{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:48:13Z","timestamp":1782712093823,"version":"3.54.5"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T00:00:00Z","timestamp":1782691200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent high-risk human papillomavirus (HR-HPV) infection is a key driver of cervical carcinogenesis. Vaginal microecology acts as a host defense barrier, and its dysbiosis may affect HPV clearance. The interplay among microbial diversity, viral load, and sexually transmitted pathogens remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This cross-sectional study enrolled 330 women from a gynecological clinic in Shanghai (December 2025 \u2013 February 2026). HR-HPV genotyping and viral load were determined by fluorescence quantitative PCR. Vaginal culturable bacteria were identified using MALDI-TOF MS, and culturable bacterial richness (Sobs index) were calculated. Routine vaginal parameters and sexually transmitted pathogens (Chlamydia trachomatis, Neisseria gonorrhoeae, Ureaplasma urealyticum [UU]) were assessed. Microecological characteristics were compared between HR-HPV-positive and -negative groups, with subgroup analyses within the positive group by viral load, genotype, and single\/multiple infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The HR-HPV positivity rate was 43.94% (145\/330), with HPV52, HPV53, and HPV16 being predominant, and the highest rate in women &amp;gt;50 years. The HR-HPV-positive group had significantly higher bacterial richness (Sobs index) than the negative group (all P&amp;lt;0.05). Among positive patients, those with high viral load (logarithm &amp;gt;4) had significantly higher Sobs index than those with low viral load (P &amp;lt; 0.05). Proportions of patients with pH&amp;gt;4.5, positive H\n                      <jats:sub>2<\/jats:sub>\n                      O\n                      <jats:sub>2<\/jats:sub>\n                      , positive leukocyte esterase, and Lactobacillus count &amp;lt;20 were significantly higher in the positive group (all P&amp;lt;0.05). UU positivity was significantly higher in the positive group (78.1% vs. 52.3%, P&amp;lt;0.05), while CT and NG showed no significant differences. Within the positive group, no significant differences in diversity or routine parameters were observed across subgroups (all P&amp;gt;0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HR-HPV infection is associated with elevated culturable bacterial richness and dysbiosis; high viral load correlates with more pronounced microbial alterations. UU co-infection is positively associated with HR-HPV. These findings support incorporating vaginal microecological assessment and UU screening into HR-HPV management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1851005","type":"journal-article","created":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:41:23Z","timestamp":1782711683000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Vaginal microecological diversity and Ureaplasma urealyticum co-infection in high-risk HPV infection: a cross-sectional study"],"prefix":"10.3389","volume":"16","author":[{"given":"Nanqiu","family":"Peng","sequence":"first","affiliation":[{"name":"College of Medical Technology, Shanghai University of Medicine & Health Sciences","place":["Shanghai, China"]},{"name":"Department of Research, Zhoupu Hospital Affiliated to Shanghai University of Medicine & Health Sciences","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyi","family":"Zhang","sequence":"additional","affiliation":[{"name":"College of Medical Technology, Shanghai University of Medicine & Health Sciences","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"He","sequence":"additional","affiliation":[{"name":"Department of Quality Management, Xuhui District Center for Disease Control and Prevention (Xuhui District Health Supervision Institute)","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li","family":"Xie","sequence":"additional","affiliation":[{"name":"Clinical Laboratory, Wusong Central Hospital","place":["Shanghai, China"]},{"name":"Wusong Hospital, Zhongshan Hospital Affiliated to Fudan University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,29]]},"reference":[{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217108","article-title":"HPV-based screening for cervical cancer among women 55-59 years of age","volume":"14","author":"Bergengren","year":"2019","journal-title":"PloS One"},{"key":"B1","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1038\/488S1a","article-title":"Human papillomavirus","volume":"488","author":"Brody","year":"2012","journal-title":"Nature"},{"key":"B2","article-title":"ICO\/IARC information centre on HPV and cancer (HPV information centre). Human papillomavirus and related diseases in the world","author":"Bruni","year":"2023"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1002\/jcla.23072","article-title":"Prevalence of Ureaplasma urealyticum, Chlamydia trachomatis, and Neisseria gonorrhoeae in gynecological outpatients, Taizhou, China","volume":"34","author":"Cai","year":"2020","journal-title":"J. Clin. Lab. Anal."},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/j.micpath.2024.106761","article-title":"Effects of vaginal microbiota on human papillomavirus infection and its related diseases","volume":"193","author":"Chen","year":"2024","journal-title":"Microb. Pathog."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.631972","article-title":"The female vaginal microbiome in health and bacterial vaginosis","volume":"11","author":"Chen","year":"2021","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1186\/s12985-025-02855-y","article-title":"Epidemiological characteristics andgenotype distribution of human papillomavirus infection in Yangpu district, Shanghai, 2020-2024","volume":"22","author":"Cheng","year":"2025","journal-title":"Virolj"},{"key":"B29","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1007\/s10096-023-04722-6","article-title":"HPV positivity status in males is related to the acquisition of HPV infection in females in heterosexual couples","volume":"43","author":"Huang","year":"2024","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1915","DOI":"10.3892\/ol.2020.11738","article-title":"Multiple sexual partners and vaginal microecological disorder are associated with HPV infection and cervical carcinoma development","volume":"20","author":"Huang","year":"2020","journal-title":"Oncol. Lett."},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1186\/s13000-021-01072-9","article-title":"Accuracy of HPV E6\/E7 mRNA examination using in situ hybridization in diagnosing cervical intraepithelial lesions","volume":"16","author":"Hui","year":"2021","journal-title":"Diagn Pathol."},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.srhc.2025.101067","article-title":"Sexually transmitted infections (Chlamydia trachomatis, genital HSV, and HPV) and female fertility: a scoping review","volume":"43","author":"Kristensen","year":"2025","journal-title":"Sex Reprod. Healthc"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2812","DOI":"10.1038\/s41598-022-06731-5","article-title":"Changes of the vaginal microbiota in HPV infection and cervical intraepithelial neoplasia: a cross-sectional analysis","volume":"12","author":"Lin","year":"2022","journal-title":"Sci. Rep."},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1016\/j.isci.2025.112476","article-title":"Exploring the role of the vaginal microbiome in HPV infection dynamics: A prospective cohort study","volume":"28","author":"Liu","year":"2025","journal-title":"iScience"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2024.116394","article-title":"Prevalence of Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum among outpatientsin Central China: a retrospective study","volume":"110","author":"Liu","year":"2024","journal-title":"Diagn Microbiol. Infect. Dis."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-021-03201-w","article-title":"Dysbiosis of vaginal microbiota associated with persistent high-risk human papilloma virus infection","volume":"20","author":"Mei","year":"2022","journal-title":"J. Transl. Med."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2025.1618846","article-title":"Association between vaginal microecological alterations and high-risk human papillomavirus infection: a cross-sectional study","volume":"15","author":"Peng","year":"2025","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B7","first-page":"644","article-title":"HPV 16 and 18 viral loads are greater in patients with high-grade cervical epithelial lesions","volume":"37","author":"Ramirez-Flores","year":"2016","journal-title":"Eur. J. Gynaecol Oncol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1007\/s00404-013-3122-3","article-title":"Chlamydia trachomatis infection: implications for HPV status and cervical cancer","volume":"289","author":"Silva","year":"2014","journal-title":"Arch. Gynecol Obstet"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2232","DOI":"10.1002\/ijc.34333","article-title":"The current status of cell-free human papillomavirus DNA as a biomarker in cervical cancer and other HPV-associated tumors: A review","volume":"152","author":"Sivars","year":"2023","journal-title":"Int. J. Cancer"},{"key":"B23","doi-asserted-by":"publisher","first-page":"6508180","DOI":"10.1155\/2020\/6508180","article-title":"Clinical significance of the interaction between human papillomavirus (HPV) type 16 and other high-risk human papillomaviruses in women with cervical intraepithelial neoplasia (CIN) and invasive cervical cancer","volume":"2020","author":"Spinillo","year":"2020","journal-title":"J. Oncol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1186\/s12885-025-13516-2","article-title":"The impact of HPV\/HIV co-infection on immunosuppression, HPV genotype, and cervical cancer biomarkers","volume":"25","author":"Swase","year":"2025","journal-title":"BMC Cancer"},{"key":"B9","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1186\/s12967-025-06811-w","article-title":"Associations among HPV persistence, the vaginal microbiome, and cervical cancer recurrence","volume":"23","author":"Tsementzi","year":"2025","journal-title":"J. Transl. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1080\/09553002.2025.2510668","article-title":"High HPV viral load predicts worse prognosis in patients with cervical cancer treated with radiochemotherapy","volume":"101","author":"Wang","year":"2025","journal-title":"Int. J. Radiat Biol."},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.70312","article-title":"Patterns of co-infection of HPV52 with other HPV genotypes and their risks of cervical precancer and carcinoma","volume":"97","author":"Wang","year":"2025","journal-title":"J. Med. Virol."},{"key":"B20","volume-title":"Cervical cancer elimination: global action plan 2025 update","year":"2025"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000042914","article-title":"Correlation analysis between vaginal microecology and high-risk human papillomavirus (HR-HPV)-positive cervical squamous intraepithelial lesions (SIL)","volume":"104","author":"Zeng","year":"2025","journal-title":"Med. (Baltimore)"},{"key":"B30","doi-asserted-by":"publisher","first-page":"489","DOI":"10.33073\/pjm-2021-046","article-title":"Characteristics of the cervicovaginal microenvironment in childbearing-age women with different degrees of cervical lesions and HR-HPV positivity","volume":"70","author":"Zhai","year":"2021","journal-title":"Pol. J. Microbiol."},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2024.106397","article-title":"Ureaplasma parvum serovar 6 may be a novel element in the progression of HPV infection to CIN: A cross-sectional study of 7058 women","volume":"90","author":"Zhang","year":"2025","journal-title":"J. Infect."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2024.e35736","article-title":"Patterns of single and multiple HPV infections in female: A systematic review and meta-analysis","volume":"10","author":"Zhou","year":"2024","journal-title":"Heliyon"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3390\/ijms26094258","article-title":"Association between vaginal microbiota and cervical dysplasia due to persistent human papillomavirus infection: A systematic review of evidence from shotgun metagenomic sequencing studies","volume":"26","author":"\u017dukien\u0117","year":"2025","journal-title":"Int. J. Mol. Sci."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1851005\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T05:41:25Z","timestamp":1782711685000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1851005\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,29]]},"references-count":31,"alternative-id":["10.3389\/fcimb.2026.1851005"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1851005","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,29]]},"article-number":"1851005"}}