HPV+/NILM.