HPV52 predominates in cervical infections and precancerous lesions in Chongqing, China: a 6-year study linking genotypes to vaginal microecology.
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BACKGROUND: Cervical cancer continues to pose a considerable public health burden in Southwest China, yet region-specific data on HPV genotypes, age-related patterns, and their associations with vaginal microecology are limited. METHODS: From 2019 to 2024, 24,050 women aged 18-80 years were recruited at the People's Hospital of Liangjiang New Area, Chongqing. All participants underwent HPV genotyping for 23 subtypes using PCR reverse dot blot hybridization, ThinPrep cytology test (TCT), and vaginal microecological evaluation. This integrated detection strategy allowed us to further analyze the overall HPV positive rate, age-specific genotype distribution, the correlation between HPV infection and cervical lesions, and the interactive relationship between HPV infection and vaginal microecology. RESULTS: The overall detection rate of HPV was 21.7% (5,211/24,050), increasing from 7.5% (2019) to 30.1% (2022) and remaining stable at ~25% throughout 2023-2024. HPV52 was the predominant genotype in single (19.9%, 690/4375) and multiple (11.2%, 493/4418) infections, with HPV16 and HPV53 ranking closely behind. HPV prevalence peaked at ≤20 years (40.3%) and >60 years (39.2%). HPV16 positivity increased with lesions severity (LSIL: 18.3%, HSIL: 36.1%, SCC: 60.9%). In contrast, HPV52 was mainly associated with precancerous lesions (LSIL: 26.6%, ASCUS: 26.0%). Additionally, multiple infections were associated with a higher prevalence of abnormal cytology. Women diagnosed with vulvovaginal candidiasis (VVC), bacterial vaginosis (BV) and trichomoniasis vaginitis (TV) had significantly higher HPV52/16 positivity than controls. High-risk HPV (HR-HPV) positivity was correlated with poorer vaginal cleanliness (p < 0.001). CONCLUSION: HPV52 predominates in infections and precancerous lesions in Chongqing. Vaginal microecological disturbance was strongly associated with HR-HPV infection. HPV16 was enriched in severe dysbiosis (Grade III and IV), whereas HPV52 showed broader associations with BV, TV and VVC. These results suggest that the 9-valent vaccine, which covers HPV52 and HPV58, may be a relevant option for this region, and support enhanced follow-up for HPV52/58-positive women as well as integrated management of dysbiosis. By providing the most recent data (2019-2024, including the post-2022 stabilization phase) and the first genotype-specific, dose-response evidence on HPV-microecology from Chongqing, this study fills a critical gap in China's cervical cancer surveillance.