{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T16:20:05Z","timestamp":1777911605259,"version":"3.51.4"},"reference-count":62,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      With the expansion of cervical cancer screening in China, clarifying the epidemiology of high-risk human papillomavirus (HR-HPV) and co-infecting reproductive tract bacterial pathogens in underserved regions is increasingly important. We investigated the prevalence and co-infection patterns of HR-HPV and bacterial pathogens (\n                      <jats:italic>Chlamydia trachomatis<\/jats:italic>\n                      ,\n                      <jats:italic>Ureaplasma urealyticum<\/jats:italic>\n                      ,\n                      <jats:italic>Neisseria gonorrhoeae<\/jats:italic>\n                      ) among rural women in Hainan, and examined their associations with cervical epithelial lesions to inform optimized risk stratification for this population.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Within a screening cohort of 8,925 women in Hainan (May\u2013October 2025), we employed a nested case\u2013control design enrolling 869 HR-HPV-positive cases and 473 negative controls, which were randomly selected from HR-HPV-negative women, with age adjustment applied in statistical analyses. Participants underwent genotyping for HR-HPV and bacterial sexually transmitted infections (\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      ,\n                      <jats:italic>U. urealyticum<\/jats:italic>\n                      ,\n                      <jats:italic>N. gonorrhoeae<\/jats:italic>\n                      ). Cervical abnormalities were assessed via ThinPrep Cytologic Test and subsequent histopathology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      HR-HPV infection was associated with older age and lower educational attainment (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Among HR-HPV subtypes, single-type HR-HPV infection predominated (83.08%).\n                      <jats:italic>U. urealyticum<\/jats:italic>\n                      was the most prevalent reproductive tract bacterial pathogen (45.75%) and was more frequently co-detected in HR-HPV-positive women than in controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Network analysis further identified\n                      <jats:italic>U. urealyticum<\/jats:italic>\n                      as a central hub, showing strong co-occurrence with HR-HPV52 and HR-HPV58. Clinically,\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      was independently associated with higher odds of atypical squamous cells of undetermined significance (aOR\u202f=\u202f2.82,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.025), whereas\n                      <jats:italic>U. urealyticum<\/jats:italic>\n                      was associated with an increased risk of cervical intraepithelial neoplasia grade 1 (aOR\u202f=\u202f1.79,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.040).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This study highlights a distinct co-infection ecosystem centered on\n                      <jats:italic>U. urealyticum<\/jats:italic>\n                      in rural women, where\n                      <jats:italic>C. trachomatis<\/jats:italic>\n                      and\n                      <jats:italic>U. urealyticum<\/jats:italic>\n                      drive differentiated risks for early cervical lesions. Consequently, public health strategies should prioritize this underrepresented rural population. Integrating targeted bacterial STIs testing into HPV screening could significantly enhance risk stratification and intervention efficiency in settings with limited resources.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1773020","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T06:31:26Z","timestamp":1771828286000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["High-risk HPV and bacterial STIs in a primary screening population in rural Hainan, China: prevalence, co-infection, and association with cervical abnormalities"],"prefix":"10.3389","volume":"14","author":[{"given":"Guoxuan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Center for Laboratory Medicine, Affiliated Women and Children\u2019s Medical Center of Hainan Medical University","place":["Haikou, Hainan, China"]},{"name":"Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medicine and Life Sciences, Hainan Medical University","place":["Haikou, Hainan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhe","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Center for Laboratory Medicine, Affiliated Women and Children\u2019s Medical Center of Hainan Medical University","place":["Haikou, Hainan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feifei","family":"Yin","sequence":"additional","affiliation":[{"name":"Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, Key Laboratory of Tropical Translational Medicine of Ministry of Education, School of Basic Medicine and Life Sciences, Hainan Medical University","place":["Haikou, Hainan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Lu","sequence":"additional","affiliation":[{"name":"Reproductive Medical Center, Hainan Women and Children\u2019s Medical Center","place":["Haikou, Hainan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1136\/ijgc-2020-001285","article-title":"World Health Organization call for action to eliminate cervical cancer globally","volume":"30","author":"Gultekin","year":"2020","journal-title":"Int J Gynecol Cancer"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"322","DOI":"10.1016\/j.jncc.2024.11.006","article-title":"Global burden of cervical cancer: current estimates, temporal trend and future projections based on the GLOBOCAN 2022","volume":"5","author":"Wu","year":"2025","journal-title":"J 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