Objective:

To assess the associations between vaginal microecological status and high-risk human papillomavirus (hrHPV) infection using a large hospital-based dataset.

Approach:

• Study Design: A retrospective cross-sectional study involving 14,359 women with same-visit vaginal and cervical sampling for microecological assessment and hrHPV genotyping.
• Statistical Analysis: Associations were examined using chi-square tests, Fisher’s exact tests, and logistic regression analyses, with sensitivity analyses conducted to assess robustness.

Key Findings:

• Overall hrHPV positivity was 15.99% (2,296/14,359, 95% CI, 15.39–16.60), with the highest rate in women aged ≤20 years (35.46%).
• Bacterial vaginosis (BV) was associated with higher odds of hrHPV positivity (OR = 1.572, 95% CI: 1.052–2.218).
• Trichomonal vaginitis (TV) was associated with higher odds of hrHPV positivity (OR = 1.738, 95% CI: 1.126–2.684).
• BV and TV were linked to hrHPV12 positivity, while TV was specifically associated with HPV16/18 positivity (OR = 1.970, 95% CI: 1.015–3.823).

Interpretation:

The associations between vaginal microecological status and hrHPV positivity varied by age and hrHPV genotype category.

Limitations:

• The study is retrospective and may be subject to biases inherent in such designs.
• Exclusion criteria may limit the generalizability of findings.

Conclusion:

Age and hrHPV genotype category should be considered when interpreting the relationship between vaginal microecological status and hrHPV positivity.