Study On The Distribution Of Pathogens In Female Lower Reproductive Tract And Its Correlation With Cervical Lesions In Rural Areas

ObjectiveTo describe the epidemiological distribution of sexually transmitted infection(STI)in the lower genital tract(UP,Mh,UU,TV,CT,MG,HPV,etc.)and influencing factors of infection in a natural female population in rural areas,to investigate the correlation between the different pathogens infections,and to prospectively explore the association between various lower genital tract pathogens and cervical lesions(cytological abnormalities and pathological abnormalities)and their interaction.Materials and methodsFrom 2016 to 2018,12,121 healthy adult rural women aged 21-64 years were screened for cervical cancer in Hangjin Banner and Yjinholuo Banner,in Erdos City of Inner Mongolia,in Wuxiang County of Shanxi Province,and in Yanting County of Sichuan Province.A variety of lower genital tract pathogens were detected by second-generation sequencing technology for residual cervical cytology specimens at baseline.Spearman correlation analysis was used to explore the association of pathogen infections,and multifactorial unconditional dichotomous logistic regression was used to analyze the influencing factors of non-HPV STI and the association between lower genital tract pathogen infections and cervical lesions.High risk HPV(hrHPV)and non-HPV STI on cervical lesions were evaluated by unconditional dichotomous logistic regression models.The multiplicative interaction between hrHPV and non-HPV STI on cervical lesions was evaluated by unconditional dichotomous logistic regression models,and the additive interaction between hrHPV and non-HPV STI on cervical lesions was evaluated using SAS 9.4 and Excel to calculate the relative excess risk ratio(RERI),attribution ratio(AP)and interaction index(SI).Results(1)The total prevalence of lower genital tract pathogens in the natural population of selected adult women in rural areas of China was 76.70%(95%CI:75.94%-77.45%),with the highest STI positivity rate in the group of women aged 40-44 years.Among the three regions in this study,Wuxiang County of Shanxi Province had the highest prevalence of lower genital tract pathogens in women and Yanting County of Sichuan Province had the lowest prevalence.The top five pathogens with the highest rates of infection were UP(55.21%),Mh(28.19%),UU(19.07%),hrHPV(16.07%)and TV(6.14%).logistic regression analysis showed that age,education level,menopause,history of alcohol consumption,smoking history,contraception,HPV infection,and etc.were all independent influencing factors for the occurrence of non-HPV STI.Spearman’s correlation analysis showed a positive correlation between most pathogenic infections,but the correlation was weak(p=0.01-0.50,P<0.05),and there was a negative correlation between UP and UU(p=-0.21,P<0.05).(2)There was a significant association between STI and the occurrence of cervical lesions.Infection with hrHPV,lrHPV,UP,Mh,TV and MG were risk factors for the development of ASC-US+.Infection with hrHPV and MG was a risk factor for the development of ASC-H+,infection with hrHPV,lrHPV,Mh and CT was a risk factor for the development of CIN1+,infection with hrHPV was a risk factor for the development of CIN2+,and non-HPV STI was not significantly associated with CIN2+.(3)There may be a synergistic effect of hrHPV and non-HPV STI in ASC-US+cytological outcome with RERI of 2.16(95%CI:0.60,3.73),AP of 0.29(95%CI:0.09,0.48)and SI of 1.49(95%CI:1.07,2.07).The interaction between hrHPV and non-HPV STI in LSIL+cytological outcomes was not statistically significantly different.Among them,there may be a synergistic effect between hrHPV and UP in ASC-US+cytology outcomes.The interaction between hrHPV and non-HPV STI in abnormal pathology outcomes was a statistically insignificant difference.Conclusion1.The prevalence of pathogenic infections in the lower genital tract of adult women in rural areas is high.Age,menopause,history of smoking,history of alcohol consumption,and HPV infection are closely associated with the occurrence of non-HPV STI.Understanding the distribution of pathogenic infections is a guide to the prevention and treatment of lower genital infections in women.There is a positive correlation between most pathogenic infections,but the correlation is weak and pathogenic infections may be mutually reinforcing.2.STI was significantly associated with the development of cervical lesions,especially low-grade lesions.Infection with hrHPV,lrHPV,UP,Mh,TV and MG were risk factors for ASC-US+,non-HPV STI was not significantly associated with CIN2+ and only hrHPV was a risk factor for the development of CIN2+.3.hrHPV and non-HPV STI may have a synergistic effect in ASC-US+cytologic findings,but the interaction was not statistically significantly different in abnormal pathologic findings.