Nationwide epidemiology of HPV E6/E7 mRNA in China: genotype distribution in 11,118 women

Background Persistent infection with carcinogenic human papillomavirus (HPV) is the necessary cause of cervical cancer. However, the distribution of transcriptionally active high-risk HPV genotypes across age groups and geographic regions in China remains insufficiently characterized. We aimed to define the nationwide epidemiologic profile of HPV E6/E7 mRNA positivity in China and to evaluate age-, region-, and proxy-defined source-population heterogeneity. Methods In this retrospective cross-sectional study, 11,118 female cervical specimens retrieved for HPV E6/E7 mRNA testing between August 14, 2024 and October 23, 2025 were analyzed from seven geographic regions of China. Fourteen high-risk HPV genotypes were detected using the Biotron HPV E6/E7 mRNA Genotyping Assay. Descriptive, co-detection, and multivariable logistic regression analyses with institution-level cluster-robust standard errors were performed. Results Overall high-risk HPV E6/E7 mRNA positivity was 16.32% (1,815/11,118). HPV52, HPV58, and HPV16 were the dominant genotypes, followed by HPV18 and HPV51. Overall positivity varied significantly across age groups, regions, institution-level proxy categories, and department-based clinical-context proxy categories. Central China had the highest overall positivity rate, whereas East China had the lowest. Significant age-related heterogeneity was observed for several major genotypes, especially HPV52, HPV58, and HPV16. Multi-type positivity accounted for 11.8% of positive samples, with HPV52 and HPV58 forming the most prominent co-detection pattern. In multivariable analyses, older age and several non-East regions were associated with higher odds of overall positivity, whereas the opportunistic screening proxy group showed markedly lower odds of positivity than the gynecology-related clinical attendance proxy group. Conclusion Transcriptionally active high-risk HPV infection in China is characterized by dominance of HPV52, HPV58, and HPV16 and by marked heterogeneity across age, geography, and proxy-defined testing contexts. These findings may support more refined HPV surveillance and risk-adapted prevention strategies.