Objective To evaluate the associations of vaginal microecology with human papilloma virus (HPV) infection and cervical lesions.

Methods A total of 772 patients with abnormal preliminary screening results of thin layer liquid based cytology (TCT) were selected, were graded according to the degree of lesions, and the infection of high-risk human papillomavirus (HR-HPV) was analyzed. A total of 156 patients without intraepithelial pathological cells and malignant cells (NILM) and negative HPV typing were selected in the initial TCT screening during the same period. All patients were divided into TCT abnormal HPV-positive patients, TCT abnormal HPV-negative patients and TCT normal HPV-negative patients. All patients underwent vaginal microecological examination. Associations of vaginal microecology with HR-HPV and cervical lesion were evaluated.

Results Among 772 patients with abnormal TCT results, the HPV infection rate was 48.06%. Among them, multiple types of infection accounted for 22.37% of HPV infections. The higher infection rate of the subtypes were HPV52, HPV16 and HPV58. The HPV infection rate in the 772 patients with high-grade squamous intraepithelial lesions (HSIL) was higher than that in the patients with low-grade squamous intraepithelial lesions (LSIL), atypical squamous cells of undetermined significance (ASCUS) and atypical glandular epithelial cells (AGC), and the difference was statistically significant (P < 0.05). In the vaginal microecological study, the positive rates of sialic ananase, leukocyte esterase and bacterial vaginosis (BV) in TCT abnormal HPV-positive patients were compared with those in TCT abnormal HPV-negative patients, and the differences were statistically significant (P < 0.05). The level of hydrogen peroxide, sialic anhydrolase, leucocytoesterase, β-glucuronidase, coagulase positive rate, BV, aerobic vaginitis (AV), vaginal mixed infection, proportion of vaginal microecological disorders, cleanliness (Ⅲ to Ⅳ) and lactobacillus positive rate in HPV-positive patients with abnormal TCT were compared with those in normal HPV-negative patients, the difference was statistically significant (P < 0.05). Hydrogen peroxide, sialic anhydrase, leocytoesterase positive, BV, co-infection, vaginal dysbiosis, cleanliness (Ⅲ to Ⅳ) were risk factors for HR-HPV positive and/or cervical cytology abnormalities (OR>1, P < 0.05), and lactobacillus positive was a protective factor for HR-HPV positive and/or cervical cytological abnormalities (OR < 1, P < 0.05).

Conclusion Vaginal microecology is related to HR-HPV infection and cervical lesions, and the imbalance of vaginal microecology is more likely to lead to HR-HPV infection and promote the occurrence and development of cervical lesions.