HPV positivity was 28.77%, with types 16, 52, 58, 53 and 51 most frequently detected and age-related peaks at 26–30 and 61 or older.
Bacterial vaginosis and trichomoniasis were associated with HPV infection; the study also examined persistence and cervical lesions.
What connects common vaginal conditions with infection by human papillomavirus, the principal cause of cervical cancer?
Does recurrent vaginitis increase HPV risk? And what happens when HPV infection coexists with a disrupted vaginal microbial environment?
A large study of more than 57,000 women found statistically significant associations between HPV infection and some vaginal conditions.
Associations were observed for bacterial vaginosis, trichomoniasis and mixed vaginitis. That does not mean these conditions directly cause HPV infection or cervical cancer.
Researchers at the First Affiliated Hospital of Xi’an Jiaotong University published the study in Virology Journal on October 21. They retrospectively analyzed 57,035 female outpatients who underwent HPV genotyping at a university hospital in Shaanxi, China, between 2016 and 2021.
HPV positivity: two age-related peaks
Overall HPV positivity was 28.77%, or approximately three in 10 tested women. High-risk-only infections and infections involving a single genotype predominated.
The source article reports HPV 16 as the most frequently detected high-risk genotype, followed by 52, 58, 53 and 51. HPV 16 is particularly closely associated with cervical cancer.
Positivity peaked at ages 26–30 and rose again among women aged 61 or older.
The researchers considered age-related differences relevant to prevention and screening strategies. Because the population consisted of university-hospital outpatients, the figures cannot be generalized to all women in China or Korea.
Vaginal microbial conditions and HPV
A key focus was the relationship between HPV and the vaginal microbial environment.
The vagina contains a range of microorganisms. In a healthy environment, lactobacilli help maintain acidity and limit pathogen growth. Disruption of the microbial balance can accompany bacterial vaginosis or other forms of vaginitis.
The team examined bacterial vaginosis, aerobic vaginitis, trichomoniasis, vulvovaginal candidiasis and mixed vaginitis in relation to HPV.
Bacterial vaginosis, trichomoniasis and mixed vaginitis showed significant positive associations with HPV positivity. Candidal vaginitis showed an association in the opposite direction.
The relationships varied by HPV genotype. Different vaginal conditions did not all have the same association with HPV.
The study cannot determine whether microbial disruption facilitates HPV infection, HPV alters the vaginal environment, or shared factors affect both. It does not show that treating vaginitis clears HPV or prevents cervical cancer.
Persistent HPV and cervical abnormalities
For HPV, persistence and genotype matter alongside whether a test is positive.
Many infections clear naturally. Persistent infection with some high-risk types can cause cervical cell changes and progress to precancerous lesions.
Among 3,542 women with follow-up data, 33.75% had persistent infection. Persistence was most frequent in the group with both high- and low-risk HPV.
HPV positivity was also associated with abnormal cervical cytology. Nine high-risk genotypes showed significant associations with cytological abnormalities.
HPV 16 was detected in 69.7% of cervical cancer cases included in the study, emphasizing its importance.
Detection of HPV 16 does not mean cancer is inevitable. Risk assessment also depends on persistence, cervical screening results and, when needed, biopsy findings.
What nine-valent vaccine coverage means here
The team examined the distribution of genotypes targeted by the nine-valent vaccine across levels of cervical-lesion severity.
The vaccine targets high-risk types 16, 18, 31, 33, 45, 52 and 58, along with low-risk types 6 and 11, which are major causes of genital warts.
The proportion of detected genotypes covered by the vaccine tended to increase with lesion severity. This highlights the importance of those genotypes in cervical-cancer prevention.
Types 53 and 51, relatively common in this study, are not direct targets of the nine-valent vaccine. Vaccination does not prevent every potentially relevant HPV infection, so recommended cervical screening remains important.
The study analyzed the distribution of vaccine-targeted genotypes, not the effectiveness of vaccination in vaccinated participants.
Vaginal conditions and HPV need their own follow-up
The research suggests that HPV should be studied alongside the vaginal microbial environment, rather than as a viral issue in isolation.
When bacterial vaginosis or trichomoniasis coexists with HPV, each condition needs appropriate diagnosis and management.
Vaginitis does not establish that someone has HPV, and its treatment does not necessarily clear HPV. A positive HPV result also does not mean an infection will immediately lead to cancer; appropriate screening and follow-up are more useful than unnecessary alarm.
This single-center retrospective observational study does not prove causation. Longitudinal studies are needed to determine how microbial changes affect persistent HPV or lesion progression.
Cervical health assessment involves HPV type and persistence, cervical cell changes and the microbial environment, rather than a positive or negative result alone.
Related reading: A separate study of HPV and the cervical microbiome.
Source: “Epidemiological profile of HPV infection, associations with cervical lesions and vaginal microecological disorders, and nine-valent vaccine coverage in Northwest China: a 6-year retrospective study of 57,035 women,” published in Virology Journal on October 21, 2026. Xintong Li, Ruina Li and colleagues at the First Affiliated Hospital of Xi’an Jiaotong University analyzed outpatient genotyping records from 2016–2021 and follow-up data for a subset. DOI: 10.1186/s12985-026-03341-9.
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