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Associations between vaginal microecological status and high-risk human papillomavirus positivity in women from
Junxia Wang1, Xinyong Liu2, Fangfei Liu1
1Central Research Laboratory, The Second Qilu Hospital of Shandong University, Jinan, China.
Background:
Evidence regarding the associations between vaginal microecological status and high-risk human papillomavirus (hrHPV) genotype categories remains limited, particularly in large-sample studies. Using a large hospital-based laboratory dataset with same-visit vaginal and cervical sampling, this study assessed the associations between vaginal microecological status and hrHPV infection.
Methods:
A total of 14,359 women were included in this retrospective cross-sectional study. Vaginal and cervical specimens collected during the same hospital visit were used for vaginal microecological assessment and hrHPV genotyping, respectively. HrHPV-positive cases were further assigned to two mutually exclusive analytical genotype categories: HPV16/18 positivity and hrHPV12 (12 non-HPV16/18 high-risk genotypes) positivity. Associations were examined using the chi-square test or Fisher's exact test, and univariable and multivariable logistic regression analyses. Sensitivity analyses excluding women with mixed vaginitis were conducted to assess the robustness of the primary findings.
Results:
Overall hrHPV positivity was 15.99% (2,296/14,359, 95% CI, 15.39-16.60) and differed significantly by age (p < 0.001), with the highest rate in women aged ≤20 years (35.46%). Detection rates of bacterial vaginosis (BV), aerobic vaginitis (AV), trichomonal vaginitis (TV), and vulvovaginal candidiasis (VVC) also differed across age groups (all p < 0.001). In the multivariable analyses, BV (OR = 1.572, 95% CI: 1.052-2.218) and TV (OR = 1.738, 95% CI: 1.126-2.684) were associated with higher odds of overall hrHPV positivity after adjustment for available variables. In models stratified by hrHPV genotype category, BV (OR = 1.599, 95% CI: 1.036-2.467) and TV (OR = 1.653, 95% CI: 1.004-2.723) were associated with hrHPV12 positivity, whereas TV (OR = 1.970, 95% CI: 1.015-3.823) was associated with HPV16/18 positivity. Sensitivity analyses after excluding women with mixed vaginitis showed generally similar effect directions for the main associations.
Conclusion:
HrHPV positivity and vaginal microecological abnormalities showed age-specific distributions, and the associations between vaginal microecological status and hrHPV positivity showed heterogeneity across hrHPV genotype categories. These findings provide large-scale epidemiological evidence suggesting that age and hrHPV genotype category may need to be considered when interpreting the relationship between vaginal microecological status and hrHPV positivity.
