What question did this study set out to answer?

Explore the prevalence of vaginal microecological disorders and their association with HPV infection in pregnant women.

April 22, 2026Open Access

Prevalence of vaginal microecological disorder and its association with HPV infections in pregnant women attending prenatal examinations

Key Points

Explore the prevalence of vaginal microecological disorders and their association with HPV infection in pregnant women.
Conducted a cross-sectional study with 630 pregnant women from Fujian Maternity and Child Health Hospital.
Performed Aptima HPV E6/E7 mRNA assays and vaginal microecological examinations.
Analyzed clinical characteristics and virological results.
38.3% of participants showed vaginal microecological disorders, with bacterial vaginosis as a common subtype.
28.6% tested positive for high-risk HPV E6/E7 mRNA, with notable links to bacterial vaginosis and leukocyte esterase.
HPV vaccination correlated with lower rates of high-risk HPV positivity.

Abstract

Vaginal infections are closely associated with human papillomavirus (HPV) infection, yet research on vaginal microecology and HPV mRNA expression in pregnant women remains limited. This study aimed to explore the prevalence of vaginal microecological disorders and their relationship with HPV infection among pregnant women. A cross-sectional study was conducted involving 630 pregnant women who received prenatal care at Fujian Maternity and Child Health Hospital from 2023 to 2024. All participants underwent both the Aptima HPV E6/E7 mRNA assay and vaginal microecological examinations. Clinical characteristics, virological results, and vaginal microecological alterations were analyzed. Of the 630 participants, 241 (38.3%) exhibited vaginal microecology disorders, with aerobic vaginitis (AV, 12.7%) being the most common subtype. A total of 97 (15.4%) participants had received HPV vaccination. The overall high-risk (HR)-HPV E6/E7 mRNA positivity rate was 28.6 % , including 4.8 % for HPV16/18/45 and 23.8 % for the other 11 high-risk genotypes. Age-adjusted multivariate logistic regression analysis identified the following independent risk factors for HR-HPV E6/E7 mRNA positivity: bacterial vaginosis (BV) (aOR = 2.42, 95% CI = 1.25-4.70, P = 0.009), Nugent score ≥7 (aOR= 2.35, 95% CI = 1.21-4.57, P = 0.012), leukocyte esterase positivity (aOR = 1.49, 95% CI = 1.03-2.15, P = 0.036), and lack of HPV vaccination (aOR = 1.99, 95% CI = 1.27-3.12, P = 0.003). Vaginal microecological disorders-particularly BV and leukocyte esterase-are independent risk factors for HR-HPV E6/E7 mRNA positivity. To optimize the management of HPV-infected pregnant individuals, enhanced focus on the prevention and targeted treatment of BV is warranted.IMPORTANCEThis study addresses the limited evidence linking vaginal microecology to high-risk human papillomavirus (HR-HPV) infection in pregnancy. Bacterial vaginosis, high Nugent score, and leukocyte esterase positivity were independently associated with HPV infection, whereas HPV vaccination offered protection. These results underscore the value of integrating vaginal microecological assessment and HPV testing into routine prenatal care.

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