Age-Specific Vaginal Microecological Dysbiosis Associated with HPV Infection: A Large-Scale Cross-Sectional Study with Targeted Functional Sequencing Validation

This study aimed to characterize the age-dependent trajectory of vaginal microbiota composition and function across the female lifespan, and to evaluate the selective impact of HPV infection on microecological stability and infectious risk. A total of 23,672 women were stratified into four age groups (18-34, 35-44, 45-55, >55 years). Vaginal microecological profiles were assessed using Gram staining, pH, H2O2, leukocyte esterase, and sialidase assays. HPV genotyping was performed in 2,116 women. Functional microbiota profiling was conducted in a subset (n = 88) using 16S rRNA sequencing, BugBase phenotype prediction, and COG/KEGG pathway analysis. The findings reveal age-dependent microbial vulnerability to HPV infection and support age-specific microecological interventions to reduce HPV persistence and cervical cancer risk.