Correlation analysis of bacterial vaginosis with HPV infection and different grades of cervical lesions

OBJECTIVE: To analyze the correlations between bacterial vaginosis (BV), human papillomavirus (HPV) infection and cervical lesions of varying grades in a single-center population from southeastern China, so as to provide a reference for optimizing early cervical cancer screening strategies. METHODS: A retrospective analysis was conducted on the clinical data of 1427 women who underwent combined cervical cancer screening at the gynecology outpatient/inpatient department of The Affiliated Hospital (Group) of Putian University from January 2022 to March 2025. The data included results for BV, HPV, and ThinPrep cytologic test (TCT). Chi-square tests or Fisher's exact tests were used to analyze the distribution characteristics of HPV infection in patients with different cervical lesions, explore the relationship between BV and single, dual, or multiple HPV infections, assess the correlation between BV and different types of cervical lesions, and evaluate the association and influencing factors of BV combined with HPV infection on different grades of cervical lesions. RESULTS: High-risk HPV types were predominantly HPV-52 (19.3%) and HPV-16 (17.5%), while low-risk HPV-81 (20.5%) was the most common. The rates of dual and multiple (≥ 3 types) HPV infections were significantly higher in the BV-positive group than in the BV-negative group (37.1% vs. 27.4%, P = 0.009). The BV-positive rate increased with the severity of cervical lesions, being highest in high-grade squamous intraepithelial lesion (HSIL) (46.4% vs. NILM 10.5%, P < 0.001). Within the BV-positive subgroup, individuals with multiple HPV infections were more likely to present with atypical squamous cells of undetermined significance (ASC-US). Both multiple HPV infection and BV positivity were statistically significant correlates for higher-grade cervical lesions in the multivariable ordinal logistic regression model (P < 0.001). CONCLUSION: This study demonstrated a significant association between bacterial vaginosis (BV) positivity and multiple HPV infection as well as high-grade cervical lesions in a female population from southeastern China. It provides regional epidemiological data that suggest a potential role for BV testing in risk stratification. Nevertheless, these findings are preliminary, and any clinical application would require rigorous prospective validation of predictive performance, cost-effectiveness, and impact on screening outcomes before implementation can be considered.