BMC Womens Health. 2026 Jul 20. doi: 10.1186/s12905-026-04714-6. Online ahead of print.
ABSTRACT
BACKGROUND: To investigate whether vaginal dysbiosis is associated with an increased risk of cervical lesions infected with non-16/18 high-risk human papillomavirus (HR-HPV) genotypes and to inform risk-stratified cervical cancer screening strategies.
METHODS: This cross‑sectional study included 2,264 women attending Jiaxing Maternal and Child Health Hospital between June 2023 and October 2024. HPV genotyping, vaginal microecological assessment, and Thinprep cytologic test (TCT) were performed. HR- HR-HPV infections were classified as HPV16/18-positive or non-16/18 HR-HPV infections. Logistic regression models were used to evaluate associations, adjusting for age. Multiplicative interaction was assessed using Wald tests for product terms. Benjamini‑Hochberg FDR correction was applied for multiple comparisons.
RESULTS: The overall HPV prevalence was 49.87%, with HR-HPV detected in 36.13%. HR‑HPV infection was significantly associated with cervical lesions in both normal (OR = 11.45) and dysbiotic (OR = 4.40) vaginal microbiota (both P < 0.001). Stratified analyses showed higher point estimates for HPV58 and HPV59 in the dysbiosis group (OR = 10.98 and 9.51, respectively) than in the normal group (OR = 7.50 and 6.44, respectively). However, formal multiplicative interaction tests did not reach statistical significance (Wald P = 0.526 and 0.559, respectively; FDR‑adjusted q = 0.559 for both). No HPV subtype remained significantly associated with ASC‑US after FDR correction.
CONCLUSIONS: In this cross‑sectional study, vaginal dysbiosis is specifically associated with cervical lesions among women with non‑16/18 HR‑HPV infections, particularly HPV58 and HPV59, which showed elevated point estimates in the presence of dysbiosis. However, formal multiplicative interaction tests did not reach statistical significance. These findings are exploratory and hypothesis‑generating; causality cannot be inferred due to the cross‑sectional design. Prospective studies are needed to validate the observed associations before any clinical application can be considered. Our results should be interpreted with caution and do not support changes to current screening practice.
PMID:42477712 | DOI:10.1186/s12905-026-04714-6
