ArticleFrontiers in medicine2026
Development and internal validation of a vaginal microecology-based multivariable prediction model for persistent high-risk human papillomavirus infection: a retrospective study.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: 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. Objective: To develop and internally validate a multivariable prediction model for persistent/recurrent HR-HPV positivity at 12 months using vaginal microecological and clinical characteristics. Methods: 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 ( Results: 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 5.383-13.955, Conclusions: 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.
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