Background  High-risk human papillomavirus (HR-HPV) infection does not always lead to precancerous lesions or cervical cancer, but changes in vaginal microbial diversity may be a concomitant factor for the development of cervical lesions due to persistent HPV infection.

  Objective  To investigate the association between vaginal microecological changes and HR-HPV infection, so as to provide a reference for the prevention and treatment of cervical cancer.

  Methods  A total of 324 patients, aged 21-72 years, who underwent the microecological detection of vaginal discharge and the determination of human papillomavirus genotype at the outpatient service of Department of Obstetrics and Gynecology in the First Medical Center of Chinese PLA General Hospital from October 2021 to March 2022 were enrolled as research subjects, and the association between vaginal microecological abnormalities and HR-HPV infection was analyzed.

  Results  Among the 324 patients, 71 cases were positive for HR-HPV, with a positive rate of 21.91% (71/324); among the 178 patients with normal vaginal microecology, 43 cases were positive for HR-HPV, with a positive rate of 24.16% (43/178), while among the 146 patients with vaginal microecological abnormalities, 28 cases were positive for HR-HPV, with a positive rate of 19.18% (28/146). Among the patients with abnormal vaginal microecological results, 37 had bacterial vaginosis (BV) or intermediate BV, with a positive rate of HR-HPV of 40.54% (15/37); 32 had flora inhibition, with a positive rate of HR-HPV of 18.75% (6/32); 77 patients had normal vaginal flora with inflammatory reaction, with a positive rate of HR-HPV of 9.09% (7/77). There was no significant difference in the positive rate of HPV between the normal vaginal microecology group and the flora inhibition group (P>0.05), while there was a significant difference between the BV/intermediate BV group and the normal vaginal flora+inflammatory reaction group (P<0.05). The logistic regression analysis showed that patients with BV or intermediate BV were more likely to have HR-HPV infection(OR=2.240, P=0.030); and those with normal vaginal flora with inflammatory reaction were associated with lower probability of HR-HPV infection (OR=0.329, P=0.009) .

  Conclusion  Vaginal microecological changes caused by BV and simple leukocytosis are significantly associated with HR-HPV infection.