| Research background and purpose:Reproductive tract infection is caused by the invasion of reproductive system by many pathogens.The number of new cases of female reproductive tract infection in the world is as high as 333 million every year,mainly due to high-risk human papillomavirus(HR-HPV)infection and bacterial vaginosis(BV)caused by anaerobic bacteria infection.There are some differences in the incidence of reproductive tract infection among different female populations,and it is of great significance to study its risk factors for controlling female reproductive tract infection.In recent years,studies have shown that taking a cervical sample by oneself can improve women’s compliance in human papillomavirus(HPV)infection screening.Therefore,this study investigated the prevalence of HR-HPV infection and BV among the natural female population in Mianyang City,explored the relationship between reproductive tract infection of two different pathogens and the risk factors of HR-HPV infection and BV,and discussed the feasibility of self-sampling as a method for female HPV infection screening in rural areas and obtaining information on risk factors of reproductive tract infection.Materials and Methods:In this study,women who participated in cervical cancer screening in Mianyang City were selected as the research objects,and demographic information,influencing factors of reproductive tract infection and awareness and acceptance of HPV self-sampling were collected by questionnaire.Doctors collect specimens of middle vaginal secretions and cervical exfoliated cells,while women collect cervical specimens themselves.HPV was detected by Polymerase Chain Reaction(PCR)detection technology,and BV was detected by functional enzymology combined with microscopic examination.The utilization rate(constituent ratio)represented the count data.The relationship between study variables and HR-HPV infection and BV respectively,the correlation between HR-HPV infection and BV incidence,and factors affecting the acceptance of self-sampling HPV testing among women in rural areas were analyzed usingχ~2 test or Fisher’s exact test.The risk factors for HR-HPV infection and BV incidence were analyzed using Logistic regression model.To compare the consistency of HPV test results between self-sampling and doctor-sampling samples using Kappa test.Two-sided P<0.05 was considered statistically significant.Result:1.Current status of reproductive tract infection:A total of 4074 women were included in the analysis in Mianyang City,Sichuan Province.The HR-HPV infection rate among women in natural population was 11.0%in Mianyang.The age-specific HPV infection rate showed a bimodal distribution in the included total population(P<0.001),with peaks in the 21～30 and>50 age groups.The infection rate of other 12types of HR-HPV except 16/18 is the highest,at 9.5%(P<0.001).Compared with the HR-HPV infection rate among women in urban areas(8.7%),it is higher in rural areas(13.1%)(P<0.001).Between urban and rural areas,there is no significant difference in the infection rate of different HPV types(P>0.05).A total of 1,860 women were included in the analysis in urban areas.The distribution of HR-HPV infection rate with age also showed a bimodal state(P=0.035),and the infection type showed no significant difference among all ages(P>0.05).A total of 2214 women in rural areas were included in the analysis and the HR-HPV infection rate increased with age(P=0.010).The infection rates of HPV type 16/18 and other HR-HPV types showed significant differences among all age groups(P<0.05).The prevalence of BV among natural female population in urban area of Mianyang City was 14.8%.The prevalence of BV increased with age(P<0.001):the lowest prevalence of BV was 7.7%in women between 21 and30 years old,and the highest prevalence of BV was 27.9%in women over 50 years old.The highest prevalence of BV was 19.2%(P=0.038)in females with the age of first sexual intercourse less than 19 years old.Compared with The prevalence of BV in the regular menstruation group(13.8%),it is significantly higher in the irregular menstruation group(18.0%)(P=0.030).Among people with different first-time production methods,the highest prevalence of BV was 16.1%in the spontaneous labor group(P=0.021).There was a correlation between HR-HPV infection and BV(P<0.001).2.Risk factors of reproductive tract infection:Univariate logistic regression analysis showed that age,age of first sexual intercourse,number of sexual partners in recent two years and BV were correlated with HR-HPV infection;and BV was associated with age,age of first sexual life,regular menstruation,first mode of production and BV(all P<0.05).Multivariate Logistic regression analysis showed that the age of 19～22 years old for first sexual intercourse,1～2 sexual partners in recent 2years and BV infection were the risk factors of HR-HPV infection;and the older women were,the age of<19 years old for first sexual intercourse,the average frequency of sexual intercourse was more than 8 times per month in recent 2 months and HR-HPV infection were the risk factors of BV(all P<0.05).3.Feasibility study of self-sampling screening:331 women were selected from women from rural areas,of which 106 women completed doctor sampling and self-sampling cervical sample collection,another 225 completed cervical sample collection by doctors only.Compared with women who without conduct self-sampling,the women who completed the collection of self-sampling cervical samples tended to be willing to conduct self-sampling for future examinations(P<0.001).HPV infection screening by self-sampling method was preferred in 52.3%of women.The analysis of influencing factors on women’s acceptance of HPV self-sampling screening in rural areas of Mianyang City showed that age,work status,travel time from residence to hospital and whether or not self-sampling was conducted this time might be the factors affecting women’s acceptance of HPV self-sampling screening(all P<0.05).Compared to the positive rate(9.4%)of HPV samples taken by the doctor,the positive rate of self-sampling was higher(17.9%)(P=0.004).The overall coincidence rate of self-sampling and doctor-sampling HPV test results was 91.5%,and the Kappa value was 0.646(P<0.001).Conclusion:1.The age distribution and infection classification of HR-HPV infection among natural women in Mianyang city is similar to that in the whole country,mainly distributed among young women and elderly women,and HR-HPV infection rates among women in rural areas is higher than that in urban areas.BV is mainly distributed in older women,earlier initial sexual life,irregular menstruation and natural childbirth.As HR-HPV infection is positively correlated with the occurrence of BV,patients with positive HR-HPV infection are also the high-risk population for the occurrence of BV,and it is recommended that the BV should be detected in the population with positive HR-HPV infection in the future,which was of great significance for the promotion of female reproductive health.2.HPV infection and BV in reproductive tract infection among women of natural population are closely related to age and sexual behavior in Mianyang city.It is suggested that sexual health education for young women should be strengthened,attention should be paid to the prevention and clinical discovery of reproductive tract infection in the elderly,and good hygiene habits and lifestyle should be advocated at the same time,which can effectively carry out primary prevention of reproductive tract infection.3.The HPV test results of the two methods of self-sampling and doctor sampling have medium consistency,and the HPV infection screening method based on the cervical self-sampling is expected to be applied in rural areas,so that the compliance of women participating in the genital tract infection screening is improved,and the HPV infection screening method can be used as an acquisition method for information on risk factors of the genital tract infection. |
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