Correlations of vaginal microecology with human papillomavirus infection and cervical lesions
Objective To observe the vaginal microecological status,and to investigate its correlations with human papillomavirus(HPV)infection and HPV-negative cervical lesions.Methods From January 2019 to July 2023,16 775 women received vaginal secretion test,HPV detection and ThinPrep cytologic test(TCT)in Henan Provincial People's Hospital.The HPV infection was detected by PCR+membrane hybridization to record HPV infection rate.According to the HPV infection,16 775 women were divided into high-risk HPV-positive group(n=1714)and high-risk HPV-negative group(n=15 061),as well as low-risk HPV-positive group(n=849)and low-risk HPV-negative group(n=15 926).The vaginal microecological conditions[abnormal rate of Lactobacillus,positive rate of bacterial vaginosis(BV),positive rate of Candida,positive rate of Trichomonas,abnormal leucorrhea cleanliness rate,abnormal rate of vaginal pH]were compared between high-risk and low-risk HPV-positive groups and-negative groups.Multivariate logistic regression was used to analyze the influencing factors of high-risk and low-risk HPV infection in women.Totally 14 254 HPV-negative women were divided into TCT-positive group(n=351)and TCT-negative group(n=13 903)according to cervical cytological lesions classification≥atypical squamous cell of undetermined significance(ASC-US),and the vaginal microecological status was compared between two groups.Multivariate logistic regression was used to analyze the influencing factors of positive TCT in HPV-negative women.Totally 351 patients with positive TCT were divided into ASC-US group(n=273),atypical squamous cell-cannot exclude high-grade squamous intraepithelial lesion(ASC-H)group(n=10),low-grade squamous intraepithelial lesion(LSIL)group(n=60)and high-grade squamous intraepithelial lesion(HSIL)group(n=8),and the abnormal rate of Lactobacillus,positive rate of BV and positive rate of Candida were compared among four groups.Results(1)Among 16 775 women,2 521(15.03％)were infected with HPV,including 1 714(10.22％)with high-risk HPV infection,849(5.06％)with low-risk HPV infection and 42(0.25％)with mixed high-risk and low-risk HPV infection;there were 5 695(33.95％)with abnormal Lactobacillus,1 639(9.77％)with positive BV,1 119(6.67％)with positive Candida,60(0.36％)with positive Trichomonas,7 910(47.15％)with abnormal leucorrhea cleanliness and 484(2.89％)with abnormal vaginal pH value.(2)The abnormal rates of Lactobacillus(67.91％,64.78％),the positive rates of BV(14.18％,16.96％)and the positive rates of Candida(8.17％,9.89％)in high-risk and low-risk HPV-positive groups were higher than those in high-risk and low-risk HPV-negative groups(30.08％,32.31％;9.27％,9.39％;6.50％,6.50％)(P＜0.05).There were no significant differences in the Trichomonas positive rate and leucorrhea cleanliness abnormal rate(P＞0.05).The abnormal rate of vaginal pH was higher in low-risk HPV-positive group(4.36％)than that in low-risk HPV-negative group(2.81％)(x2=6.923,P=0.009),and showed no significant difference between high-risk HPV-positive group and high-risk HPV-negative group(P＞0.05).(3)Abnormal Lactobacillus(OR=4.918,95％CI:4.418-5.475,P＜0.001),positive BV(OR=1.616,95％CI:1.396-1.871,P＜0.001),and positive Candida(OR=1.278,95％CI:1.062-1.537,P=0.009)were the risk factors of high-risk HPV infection in women.Abnormal Lactobacillus(OR=3.854,95％CI:3.335-4.455,P＜0.001),positive BV(OR=2.053,95％CI:1.661-2.538,P＜0.001)and positive Candida(OR=1.569,95％CI:1.240-1.984,P＜0.001)were also the risk factors of low-risk HPV infection.(4)In 14 254 women with negative HPV,there were 351 with positive TCT(2.46％),including 273 with ASC-US,10 with ASC-H,60 with LSIL,and 8 with HSIL.TCT was negative in 13 903 women.The abnormal rate of Lactobacillus,positive rate of BV and positive rate of Candida were higher in TCT-positive group(44.73％,17.09％,11.11％)than those in TCT-negative group(27.66％,8.63％,6.19％)(P＜0.05),and there were no significant differences in the Trichomonas positive rate,leucorrhea cleanliness abnormal rate and vaginal pH abnormal rate between two groups(P＞0.05).Abnormal Lactobacillus(OR=1.761,95％CI:1.360-2.281,P＜0.001),positive BV(OR=1.446,95％CI:1.036-2.018,P=0.030)and positive Candida(OR=1.501,95％CI:1.051-2.143,P=0.025)were the risk factors of positive TCT in HPV-negative women.(5)The abnormal rate of Lactobacillus decreased sequentially in ASC-H group,ASC-US group,HSIL group and LSIL group(70.00％,49.45％,37.50％,20.00％)(P＜0.05),the positive rate of BV also decreased sequentially in ASC-H group,ASC-US group,LSIL group and HSIL group(30.00％,20.15％,3.33％,0)(P＜0.05),and there was no significant difference in the Candida positive rate among four groups(P＞0.05).Conclusion Lactobacillus deficiency,BV and Candida vaginitis increase the risk of high-risk and low-risk HPV infection and cervical lesions,and the women with vaginal microecological imbalance have an increased risk of HPV infection and cervical lesions.
vaginal microecologyhuman papillomaviruscervical lesionsLactobacillusbacterial vaginosisCandida vaginitisThinPrep cytologic test
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