{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T06:19:02Z","timestamp":1783059542665,"version":"3.54.6"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"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. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Persistent high-risk human papillomavirus (HR-HPV) infection is a key determinant of cervical carcinogenesis, yet early identification of women at increased risk of persistence remains challenging in routine clinical practice. Vaginal microecological disturbances have been associated with HR-HPV persistence, but their integration into individualized risk prediction models has been insufficiently explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To develop and internally validate a multivariable prediction model for persistent\/recurrent HR-HPV positivity at 12 months using vaginal microecological and clinical characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective study included women with baseline HR-HPV positivity, available baseline vaginal microecological examination results, and completed 12-month HR-HPV follow-up testing at a tertiary hospital gynecologic outpatient clinic between January 2019 and December 2024. A total of 1,186 women were included and randomly divided into a training cohort (\n                      <jats:italic>n<\/jats:italic>\n                      = 830) and an internal validation cohort (\n                      <jats:italic>n<\/jats:italic>\n                      = 356). Persistent\/recurrent HR-HPV positivity was defined as any HR-HPV positivity at the 12-month follow-up among women who were HR-HPV-positive at baseline, regardless of whether the same HR-HPV genotype was detected at both time points. Candidate predictors were selected in the training cohort using least absolute shrinkage and selection operator (LASSO) regression with ten-fold cross-validation. Variables retained at the one-standard-error criterion (\u03bb_1se) were entered into a multivariable logistic regression model, which was subsequently presented as a nomogram. Model discrimination, calibration, and clinical utility were evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves with the Hosmer\u2013Lemeshow goodness-of-fit test, and decision curve analysis, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among the 1,186 women, 354 (29.8%) had persistent\/recurrent HR-HPV positivity at 12 months. LASSO regression retained seven predictors for final model development: age, smoking status, HPV16\/18 infection, vaginal pH, non-Lactobacillus-dominant microbiota, bacterial vaginosis, and moderate-to-severe local inflammation. In multivariable logistic regression, all seven variables remained independently associated with persistent\/recurrent HR-HPV positivity. HPV16\/18 infection showed the strongest association (OR 8.564, 95% CI 5.383\u201313.955,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.001). The final model showed good apparent discrimination in the training cohort (AUC 0.892, 95% CI 0.870\u20130.914) and maintained acceptable discrimination in the internal validation cohort (AUC 0.821, 95% CI 0.775\u20130.867). Calibration was acceptable in both cohorts, with Hosmer\u2013Lemeshow\n                      <jats:italic>P<\/jats:italic>\n                      -values of 0.149 and 0.296, respectively. Decision curve analysis suggested potential net clinical benefit across a range of threshold probabilities in both cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We developed and internally validated a vaginal microecology-based multivariable prediction model for persistent\/recurrent HR-HPV positivity that showed promising discrimination, acceptable calibration, and potential clinical usefulness within this single-center cohort. This internally validated model may support individualized risk stratification and help identify women who may benefit from closer follow-up; however, external validation in independent cohorts is needed before broader clinical implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1851813","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T05:38:29Z","timestamp":1783057109000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and internal validation of a vaginal microecology-based multivariable prediction model for persistent high-risk human papillomavirus infection: a retrospective study"],"prefix":"10.3389","volume":"13","author":[{"given":"Li","family":"He","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mianzhu City People's Hospital","place":["Mianzhu, Sichuan, 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