Retrospective cohort links age, HPV type to persistence in women with cervical LSIL

In a retrospective cohort study of 3,563 women with cervical low-grade squamous intraepithelial lesions, persistent high-risk human papillomavirus infection was independently associated with older age, infection with HPV-52 or HPV-58, and infection with multiple high-risk HPV types. The study, conducted at Guangdong Women and Children Hospital in Guangzhou from January 2021 through August 2025, also found that bacterial vaginosis, intermediate bacterial vaginosis and vulvovaginal candidiasis were inversely associated with persistent infection. These observations represent statistical associations from retrospective data and do not establish that the factors cause infection to persist.

Researchers classified participants as persistently infected when the same high-risk HPV subtype was detected for at least 365 days, a group that included 919 women. The remaining 2,644 women were classified as having transient infection, defined as detection for more than 30 but fewer than 365 days. All participants underwent vaginal microecological testing, HPV genotyping and cervical cytology concurrently. The investigators used multivariable logistic regression to identify factors independently associated with persistent high-risk HPV infection, reporting odds ratios with 95% confidence intervals and P values.

Age was associated with persistence in five-year increments: each additional five years corresponded to an odds ratio of 1.13, with a 95% confidence interval of 1.09 to 1.17 and P<0.001. HPV-52 and HPV-58 infection together were associated with higher odds of persistence, with an odds ratio of 1.65 (95% CI 1.38–1.98; P<0.001). Multiple high-risk HPV infections were also associated with persistence, producing an odds ratio of 1.50 (95% CI 1.24–1.81; P<0.001). By contrast, bacterial vaginosis was associated with lower odds of persistent high-risk HPV infection, with an odds ratio of 0.69 (95% CI 0.55–0.88; P=0.002), as was intermediate bacterial vaginosis at 0.66 (95% CI 0.52–0.84; P<0.001). Vulvovaginal candidiasis had an odds ratio of 0.75 (95% CI 0.58–0.96; P=0.024) in the adjusted analysis.

The study also assessed recurrence burden for aerobic vaginitis, bacterial vaginosis and vulvovaginal candidiasis using negative binomial regression, with recurrence expressed as an incidence density per 100 person-years. Among women with persistent high-risk HPV infection, aerobic vaginitis had the highest measured recurrence burden, estimated at 35.77 episodes per 100 person-years (95% CI 33.17–38.53). The supplied research report states that this burden exceeded the burdens of the other vaginal conditions evaluated, although the complete numerical estimates for those comparisons are not present in the available abstract. The reported result therefore identifies aerobic vaginitis as the condition with the highest recurrence rate in this subgroup, rather than demonstrating that it caused HPV persistence.

Because the design was retrospective and observational, the findings are subject to several constraints. The results describe a single hospital population in Guangzhou and may not apply to women with cervical low-grade lesions treated elsewhere or to people with different HPV subtype distributions. The persistence classification depended on repeated detection of the same high-risk HPV subtype, while the transient category required infection to be present for more than 30 but less than 365 days. The reported models adjust for measured variables, but the available study summary does not specify all potential confounders or establish the completeness of follow-up. The inverse associations involving bacterial vaginosis, intermediate bacterial vaginosis and vulvovaginal candidiasis likewise should not be interpreted as protective effects. Overall, the study offers a hospital-based pattern analysis of viral persistence and recurrent vaginal infection in women with cervical low-grade squamous intraepithelial lesions, with the largest adjusted associations involving age, HPV-52/58 and multiple high-risk HPV infections.

Subject of Research: Risk factors for persistent high-risk HPV infection and recurrent vaginal infections among women with cervical low-grade squamous intraepithelial lesions

Article Title: Risk factors for persistent high-risk HPV infection and recurrence burden of vaginal infections in women with cervical low-grade squamous intraepithelial lesions: a retrospective cohort study

Article References: Bai, R., Tang, Z., Ji, C., Tang, L., Liu, Y., & Luo, M. (2026). Risk factors for persistent high-risk HPV infection and recurrence burden of vaginal infections in women with cervical low-grade squamous intraepithelial lesions: a retrospective cohort study. Frontiers in Cellular and Infection Microbiology, 16, Article 1983448. https://doi.org/10.3389/fcimb.2026.1983448

Image Credits: AI Generated

DOI: 10.3389/fcimb.2026.1983448

Keywords: high-risk HPV, cervical LSIL, persistent infection, HPV-52, HPV-58, aerobic vaginitis, bacterial vaginosis, vulvovaginal candidiasis, retrospective cohort, viral persistence, Risk, factors