Background Human papillomavirus (HPV) infection may exist after cervical conectomy for cervical intraepithelial neoplasia (CIN). There is still no consensus on the infection status and associated factors in these patients.

Objective To compare the data of persistent HPV infection after cervical conectomy for CIN and analyze the associated factors.

Methods Clinical data about 1 895 CIN patients who underwent cervical conectomy in the Department of Obstetrics and Gynecology of the First Medical Center of Chinese PLA General Hospital from September 2017 to December 2021 and participated in postoperative follow-up at least once were retrospectively analyzed. The basic information, preoperative HPV infection type, surgical and pathological information, postoperative HPV persistent infection type, postoperative vaccination information were summarized, and the related factors of postoperative HPV persistent positive were analyzed.

Results The preoperative HPV positive rate was 79.37%, and 29.45% of them were HPV multiple infections. After conization, 358 cases were found to be HPV positive upon follow-up, resulting in a positivity rate of 18.89%. Compared to the postoperative HPV-negative group, the HPV-positive group had a higher proportion of high-risk types HPV16/18 (60.61% vs 37.80%, P < 0.001). There were statistically significant differences in preoperative pathological types, differences in pathological grades before and after surgery, and conization diameter among the two groups (P < 0.05). In the first follow-up conducted 3 to 6 months post-surgery, 251 cases in the HPV-positive group were re-examined, of which 110 had different HPV typing compared to preoperative results; in the subsequent follow-up, 107 cases in the conversion group had different HPV typing compared to preoperative results. Tracking the HPV vaccination status of some participants: compared to the participants who did not receive the vaccine, those vaccinated after conization had a significantly lower HPV infection rate (6.49% vs 19.72%, P=0.004). Multivariate logistic regression analysis indicated that for postoperative HPV infection, patients with an increased postoperative pathological grade had a higher probability of HPV infection (OR=2.054; 95% CI: 1.424 - 2.964), while vaccinated patients had a lower probability of infection (OR=0.276; 95% CI: 0.110 - 0.695).

Conclusion The probability of HPV reinfection is high after conization, and patients with an increase in postoperative pathological grade are more susceptible to reinfection. Additionally, receiving the HPV vaccine has a significant effect on preventing HPV reinfection.