Relationship between vaginal microecology and human papillomavirus infection as well as cervical intraepithelial neoplasia in 2,147 women from Wenzhou, the southeast of China

Abstract

Objective: The female reproductive tract is a significant microecological region, and its micro-environment can directly affect women’s cervical health. This research aimed to investigate the effect of vaginal microecology on human papillomavirus (HPV) infection and cervical intraepithelial neoplasia(CIN). Methods: A retrospective cohort study enrolling 2,147 women who underwent a colposcopic examination between August 2021 and August 2022 was conducted. The relationship between vaginal microecology and HPV infection as well as cervical lesions were assessed using the chi-square test, univariate and multivariate logistic regression analyses, and Cochran-Armitage trend test. Results: HPV infection was linked to the imbalance of vaginal microecology [odds ratio (OR)=3.00, 95% confidence interval (CI)=1.66–5.43; P<0.001]. Clue cell (OR=1.59, 95% CI=0.99–2.54; P=0.054) and sialidase (OR=1.54, 95% CI=1.01–2.35; P<0.046) were considered as significant risk factors for HPV infection. Further analysis showed that vaginal microecological disorder was more likely to be detected in patients infected with HPV 16/18 subtypes (OR=9.86, 95% CI=2.37–41.80; P=0.002). Although there was no significant correlation between the incidence of vaginal microecological disorder and the severity of cervical lesions (P > 0.05), the proportions of abnormal PH value (OR=2.6, 95% CI=1.63–10.42; P=0.001) and abnormal vaginal cleanliness (OR=2.6, 95% CI=1.36–4.0; P= 0.004) increased as the histological stage progressed. Conclusion: Vaginal microecology associates with HPV infection and the progression of cervical lesions. Detection of vaginal secretion may contribute to the development of targets for micro-environmental modulation with probiotics and the reduction of the incidence of cervical cancer.