A retrospective analysis of the correlation between vaginal microecology and high-risk HPV infection among 5727 women

To explore the association between vaginal microecological status and high-risk human papillomavirus (HR-HPV) infection, providing large-sample evidence for HR-HPV prevention/control and vaginal microecological imbalance intervention.

Clinical data of 5,727 women who underwent both HR-HPV and vaginal microecology testing in the Clinical Laboratory of the South Campus of Shanghai East Hospital (January 2023-November 2025) were retrospectively analyzed. Participants were divided into HR-HPV-positive (n = 503, 8.78%) and negative (n = 5,224, 91.22%) groups. Core microecological indicators (Lactobacillus abundance, pathogenic microorganisms, epithelial cells, etc.) were compared by chi-square test. Univariate and multivariate regression analyses were performed with HR-HPV positivity, HPV16 positivity, and HPV18/45 positivity as outcomes, incorporating 10 independent variables.

Compared with the HR-HPV-negative group, the positive group had significantly higher proportions of vaginal cleanliness grades Ⅲ (22.47%) and Ⅳ (20.87%) (χ²=22.25, P < 0.001), intermediate bacterial vaginosis (BV, 42.94%) and BV (10.74%) (χ²=32.87, P < 0.001), as well as mild aerobic vaginitis (AV, 28.63%) and severe AV (0.99%) (χ²=8.314, P < 0.05). Significant differences were also observed in miscellaneous bacteria positive rate (89.07%), clue cell positive rate (8.15%), and epithelial cell (2 + and 4+) proportion (28.23%) (χ²=45.82, 11.09, 11.34; all P < 0.05). Univariate analysis identified 7 significant variables for HR-HPV infection, and multivariate analysis confirmed 5 independent factors (age, Lactobacilli, epithelial cells, miscellaneous bacteria, white blood cells). Age and miscellaneous bacteria were associated with HPV16 infection, while Lactobacillus levels were significantly associated with HPV18/45 infection.

Large-sample analysis confirms that HR-HPV infection is closely associated with vaginal microecological imbalance, mainly manifested by abnormal bacterial and fungal proliferation. Vaginal microecological disorder may be a risk factor for HR-HPV infection, and its regulation can assist in HR-HPV prevention and treatment.

Not applicable.