Objective To investigate the relationship between vaginal microecology and cervical precancerous lesions as well as high-risk human papillomavirus (HR-HPV) infection.

Methods A total of 156 patients with HR-HPV infection were selected as study subjects. Based on whether the patients had concurrent cervical intraepithelial neoplasia (CIN) or not, they were divided into concurrent group and non-concurrent group. Vaginal microecological indicators, including pH value, hydrogen peroxide (H₂O₂), sialidase, leukocyte esterase, β-glucuronidase and coagulase, were compared between the two groups. The incidence of bacterial vaginosis, aerobic vaginitis and trichomonal vaginitis in the two groups was recorded. The influencing factors for the development of cervical precancerous lesions in patients with HR-HPV infection were analyzed.

Results Among the 156 patients with HR-HPV infection, 62(39.74%) developed CIN. There were no statistically significant differences in age, body mass index, number of pregnancies, number of deliveries and genotypes between the concurrent group (n=62) and the non-concurrent group (n=94) (P>0.05). The proportion of patients with a pH value ≥4.5 and positive results for H₂O₂, sialidase, β-glucuronidase and coagulase in the concurrent group was higher than that inthe non-concurrent group, with statistically significant differences (P < 0.05). The incidence of bacterial vaginosis and aerobic vaginitis in the concurrent group was higher than that in the non-concurrent group, with statistically significant differences (P < 0.05). Multivariate logistic regression analysis showed that a pH value ≥4.5, positive results for H₂O₂ (+), sialidase (+), β-glucuronidase (+), coagulase (+), bacterial vaginosis and aerobic vaginitis were risk factors for the development of cervical precancerous lesions in patients with HR-HPV infection (P < 0.05).

Conclusion Vaginal microecological imbalance (pH value ≥4.5 and abnormal specific enzymatic indicators) in patients with HR-HPV infection, as well as bacterial vaginosis and aerobic vaginitis, are significantly associated with the occurrence of CIN. The aforementioned indicators can serve as potential biomarkers for risk stratification in patients with HR-HPV infection, providing a reference for clinical intervention.