Age-specific HPV genotype distribution and associations with cervical lesions and vaginal microecological status in Northeast China: a retrospective study of 73,828 individuals

Background Persistent high-risk human papillomavirus (HR-HPV) infection is a major etiological factor in cervical carcinogenesis. HPV prevalence and genotype distribution show substantial geographic heterogeneity across China, highlighting the need for region-specific epidemiological data. This study characterized age-specific HPV infection and genotype patterns in Northeast China and further examined their associations with cervical pathology and vaginal microecological status. Methods We retrospectively analyzed HPV genotyping data from 73,828 individuals tested between 2020 and 2024. Histopathological data were available for 8,755 women, and vaginal microecological assessments were available for 2,428 women. Age-related differences, HPV genotype distributions, infection patterns, and their associations with cervical pathology and vaginal microecological categories were evaluated using nonparametric and χ² tests. Results Overall HPV positivity was 20.83% (15,376/73,828) and showed a bimodal age distribution, with the highest prevalence among participants aged < 25 years (34.44%) and a second peak at 60–65 years (25.90%). HPV16, HPV52, and HPV58 were the three most frequently detected genotypes. Single HR-HPV infection differed significantly across cervical histopathological categories and was most frequent in cervical cancer (57.81%, P < 0.001). HPV positivity also differed across vaginal microecological categories ( P < 0.001), with the highest rate observed in the bacterial vaginosis group (32.66%); however, no individual HPV genotype remained significantly associated with microecological category after FDR correction. Conclusion These findings provide regional epidemiological evidence for HPV surveillance and cervical cancer prevention planning and support further prospective investigation of the relationship between vaginal microecological alterations and HPV infection.