Prevalence and genotype distribution of HPV infections among women in Loudi, China

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This study aims to analyze the HPV infection rate and genotype distribution characteristics among women in Loudi City, providing a scientific basis for the development of targeted prevention and control measures. Methods Our study retrospectively analyzed the results of cervical HPV screening in 48,717 women in Loudi city. The cervicovaginal infection of 18 high-risk genotypes and 6 low-risk genotypes were analyzed by PCR and reverse dot hybridization techniques. Results The overall prevalence rate of HPV infection among 48,717 cases was 21.83%, and the prevalence rate in 2021 to 2024 were 23.01%,21.13%,21.36% and 21.58%, respectively. Single infection (74.82%) was the main HPV infection pattern, followed by double infection (17.91%) and multiple infection (7.27%).The top five genotypes in terms of prevalence of HR-HPV and LR-HPV were HPV-52 (5.58%), 53 (2.71%), 58(2.48%), 16 (2.44%), 51 (1.80%) for HR-HPV, and HPV-81 (2.46%), 42 (1.42%), 43 (1.14%), 6 (0.77%), 11(0.0.25%) for LR-HPV. The Prevalence of HPV52 decreased progressively from 6.10% in 2021 to 5.04% in 2024, However, an increase in the prevalence of HPV42 has been observed, increasing from 1.29% to 1.75% between 2021–2024. The prevalence of HPV showed a bimodal U-shaped curve with age; the first and second peak common occurred among females ≤ 24 years old (28.74%) and ≥ 55 years old (30.41%), respectively. The prevalence of women aged 25–34 years was the lowest, which was 18.40%. Among single and double HPV type infections, the infection rate was highest in the age group of ≥ 55 years, while among multiple infections, the highest infection rate was in the group ≤ 24 years old. From 2021 to 2024, the infection rate of women in the ≥ 55 age group had been increasing year by year over time. Conclusion This study revealed the HPV prevalence and genotype distribution among different populations in Loudi city, which may provide guidance for HPV vaccination and cervical cancer prevention strategies in the region. Molecular Epidemiology human papillomavirus prevalence genotype high-risk HPV low-risk HPV cervical cancer Figures Figure 1 Figure 2 Introduction Cervical cancer (CC)is a common malignant tumor that severely affects women's health worldwide, ranking fourth among the causes of cancer-related deaths in women.[ 1 ] More than 85% of cervical cancer cases and deaths occur in developing countries, such as China.[ 2 ] In recent years, the incidence and mortality of cervical cancer in China have been increasing. An estimated number of 109,741 new cases and 59,060 deaths from cervical cancer were recorded annually in China[ 3 ], accounting for 20% of the annual global incidence and 17% of the annual global mortality [ 4 ].Therefore, it is urgent to take effective prevention and control measures to reduce the burden of cervical cancer in China. Most cervical cancers are caused by persistent infection with human papillomavirus (HPV).[ 5 ]HPV DNA is detected in approximately 95% of cervical malignant lesions.[ 6 ] HPV is a non-enveloped, double-stranded DNA virus with a genome of approximately 8 kilobases (kb). It infects squamous epithelial cells, leading to mucosal or cutaneous hyperproliferative lesions.[ 7 , 8 ] Unlike the taxonomic classification of most other viruses, HPV classification is primarily based on genomic sequence homology rather than antigenic structure.[ 9 ] A novel HPV subtype is defined when the L1 open reading frame (ORF) sequence of a given HPV type exhibits at least 10% divergence compared to closely related HPV types. HPVs are classified into five genera: Alpha (α), Beta (β), Gamma (γ), Mu (µ), and Nu (ν). Among these, Alpha genus HPVs possess oncogenic potential and are further categorized into low-risk and high-risk types based on their carcinogenic capability.[ 10 , 11 ] Low-risk HPV (LR- HPV) primarily includes types 6, 11, 30, 42, 43, 44, and 61. These are associated with benign lesions such as genital warts (condyloma acuminatum), flat warts, and low-grade cervical intraepithelial neoplasia (CIN1), and they rarely progress to malignancy. [ 6 , 10 ]High-risk HPV (HR-HPV) encompasses types 16, 18, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. These types are strongly linked to malignancies, including cervical, vulvar, vaginal, and other anogenital cancers, with the strongest association observed in cc.[ 12 ]Notably, HPV-16 and HPV-18 infections are the principal etiological factors for invasive cervical carcinoma, accounting for the majority of global cases.[ 13 ] The prophylactic HPV vaccine is the most effective primary prevention and control measure against cervical cancer or other HPV-related diseases.[ 14 ] China has approved bivalent (2vHPV), quadrivalent (4vHPV), and 9-valent (9vHPV) vaccines, with 9vHPV being the successor to 4vHPV vaccine. The 2vHPV vaccine prevents infection from HPV16 and 18 genotypes; 4vHPV from HPV6, 11, 16, and 18 genotypes; and 9vHPV from HPV6, 11, 16, 18, 31, 33, 45, 52, and 58 genotypes. HPV vaccines have been widely administered globally and have demonstrated significant efficacy. In countries with high HPV vaccine coverage, a marked reduction in high-grade cervical lesions and cervical cancers associated with the vaccine-targeted HPV types has been observed.[ 15 , 16 ] However, HPV vaccines exhibit marked genotype-restricted efficacy, primarily preventing infections and associated lesions caused by the vaccine-targeted HPV types.[ 17 , 18 ] Epidemiological studies have reported substantial geographical variations in the prevalence and distribution of HPV genotypes, with marked heterogeneity observed not only between different regions but also within subregions of the same country.[ 19 , 20 ] Therefore, investigating the epidemiological characteristics of HPV infection in a certain population is the foundation of making HPV vaccination strategies in this area. Loudi City, situated at the geometric center of Hunan Province, is the youngest prefecture-level city in the province. Renowned for its multifaceted industrial prominence, it holds prestigious titles including the "Pearl of Central Hunan" "World Antimony Capital", "Coal Basin of Southern China", "Modern Steel Metropolis" and "Thermal Power Nexus". Currently, there is limited data on the prevalence and genotype distribution of HPV infections in the Loudi region. This study aimed to investigate the epidemiological characteristics of HPV infection, identify the predominant HPV genotypes, and analyze age-specific infection patterns among women in Loudi. The findings are expected to provide evidence to inform regional strategies for HPV vaccination targeting high-risk populations and optimize cervical cancer screening programs, thereby contributing to cervical cancer prevention in this understudied area. Materials and methods Subjects The study adopted a retrospective approach, covering the period from June 2021 to September 2024. The subjects were patients who underwent HPV screening at Loudi Central Hospital for various reasons, including physical examinations, patient requests, diagnostic requirements prescribed by doctors, and random screenings conducted by doctors. Inclusion criteria consisted of a history of sexual activity, absence from menstruation and pregnancy, while exclusion criteria included women with no history of sexual activity, menstruating and pregnant women, women who had undergone uterine surgery. For the multiple cases, we only counted the results of the first screening. The retrospective study enrolled 48,717 female patients Participants ranged in age from 16 to 92 years (mean age: 43.7 ± 11.0 years) and were stratified into five age cohorts: ≤24 years, 25–34 years, 35–44 years, 45–54 years, and ≥ 55 years. This study was approved by the Medical Ethics Committee of Loudi Central Hospital, and all methods were performed in accordance with the relevant guidelines and regulations. Specimen collection The gynecologist first exposes the cervix with a speculum or vaginal opener and uses a cotton swab to wipe away excess secretions from the cervical opening. Take out the cervical brush and place it at the cervical opening, rotate it in one direction for 4–5 complete rotations to obtain a sufficient amount of epithelial cell sample, then put the head of the cervical brush into the elution tube, break the cervical brush handle along the crease of the brush handle, tighten the elution tube cap, do a good job of sample identification, and keep the elution tube upright. After the sample is collected, it is stored at 2 ~ 8°C, and the sample detection is completed within 24h. DNA extraction and HPV genotyping DNA extraction and HPV genotyping were performed using an HPV genotyping kit for 23 Types (Shenzhen Yaneng Bio-Tech Co., Ltd.) by PCR-RDB which was a cost-effective and beneficial cervical cancer primary screening for hospital-based opportunistic screening [ 23 ]. The kit detected 23 types of HPV: HPV6, 11, 42, 43, 16, 18, 31,33, 35, 39, 45, 51, 52, 53,56, 58, 59, 66, 68, 73,81,82,83. The process involved three steps: HPV-DNA extraction, PCR amplification and HPV-DNA hybridization. The Haema9600 (Zhuhai XZ Bio-Tech Co., Ltd.) was used for gene amplification. The amplification parameters were set as follows: ①50 ℃ for 15 min; ②95 ℃ for 10 min; ③40 cycles were performed at 94 ℃ for 30 s, 42 ℃ for 90 s and 72 ℃ for 30 s; and ④ 72℃ for 5 min. The YN-H16 (Shenzhen GL Bio-Tech Co., Ltd.) was used for DNA hybridization. After color rendering, positive detection results were indicated by clear blue dots, a blue spot in one gene locus is a single infection, and multiple blue spots were mixed infection or multiple infection. To ensure the reliability of each HPV test result, there is an IC (internal control) site on each patient’s hybrid membrane, with one positive control (HPV16 positive) and one negative control set up during each trial. In this study, in order to exclude the interference of reproductive pathogens other than HPV (CT, MH, TV, TP, SPY, HSH-2, etc.) on HPV detection results, specific reagents were added during DNA extraction, amplification, and hybridization to ensure that there was no cross-reaction. The testing doctor strictly follows the HPV interpretation rules to issue the patient’s HPV test results. Statistical analysis Single, double and multiple HPV infections were defined as infection with one, two and with three or more subtypes of HPV infections, respectively. The proportion of women in different age groups with single, double and multiple infections was then analyzed. Data were compared using Pearson χ2 or Fisher exact tests. Descriptive and inferential statistical analysis were conducted using Statistical Package for the Social Sciences version 22 (SPSS Inc., Illinios, USA), and P < .05 was considered to be statistically significant. Result Overall prevalence of HPV Infection over time A total of 10,637 HPV-positive cases were identified among 48,717 individuals screened between 2021 and 2024, yielding an overall infection rate of 21.83%. Further analysis revealed that 3,261, 2,511, 2,594 and 2,171 HPV-positive cases were detected in 2021, 2022, 2023 and 2024 respectively, with corresponding infection rates of 23.01% (3,261/14,170), 21.13% (2,511/11,883), and 21.36% (2,594/12,142). The highest prevalence was observed in 2021 (23.01%), significantly higher than subsequent years (all P 0.05). Chi-square test indicated statistically significant differences across years (χ²=16.949, P < 0.001), as shown in Table 1 . Table 1 Trends in HPV infection prevalence with statistical comparisons,2021–2024 Year Positive cases Negative cases Total cases Prevalence %(95%CI) 2021 3,261 10,909 14,170 23.01(22.30-23.73) 2022 2,511 9,372 11,883 21.13(20.37–21.90) 2023 2,594 9,548 12,142 21.36(20.60-22.13) 2024 2,271 8,251 10,522 21.58(20.78–22.39) Total 10,637 29,829 48,717 21.83(21.43–22.23) Statistical analysis: χ²test revealed significant differences across years (χ²=16.949, DF = 3, P < 0.001). Post-hoc pairwise comparisons with Bonferroni correction showed: 2021 prevalence was significantly higher than 2022 (P = 0.002), 2023 (P = 0.004), and 2024 (P = 0.008) ;No significant differences were observed among 2022–2024 (all P > 0.05); Data are presented as prevalence % (95% CI), with CIs calculated using the Wilson score method. Distribution of single, double, and multiple HPV infections Among 48,717 individuals screened for HPV, 10, 637 (21.83%) tested positive. Single HPV infections predominated , identified in 7,959 cases (74.82% of positive cases; 16.3% of the total screened population). Double infections were detected in 1,905 individuals (17.91% of positives; 3.91% of total), while multiple infections (≥ 3 subtypes) accounted for 773 cases (7.27% of positives; 1.59% of total). The stratified distribution of infection multiplicity is presented in Table 2 . Table 2 Distribution of single and multiple HPV infections among HPV-positive patients Infection Type Positive cases (n) Prevalence (%) Proportion (%) Single infection 7959 16.34 74.82 Double infections 1905 3.91 17.91 Multiple infections 773 1.59 7.27 Total 10637 21.83 100 HPV genotype distribution HPV genotyping was performed on 48,717 clinical specimens, and all 23 HPV subtypes were detected. There were 23 different HPV genotypes, including 17 HR-HPV genotypes and 6 LR-HPV genotypes, identified in this study. The prevalence of 23 HPV was demonstrated in Table 3 . The most common HR-HPV identified was HPV52 (5.58%), followed by HPV53 (2.71%), HPV58 (2.48%), HPV16 (2.44%) and HPV51 (1.80%). To be noted, HPV18 was only the twelfth most common HR HPV genotype to be detected. The top five genotypes for individuals with a single HR-HPV infection were HPV52, HPV58, HPV53, HPV16, and HPV51. As shown in Fig. 1 A, for individuals with double HPV infections, the HR-HPV that ranked top five were HPV52, HPV53, HPV16, HPV58, and HPV51. For individuals with multiple HPV infections, the HR HPV that ranked top five were HPV52, HPV53, HPV16, HPV51, and HPV58. These data suggested that HPV52 infection was predominant in HPV-positive patients. As shown in Fig. 1 B, the most common LR-HPV identified was HPV81, followed by HPV42, HPV43, HPV6, and HPV11. The most commonly detected genotype for individuals with a single LR-HPV infection was HPV81, followed by HPV42, HPV43, HPV6, and HPV11. For double and multiple LR-HPV infected individuals, the most common types of dual infection and multiple infection were the same as single infection. Table 3 Prevalence of single, double, and multiple HPV infections of 23 genotypes HPV Type Single infection Double infections Multiple infections Total infections Positive no %(95%CI) Positive no %(95%CI) Positive no %(95%CI) Positive no %(95%CI) HR-HPV 52 1822 3.74(3.57–3.91) 592 1.22(1.12–1.31) 304 0.62(0.55–0.69) 2718 5.58(5.38–5.78) 53 695 1.43(1.32–1.53) 383 0.79(0.71–0.86) 242 0.50(0.43–0.56) 1320 2.71(2.57–2.85) 58 760 1.56(1.45–1.67) 293 0.60(0.53–0.67) 154 0.32(0.27–0.37) 1207 2.48(2.34–2.62) 16 683 1.40(1.30–1.51) 300 0.62(0.55–0.69) 205 0.42(0.36–0.48) 1188 2.44(2.30–2.58) 51 469 0.96(0.88–1.05) 228 0.47(0.41–0.53) 180 0.37(0.32–0.42) 877 1.80(1.68–1.92) 68 399 0.82(0.74–0.90) 190 0.39(0.33–0.45) 150 0.31(0.26–0.36) 739 1.52(1.41–1.63) 33 265 0.54(0.48–0.61) 150 0.31(0.26–0.36) 117 0.24(0.20–0.28) 532 1.09(1.00-1.18) 56 244 0.50(0.44–0.56) 141 0.29(0.24–0.34) 107 0.22(0.18–0.26) 492 1.01(0.92–1.10) 39 260 0.53(0.47–0.60) 125 0.26(0.21–0.30) 96 0.20(0.16–0.24) 481 0.99(0.90–1.08) 66 177 0.36(0.31–0.42) 120 0.25(0.20–0.29) 113 0.23(0.19–0.27) 410 0.84(0.76–0.92) 59 186 0.38(0.33–0.44) 117 0.24(0.20–0.28) 97 0.20(0.16–0.24) 400 0.82(0.74–0.90) 18 181 0.37(0.32–0.43) 102 0.21 (0.17–0.25) 84 0.17(0.14–0.21) 367 0.75(0.68–0.83) 31 124 0.25(0.21–0.30) 84 0.17(0.14-021) 56 0.11(0.08–0.15) 264 0.54(0.48–0.61) 35 86 0.18(0.14–0.21) 42 0.09(0.06–0.11) 38 0.08(0.05–0.10) 166 0.34(0.29–0.39) 45 51 0.10(0.08–0.13) 31 0.06(0.04–0.09) 36 0.07(0.05–0.10) 118 0.24(0.20–0.29) 73 28 0.06(0.04–0.08) 18 0.04(0.02–0.05) 29 0.06(0.04–0.08) 75 0.15(0.12–0.19) 82 28 0.06(0.04–0.08) 13 0.03(0.01–0.04) 16 0.03(0.02–0.05) 57 0.12(0.09–0.15) LR-HPV 81 657 1.35(1.25–1.45) 328 0.67(0.60–0.75) 215 0.44(0.38–0.50) 1200 2.46(2.33–2.60) 42 322 0.66(0.59–0.73) 223 0.46(0.40–0.52) 149 0.31(0.26–0.35) 694 1.42(1.32–1.53) 43 258 0.53(0.47–0.59) 166 0.34(0.29–0.39) 129 0.26(0.22–0.31) 553 1.14(1.04–1.23) 6 174 0.36(0.30–0.41) 114 0.23(0.19–0.28) 87 0.18(0.14–0.22) 375 0.77(0.69–0.85) 11 58 0.12(0.09–0.15) 25 0.05(0.03–0.07) 39 0.08(0.05–0.11) 122 0.25(0.21–0.29) 83 33 0.07(0.04–0.09) 24 0.05(0.03–0.07) 14 0.03(0.01–0.04) 71 0.15(0.11–0.18) Temporal trends in type-specific HPV prevalence Significant temporal variations in genotype-specific HPV prevalence were identified through chi-square analysis of 21 HPV types over a four-year surveillance period (2021–2024). Analysis of 48,717 cervical screening samples collected between 2021 and 2024 identified distinct temporal patterns in the prevalence of 21 HPV genotypes (Table 4 ). Chi-square tests revealed statistically significant trends for two genotypes (HPV52 and HPV42), while the majority exhibited stable prevalence profiles. The Prevalence of HPV52 decreased progressively from 6.10% (367/14,184) in 2021 to 5.04% (530/10,510) in 2024 (χ² = 15.769, P < 0.01). This genotype demonstrated the most pronounced downward trajectory among all high-risk types. However, A paradoxical rise in prevalence of HPV42 was observed, increasing from 1.29% (183/14,184) to 1.75% (184/10,510) over the study period (χ² = 7.494, P = 0.006). No significant temporal variations (P ≥ 0.05) were detected for in the other 19 genotypes 19 genotypes. Notably, HPV56 displayed a non-significant upward trajectory (1.00%→1.25%, P = 0.082), suggesting potential emergence requiring surveillance. Table 4 Temporal Trends in HPV Genotype Prevalence (2021–2024) HPV type 2021 2022 2023 2024 χ² P-value 16 367(2.59) 290(2.44) 285(2.35) 246(2.34) 1.989 0.158 18 109(0.77) 96(0.81) 90(0.74) 72(0.68) 0.731 0.393 31 80(0.56) 59(0.50) 75(0.62) 50(0.48) 0.197 0.657 33 164(1.16) 107(0.90) 140(1.15) 121(1.15) 0.162 0.687 35 47(0.33) 46(0.39) 41(0.34) 32(0.30) 0.223 0.637 39 149(1.05) 110(0.93) 117(0.96) 105(1.00) 0.160 0.690 45 40(0.28) 29(0.24) 25(0.21) 24(0.23) 1.158 0.282 51 277(1.95) 212(1.78) 205(1.69) 183(1.74) 2.166 0.141 52 865(6.10) 668(5.62) 655(5.39) 530(5.04) 15.769 <0.01 53 375(2.65) 333(2.80) 327(2.69) 285(2.71) 0.028 0.866 56 141(1.00) 106(0.89) 114(0.94) 131(1.25) 3.027 0.082 58 378(2.67) 280(2.36) 284(2.34) 265(2.52) 0.838 0.360 59 122(0.86) 82(0.69) 97(0.80) 99(0.94) 0.573 0.449 66 126(0.89) 99(0.83) 99(0.82) 86(0.82) 0.444 0.505 68 220(1.55) 169(1.42) 178(1.47) 172(1.63) 0.201 0.654 73 27(0.19) 15(0.13) 17(0.14) 16(0.15) 0.565 0.452 82 15(0.11) 17(0.14) 18(0.15) 7(0.07) 0.387 0.534 6 127(0.90) 71(0.60)) 91(0.75) 86(0.82) 0.231 0.631 11 37(0.26) 39(0.33) 25(0.21) 21(0.20) 2.038 0.153 42 183(1.29) 161(1.35) 166(1.37) 184(1.75) 7.494 0.006 43 183(1.29) 125(1.05) 135(1.11) 110(1.05) 2.811 0.094 81 336(2.37) 285(2.40) 294(2.42) 285(2.71) 2.424 0.119 83 19(0.13) 16(0.13) 13(0.11) 23(0.22) 1.701 0.192 Prevalence Distribution of HPV Infection in Different Age Groups Among the 48,717 cases analyzed, the prevalence of HPV infection in the ≤ 24 years old group, 25–34 years old group, 35–44 years old group, 45–54 years old group and ≥ 55 years old group were 28.74%, 18.40%, 18.73%, 21.76% and 30.41%, respectively. The prevalence of HPV infection across age groups demonstrated a distinct U-shaped pattern in this study. The highest infection rates were observed in the youngest (< 25 years: 28.74%, 95% CI 26.39–31.10) and oldest (≥ 55 years: 30.41%, 95% CI 29.42–31.40) age groups, while middle-aged participants exhibited lower rates, ranging from 18.40% (25–34 years) to 21.76% (45–54 years), as shown in Table 5 . Single infections predominated across all ages but were most prevalent in older adults (≥ 55 years: 20.22%, 95% CI 19.36–21.09). In contrast, double infections peaked in both the < 25-year (6.64%, 95% CI 5.34–7.94) and ≥ 55-year (6.79%, 95% CI 6.25–7.33) groups. Notably, multiple infections (≥ 3 types) were highest in the youngest cohort (4.94%, 95% CI 3.81–6.07) and declined with age, though a secondary rise occurred in the ≥ 55-year group (3.40%, 95% CI 3.01–3.79), as shown in Fig. 2 . Statistical analyses confirmed significant heterogeneity in infection rates across age groups (χ² = 558.861, p < 0.001), with pairwise comparisons revealing no significant difference between the < 25-year and ≥ 55-year groups (χ² = 1.525, p = 0.217) but marked disparities between these groups and middle-aged populations ( p < 0.001). Table 5 Prevalence of HPV infection in different age groups Age, y Sample Single infection Double infections Multiple infections Total infections Positive no %(95%CI) Positive no %(95%CI) Positive no %(95%CI) %(95%CI) %(95%CI) ≤ 24 1416 243 17.16(15.20-19.12) 94 6.64(5.34–7.94) 70 4.94(3.81–6.07) 407 28.74(26.39–31.10) 25–34 10289 1463 14.22(13.54–14.89) 315 3.06(2.73–3.39) 115 1.12(0.91–1.32) 1893 18.40(17.65–19.15) 35–44 14378 2183 15.18(14.60-15.77) 404 2.81(2.54–3.08) 106 0.74(0.60–0.88) 2693 18.73(18.09–19.37) 45–54 14332 2391 16.68(16.07–17.29) 528 3.68(3.38–3.99) 200 1.40(1.20–1.59) 3119 21.76(21.09–22.44) ≥ 55 8302 1679 20.22(19.36–21.09) 564 6.79(6.25–7.33) 282 3.40(3.01–3.79) 2525 30.41(29.42–31.40) Total 48717 7959 16.34(16.01–16.67) 1905 3.91(3.74–4.08) 773 1.59(1.48–1.70) 10637 21.83(21.47–22.20) Age-Specific Temporal Trends in HPV Prevalence (2021–2024) The age-specific prevalence of HPV infection exhibited dynamic temporal trends across the study period (2021–2024), as shown in Table 6 . Among individuals aged ≤ 24 years, infection rates showed a modest decline from 0.88% (124/14,170) in 2021 to 0.73% (77/10,522) in 2024 (χ² = 3.985, p = 0.046). Similarly, significant reductions were observed in the 25–34 age group, with prevalence decreasing sharply from 4.69% (665/14,170) to 2.91% (306/10,522) (χ² = 58.469, p < 0.001). Middle-aged cohorts displayed divergent patterns: while the 35–44 group fluctuated between 5.01% (534/10,522) and 6.34% (898/14,170) (χ² = 14.373, p < 0.001), the 45–54 group demonstrated a gradual decline from 7.00% (992/14,170) to 6.01% (632/10,522) (χ² = 12.941, p < 0.001). Most strikingly, adults aged ≥ 55 experienced a marked increase in prevalence, rising from 4.11% (582/14,170) in 2021 to 31.8% (722/10,522) in 2024 (χ² = 106.300, p < 0.001). These trends collectively reflect significant age-dependent shifts (all p < 0.05), with younger and middle-aged groups showing stabilization or decline, contrasted against a doubling of infection burden in older adults. Table 6 HPV infection rates in different age groups from 2021 to 2024(n, %) Age(y) 2021 2022 2023 2024 χ² P-value ≤ 24 124(0.88) 122(1.03) 84(0.69) 77(0.73) 3.985 0.046 25–34 665(4.69) 495(4.17) 427(3.52) 306(2.91) 58.469 <0.001 35–44 898(6.34) 594(5.00) 667(5.49) 534(5.01) 14.373 <0.001 45–54 992(7.00) 767(6.45) 728(6.00) 632(6.01) 12.941 <0.001 ≥ 55 582(4.11) 533(4.49) 688(5.67) 722(6.86) 106.300 <0.001 Total 3261(23.01) 2511(21.13) 2594(21.36) 2271(21.58) 16.949 <0.001 Discussion Cervical cancer remains a leading contributor to cancer-related mortality among women globally, with persistent infection by high-risk human papillomavirus (HR-HPV) genotypes established as the predominant oncogenic driver in cervical carcinogenesis[ 21 ]. The HPV infection rate varies by region and population, the differences in lifestyle and economic development, viral genomic variation, and prophylactic HPV vaccination can all lead to differences in HPV infection rates between regions. Molecular epidemiological studies can clarify the prevalence and characteristics of HPV infection in different regions, which is crucial for the control and prevention of HPV-related cancers and for guiding prophylactic HPV vaccination.[ 22 , 23 ].Notably, population-based HPV screening initiatives have demonstrated significant efficacy in reducing both incidence rates and disease-specific mortality of cervical cancer, particularly when integrated with timely follow-up interventions[ 24 , 25 ]. This retrospective analysis examines the epidemiological characteristics of HPV infection among 48,717 female participants in Loudi City, Hunan Province, China, from January 2021 to March 2024. By establishing a comprehensive regional HPV prevalence database and genotype distribution profile, our findings aim to provide an evidence-based foundation for optimizing HPV immunization strategies and enhancing precision medicine approaches in cervical cancer prevention within this specific geographical context. Among the 48,717 female subjects in this study, HPV genotyping identified 10,637 HPV-positive cases, resulting in an overall HPV infection rate of 21.83%. This rate was similar to that of Kunming City, China (22.03%)[ 22 ], lower than rates observed in Chongqing (26.15%)[ 26 ], Jilin (34.40%)[ 27 ], and Fujian (38.3%)[ 28 ], but higher than Huzhou (15.50%)[ 29 ], Hengyang (10.16%)[ 30 ], and Wuhan (15.33%)[ 31 ], indicating geographical variations in HPV infection rates across China. This study analyzed the trends in the HPV infection rate from 2021 to 2024. The results showed that there were significant differences in the infection rate among the years (χ2 = 16.949, P < 0.001). The infection rate was the highest in 2021 (23.01%), which might be related to the backlog of cases caused by the delay in screening during the initial stage of the COVID-19 pandemic[ 32 ]. Subsequently, it significantly decreased to 21.13% in 2022 (P = 0.002), which might be associated with the promotion of the vaccination program and the denominator effect after the resumption of screening[ 33 ]. The infection rates in 2023 (21.36%) and 2024 (21.58%) tended to be stable (P > 0.05 between groups), suggesting that the effectiveness of the intervention measures may have entered a plateau phase, or there may be a continuously spreading population that has not been covered. It was crucial to understand the distribution of HPV genotypes in the local area before the widespread implementation of HPV vaccination, as it contributed to vaccine development and the establishment of optimal vaccine protection strategies. Our study revealed that the top five genotypes of high-risk HPV prevalence among female subjects were HPV52/53/58/16/51, while the top five genotypes of low-risk HPV prevalence were HPV81/42/43/6/11. Interestingly, the top five genotypes of high-risk HPV prevalence in Loudi differed only in specific genotypes when compared to Shanghai (HPV52/16/58/53/39), but were in line with the high-risk HPV infection types observed in Kunming (HPV52/16/58/53/51). This study shows that HPV52, HPV53 and HPV58 are the dominant HPV types in this region, with infection rates of 5.58%, 2.71% and 2.48% respectively. In the Southwest region, the infection rate of HPV52 is the highest, followed by HPV16 and HPV58. In the Guangdong region, the infection rate of HPV16 is the highest, followed by HPV52 and HPV58[ 34 , 35 ]. The HPV susceptibility genotypes identified in this region exhibit distinct discrepancies when juxtaposed with those documented in other regions across China. This divergence not only accentuates the remarkable complexity inherent in the distribution patterns of HPV genotypes but also serves as a compelling testament to the indispensable role of localized HPV investigation and research. Such findings underscore the necessity of region - specific studies, as they can capture the unique epidemiological characteristics of HPV infections that may be overlooked in broader, national - scale analyses. These local investigations are crucial for formulating targeted public health strategies, improving screening protocols, and ultimately enhancing the prevention and control of HPV-related diseases. The present study systematically investigated the temporal trends of HPV infections in the designated region during the period from 2021 to 2024. Statistical analyses revealed a significant upward trend in the prevalence of the HPV42 subtype over time. Of particular concern is the fact that HPV42 is not among the genotypes targeted by the nine-valent prophylactic HPV vaccine, which encompasses HPV6, 11, 16, 18, 31, 33, 45, 52, and 58. Given these findings, HPV42 infection should be prioritized in future research and public health surveillance efforts, as it represents an unaddressed gap in current vaccination strategies and may pose a substantial health risk that warrants further investigation. In this region, HPV52 and HPV58, the predominant and highly susceptible genotypes, exhibit relatively high and stable infection rates. Epidemiological investigations have unequivocally demonstrated that the detection frequencies of HPV 52 and HPV 58 are notably elevated among patients diagnosed with cervical cancer[ 36 ]. Current HPV vaccination regimens comprehensively incorporate immunogenic components targeting these specific subtypes. However, multifaceted barriers impede widespread vaccination uptake. Predominantly, inadequate public awareness regarding the efficacy and importance of HPV vaccination, coupled with the financial burden associated with vaccine administration, has led to suboptimal vaccination coverage rates. Consequently, the endemicity of HPV52 and HPV58 infections persists at elevated levels, posing a significant challenge to cervical cancer prevention and control efforts within the population. The observed bimodal age distribution of HPV infection rates, with peaks among adolescents/young adults (≤ 24 years, 28.74%) and postmenopausal women (≥ 55 years, 30.41%), highlights distinct biological and behavioral risk factors across age strata. The elevated prevalence in the ≤ 24-year cohort likely reflects behavioral vulnerabilities during sexual debut, where high rates of single (17.16%) and multiple infections (4.94%) align with early sexual activity and multi-partner exposure in unvaccinated populations[ 37 , 38 ]. In contrast, the second peak in older women (≥ 55 years) demonstrates a shift toward biological mechanisms, as evidenced by the predominance of single infections (20.22%) and cumulative double infections (6.79%). This pattern suggests viral persistence rather than incident exposure, potentially driven by immuno-senescence-related declines in T-cell-mediated viral clearance and estrogen depletion-induced epithelial fragility[ 39 , 40 ]. Intermediate age groups (25–54 years) exhibited lower infection rates (18.40–21.76%), likely attributable to standardized cervical screening protocols and stabilized sexual partnerships. However, the gradual increase from 35–44 to 45–54 years (18.73% to 21.76%) may signal early immunological or hormonal shifts preceding the pronounced risk in postmenopausal women. Notably, the ≤ 24-year cohort’s high multitype infection prevalence (4.94%) indicates concurrent exposure to multiple HPV strains during sexual networking, whereas older women’s multitype infections (3.40%) may represent decades-long accumulation of persistent subtypes. This divergence underscores the need for age-specific interventions: prophylactic vaccination for adolescents to prevent incident infections versus enhanced surveillance for viral persistence in older populations. The bimodal distribution parallels findings from Fujian Province[ 41 ], suggesting regionally conserved risk factors, yet contrasts with Western cohorts where prevalence declines monotonically after age 25[ 42 ]. Such discrepancies may reflect differences in screening adherence, sexual norms, or environmental cofactors. Future studies integrating longitudinal HPV genotyping and immunological profiling are needed to delineate persistence versus reactivation in aging populations. Public health strategies should prioritize accelerated vaccination in pre-sexual debut groups, risk-adapted screening protocols for postmenopausal women, and targeted education addressing adolescent behavioral risks and age-specific immune maintenance. These findings emphasize the importance of tailoring prevention to the unique etiological pathways governing HPV transmission and persistence across the lifespan. The HPV infection rate among women aged 25–34 was the lowest at 18.40%, showing a year-on-year decline from 2021 to 2024. Women in this age group possess mature immune systems that can both prevent HPV infections and eliminate existing HPV infections. By elucidating HPV infection patterns across different age groups of women, this study provides guiding significance for implementing preventive HPV vaccination programs and cervical cancer screening initiatives targeting high-risk age groups in the region. The simultaneous detection of three or more HPV types in a certain sample of the body is called HPV multiple infection. In our study, the prevalence of single HPV infections is higher than that of double and multiple HPV infections, accounting for 16.34% of the total cases, and HPV52 was the most commonly detected genotype in a single HPV infection. HPV52 is linked to persistent infections that may cause cervical dysplasia (pre-cancer) or cancer. Thus, more attention should be paid to single HPV52 infection. The double HPV infections and multiple HPV infections accounted for 3.91% and 1.59% of the total cases, respectively. The multiple infection rate is lower than the 3.95% multiple infection rate in the Southwest region and the 2.62% multiple infection rate in Guangdong Province[ 35 , 43 ]. Prior studies have clearly shown that patients with multiple HPV infections exhibit more severe cervical lesions and a higher incidence of cervical cancer compared to those with single infections[ 44 , 45 ]. Consequently, patients with multiple HPV infections demand close clinical monitoring. The infection rate of HPV varies due to differences in regions and ages. China has a large population, and there are disparities in its social and economic development. Preventive HPV vaccines are expensive, making it highly unlikely for all women to be vaccinated against HPV. Therefore, vaccinating high-risk groups against HPV can play a beneficial role in the prevention and control of cervical cancer. Effective strategies for the prevention and treatment of HPV should be formulated based on the local distribution characteristics of HPV. Investigative studies on the complexity of the local distribution of HPV genotypes and its epidemiology are of great significance for guiding local HPV vaccination and cervical cancer screening. Conclusions In summary, this study has estimated the prevalence of HPV infection rates, annual trends, age-specific prevalence, and type distribution in Loudi, China. The overall infection rate of HPV was 20.13%, and the top five genotypes in terms of prevalence of HR-HPV and LR-HPV were HPV52/53/16/58/39 and HPV54/61/81/42/44, respectively. HPV infection peaks were observed in women aged ≤ 24 and ≥ 56 years, highlighting the importance of HPV screening in these age groups. Furthermore, enhancing HPV vaccination rates and health education for Chinese women, particularly young women, is crucial. Developing a multivalent HPV vaccine that includes HR-HPV types 52, 53, 16, 58, 39, 58, and 68, prevalent in the region, and increasing vaccination coverage could offer targeted protection against cervical cancer in the female population of Loudi. Abbreviations HPV Human papillomavirus PCR Polymerase Chain Reaction HR-HPV High-risk HPV LR-HPV Low-risk HPV 95% CI 95% Confidence intervals. Declarations Ethics approval and consent to participate This study followed the ethical guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of Loudi Central Hospital (NO.2024.013). Consent for publication All authors consent for publication. Competing interests The authors declare no competing interests. Funding This study was supported by Hunan Provincial Natural Science Foundation of China (No. 2025JJ70365), and Loudi Science and Technology Bureau ([2023]35). Authors' contributions YYB and ZLY designed and supervised the research. YYB, HCX, LLX, and LYG were involved in the design of the survey and the collection of data. YYB performed the statistical analyses. HCX chose the main directions for data analysis. LYG and LLX interpreted the data. YYB and ZLY wrote the manuscript. ZLY revised the manuscript before submission. All authors read and approved the final manuscript. Acknowledgements We express our gratitude to the medical staff in the departments of gynecology and pathology medicine at the Loudi Central Hospital for their assistance in conducting this study. Availability of data and materials The data collected from Loudi central hospital in Loudi city can be freely shared. Any additional information may be obtained from the corresponding author on a reasonable request. 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Cancer Lett 198:187–192. https://doi.org/10.1016/S0304-3835(03)00312-4 Additional Declarations The authors declare potential competing interests as follows: Conflict of Interest Declaration The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript. Specifically: 1.No financial support, grants, or honoraria from any organization or entity related to the subject matter of the study; 2.No personal, professional, or financial ties to companies, products, or services discussed in the work; 3.No pending patents, copyrights, or licensing agreements relevant to the research; 4.No other relationships or activities that could reasonably be perceived as affecting the objectivity of the presented research. All authors have read and approved this declaration, and confirm that there are no unstated conflicts of interest. 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1","display":"","copyAsset":false,"role":"figure","size":36051,"visible":true,"origin":"","legend":"\u003cp\u003eSingle, double and multiple type infection rates of different HPV subtypes. (A)HR-HPV, (B)LR-HPV\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8593748/v1/6888e317f9d11dea1daff5b8.png"},{"id":100408543,"identity":"11f1be9f-80bc-4e2f-bbaf-e69717866faa","added_by":"auto","created_at":"2026-01-16 13:06:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":23253,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of HPV total infection, single, double and multiple infections in different age groups\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8593748/v1/4a99ab6fa943528a58d5774d.png"},{"id":100415134,"identity":"26d8f22a-96db-4651-a704-ac2bf1255e1d","added_by":"auto","created_at":"2026-01-16 13:20:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1272415,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8593748/v1/dd90961f-c1ae-4ca2-a325-f92bcd1c59af.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: Conflict of Interest Declaration\nThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript.\nSpecifically:\n1.No financial support, grants, or honoraria from any organization or entity related to the subject matter of the study;\n2.No personal, professional, or financial ties to companies, products, or services discussed in the work;\n3.No pending patents, copyrights, or licensing agreements relevant to the research;\n4.No other relationships or activities that could reasonably be perceived as affecting the objectivity of the presented research.\nAll authors have read and approved this declaration, and confirm that there are no unstated conflicts of interest.","formattedTitle":"\u003cp\u003ePrevalence and genotype distribution of HPV infections among women in Loudi, China\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCervical cancer (CC)is a common malignant tumor that severely affects women's health worldwide, ranking fourth among the causes of cancer-related deaths in women.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] More than 85% of cervical cancer cases and deaths occur in developing countries, such as China.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] In recent years, the incidence and mortality of cervical cancer in China have been increasing. An estimated number of 109,741 new cases and 59,060 deaths from cervical cancer were recorded annually in China[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], accounting for 20% of the annual global incidence and 17% of the annual global mortality [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].Therefore, it is urgent to take effective prevention and control measures to reduce the burden of cervical cancer in China.\u003c/p\u003e \u003cp\u003eMost cervical cancers are caused by persistent infection with human papillomavirus (HPV).[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]HPV DNA is detected in approximately 95% of cervical malignant lesions.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] HPV is a non-enveloped, double-stranded DNA virus with a genome of approximately 8 kilobases (kb). It infects squamous epithelial cells, leading to mucosal or cutaneous hyperproliferative lesions.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Unlike the taxonomic classification of most other viruses, HPV classification is primarily based on genomic sequence homology rather than antigenic structure.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] A novel HPV subtype is defined when the L1 open reading frame (ORF) sequence of a given HPV type exhibits at least 10% divergence compared to closely related HPV types. HPVs are classified into five genera: Alpha (α), Beta (β), Gamma (γ), Mu (\u0026micro;), and Nu (ν). Among these, Alpha genus HPVs possess oncogenic potential and are further categorized into low-risk and high-risk types based on their carcinogenic capability.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Low-risk HPV (LR- HPV) primarily includes types 6, 11, 30, 42, 43, 44, and 61. These are associated with benign lesions such as genital warts (condyloma acuminatum), flat warts, and low-grade cervical intraepithelial neoplasia (CIN1), and they rarely progress to malignancy. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]High-risk HPV (HR-HPV) encompasses types 16, 18, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68. These types are strongly linked to malignancies, including cervical, vulvar, vaginal, and other anogenital cancers, with the strongest association observed in cc.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]Notably, HPV-16 and HPV-18 infections are the principal etiological factors for invasive cervical carcinoma, accounting for the majority of global cases.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe prophylactic HPV vaccine is the most effective primary prevention and control measure against cervical cancer or other HPV-related diseases.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] China has approved bivalent (2vHPV), quadrivalent (4vHPV), and 9-valent (9vHPV) vaccines, with 9vHPV being the successor to 4vHPV vaccine. The 2vHPV vaccine prevents infection from HPV16 and 18 genotypes; 4vHPV from HPV6, 11, 16, and 18 genotypes; and 9vHPV from HPV6, 11, 16, 18, 31, 33, 45, 52, and 58 genotypes. HPV vaccines have been widely administered globally and have demonstrated significant efficacy. In countries with high HPV vaccine coverage, a marked reduction in high-grade cervical lesions and cervical cancers associated with the vaccine-targeted HPV types has been observed.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] However, HPV vaccines exhibit marked genotype-restricted efficacy, primarily preventing infections and associated lesions caused by the vaccine-targeted HPV types.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] Epidemiological studies have reported substantial geographical variations in the prevalence and distribution of HPV genotypes, with marked heterogeneity observed not only between different regions but also within subregions of the same country.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Therefore, investigating the epidemiological characteristics of HPV infection in a certain population is the foundation of making HPV vaccination strategies in this area.\u003c/p\u003e \u003cp\u003eLoudi City, situated at the geometric center of Hunan Province, is the youngest prefecture-level city in the province. Renowned for its multifaceted industrial prominence, it holds prestigious titles including the \"Pearl of Central Hunan\" \"World Antimony Capital\", \"Coal Basin of Southern China\", \"Modern Steel Metropolis\" and \"Thermal Power Nexus\". Currently, there is limited data on the prevalence and genotype distribution of HPV infections in the Loudi region. This study aimed to investigate the epidemiological characteristics of HPV infection, identify the predominant HPV genotypes, and analyze age-specific infection patterns among women in Loudi. The findings are expected to provide evidence to inform regional strategies for HPV vaccination targeting high-risk populations and optimize cervical cancer screening programs, thereby contributing to cervical cancer prevention in this understudied area.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSubjects\u003c/h2\u003e \u003cp\u003eThe study adopted a retrospective approach, covering the period from June 2021 to September 2024. The subjects were patients who underwent HPV screening at Loudi Central Hospital for various reasons, including physical examinations, patient requests, diagnostic requirements prescribed by doctors, and random screenings conducted by doctors. Inclusion criteria consisted of a history of sexual activity, absence from menstruation and pregnancy, while exclusion criteria included women with no history of sexual activity, menstruating and pregnant women, women who had undergone uterine surgery. For the multiple cases, we only counted the results of the first screening. The retrospective study enrolled 48,717 female patients Participants ranged in age from 16 to 92 years (mean age: 43.7\u0026thinsp;\u0026plusmn;\u0026thinsp;11.0 years) and were stratified into five age cohorts: \u0026le;24 years, 25\u0026ndash;34 years, 35\u0026ndash;44 years, 45\u0026ndash;54 years, and \u0026ge;\u0026thinsp;55 years. This study was approved by the Medical Ethics Committee of Loudi Central Hospital, and all methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSpecimen collection\u003c/h3\u003e\n\u003cp\u003eThe gynecologist first exposes the cervix with a speculum or vaginal opener and uses a cotton swab to wipe away excess secretions from the cervical opening. Take out the cervical brush and place it at the cervical opening, rotate it in one direction for 4\u0026ndash;5 complete rotations to obtain a sufficient amount of epithelial cell sample, then put the head of the cervical brush into the elution tube, break the cervical brush handle along the crease of the brush handle, tighten the elution tube cap, do a good job of sample identification, and keep the elution tube upright. After the sample is collected, it is stored at 2\u0026thinsp;~\u0026thinsp;8\u0026deg;C, and the sample detection is completed within 24h.\u003c/p\u003e\n\u003ch3\u003eDNA extraction and HPV genotyping\u003c/h3\u003e\n\u003cp\u003eDNA extraction and HPV genotyping were performed using an HPV genotyping kit for 23 Types (Shenzhen Yaneng Bio-Tech Co., Ltd.) by PCR-RDB which was a cost-effective and beneficial cervical cancer primary screening for hospital-based opportunistic screening [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The kit detected 23 types of HPV: HPV6, 11, 42, 43, 16, 18, 31,33, 35, 39, 45, 51, 52, 53,56, 58, 59, 66, 68, 73,81,82,83. The process involved three steps: HPV-DNA extraction, PCR amplification and HPV-DNA hybridization. The Haema9600 (Zhuhai XZ Bio-Tech Co., Ltd.) was used for gene amplification. The amplification parameters were set as follows: ①50 ℃ for 15 min; ②95 ℃ for 10 min; ③40 cycles were performed at 94 ℃ for 30 s, 42 ℃ for 90 s and 72 ℃ for 30 s; and ④ 72℃ for 5 min. The YN-H16 (Shenzhen GL Bio-Tech Co., Ltd.) was used for DNA hybridization. After color rendering, positive detection results were indicated by clear blue dots, a blue spot in one gene locus is a single infection, and multiple blue spots were mixed infection or multiple infection. To ensure the reliability of each HPV test result, there is an IC (internal control) site on each patient\u0026rsquo;s hybrid membrane, with one positive control (HPV16 positive) and one negative control set up during each trial. In this study, in order to exclude the interference of reproductive pathogens other than HPV (CT, MH, TV, TP, SPY, HSH-2, etc.) on HPV detection results, specific reagents were added during DNA extraction, amplification, and hybridization to ensure that there was no cross-reaction. The testing doctor strictly follows the HPV interpretation rules to issue the patient\u0026rsquo;s HPV test results.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSingle, double and multiple HPV infections were defined as infection with one, two and with three or more subtypes of HPV infections, respectively. The proportion of women in different age groups with single, double and multiple infections was then analyzed. Data were compared using Pearson χ2 or Fisher exact tests. Descriptive and inferential statistical analysis were conducted using Statistical Package for the Social Sciences version 22 (SPSS Inc., Illinios, USA), and P\u0026thinsp;\u0026lt;\u0026thinsp;.05 was considered to be statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOverall prevalence of HPV Infection over time\u003c/h2\u003e \u003cp\u003eA total of 10,637 HPV-positive cases were identified among 48,717 individuals screened between 2021 and 2024, yielding an overall infection rate of 21.83%. Further analysis revealed that 3,261, 2,511, 2,594 and 2,171 HPV-positive cases were detected in 2021, 2022, 2023 and 2024 respectively, with corresponding infection rates of 23.01% (3,261/14,170), 21.13% (2,511/11,883), and 21.36% (2,594/12,142). The highest prevalence was observed in 2021 (23.01%), significantly higher than subsequent years (all P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The rate declined to the lowest point in 2022 (21.13%) and remained stable during 2023\u0026ndash;2024 (21.36%-21.58%, between group P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Chi-square test indicated statistically significant differences across years (χ\u0026sup2;=16.949, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTrends in HPV infection prevalence with statistical comparisons,2021\u0026ndash;2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNegative cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTotal cases\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrevalence %(95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,261\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10,909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14,170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.01(22.30-23.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9,372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11,883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.13(20.37\u0026ndash;21.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,594\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9,548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12,142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.36(20.60-22.13)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2,271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10,522\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.58(20.78\u0026ndash;22.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10,637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29,829\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48,717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.83(21.43\u0026ndash;22.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eStatistical analysis: χ\u0026sup2;test revealed significant differences across years (χ\u0026sup2;=16.949, DF\u0026thinsp;=\u0026thinsp;3, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Post-hoc pairwise comparisons with Bonferroni correction showed: 2021 prevalence was significantly higher than 2022 (P\u0026thinsp;=\u0026thinsp;0.002), 2023 (P\u0026thinsp;=\u0026thinsp;0.004), and 2024 (P\u0026thinsp;=\u0026thinsp;0.008) ;No significant differences were observed among 2022\u0026ndash;2024 (all P\u0026thinsp;\u0026gt;\u0026thinsp;0.05); Data are presented as prevalence % (95% CI), with CIs calculated using the Wilson score method.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDistribution of single, double, and multiple HPV infections\u003c/h3\u003e\n\u003cp\u003eAmong 48,717 individuals screened for HPV, 10, 637 (21.83%) tested positive. \u003cb\u003eSingle HPV infections predominated\u003c/b\u003e, identified in 7,959 cases (74.82% of positive cases; 16.3% of the total screened population). \u003cb\u003eDouble infections\u003c/b\u003e were detected in 1,905 individuals (17.91% of positives; 3.91% of total), while \u003cb\u003emultiple infections (\u0026ge;\u0026thinsp;3 subtypes)\u003c/b\u003e accounted for 773 cases (7.27% of positives; 1.59% of total). The stratified distribution of infection multiplicity is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of single and multiple HPV infections among HPV-positive patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfection Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive cases (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrevalence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eProportion (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDouble infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple infections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\n\u003ch3\u003eHPV genotype distribution\u003c/h3\u003e\n\u003cp\u003eHPV genotyping was performed on 48,717 clinical specimens, and all 23 HPV subtypes were detected. There were 23 different HPV genotypes, including 17 HR-HPV genotypes and 6 LR-HPV genotypes, identified in this study. The prevalence of 23 HPV was demonstrated in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The most common HR-HPV identified was HPV52 (5.58%), followed by HPV53 (2.71%), HPV58 (2.48%), HPV16 (2.44%) and HPV51 (1.80%). To be noted, HPV18 was only the twelfth most common HR HPV genotype to be detected. The top five genotypes for individuals with a single HR-HPV infection were HPV52, HPV58, HPV53, HPV16, and HPV51. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA, for individuals with double HPV infections, the HR-HPV that ranked top five were HPV52, HPV53, HPV16, HPV58, and HPV51. For individuals with multiple HPV infections, the HR HPV that ranked top five were HPV52, HPV53, HPV16, HPV51, and HPV58. These data suggested that HPV52 infection was predominant in HPV-positive patients. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB, the most common LR-HPV identified was HPV81, followed by HPV42, HPV43, HPV6, and HPV11. The most commonly detected genotype for individuals with a single LR-HPV infection was HPV81, followed by HPV42, HPV43, HPV6, and HPV11. For double and multiple LR-HPV infected individuals, the most common types of dual infection and multiple infection were the same as single infection.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of single, double, and multiple HPV infections of 23 genotypes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHPV\u003c/p\u003e \u003cp\u003eType\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eSingle infection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eDouble infections\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eMultiple infections\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eTotal infections\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive no\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePositive no\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePositive no\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePositive no\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHR-HPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.74(3.57\u0026ndash;3.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.22(1.12\u0026ndash;1.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.62(0.55\u0026ndash;0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2718\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e5.58(5.38\u0026ndash;5.78)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e695\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.43(1.32\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.79(0.71\u0026ndash;0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.50(0.43\u0026ndash;0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1320\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.71(2.57\u0026ndash;2.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e760\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.56(1.45\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.60(0.53\u0026ndash;0.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e154\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.32(0.27\u0026ndash;0.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.48(2.34\u0026ndash;2.62)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.40(1.30\u0026ndash;1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.62(0.55\u0026ndash;0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e205\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.42(0.36\u0026ndash;0.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.44(2.30\u0026ndash;2.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96(0.88\u0026ndash;1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.47(0.41\u0026ndash;0.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.37(0.32\u0026ndash;0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e877\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.80(1.68\u0026ndash;1.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82(0.74\u0026ndash;0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.39(0.33\u0026ndash;0.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.31(0.26\u0026ndash;0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.52(1.41\u0026ndash;1.63)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e265\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.54(0.48\u0026ndash;0.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.31(0.26\u0026ndash;0.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.24(0.20\u0026ndash;0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.09(1.00-1.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.50(0.44\u0026ndash;0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.29(0.24\u0026ndash;0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.22(0.18\u0026ndash;0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.01(0.92\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53(0.47\u0026ndash;0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.26(0.21\u0026ndash;0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20(0.16\u0026ndash;0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.99(0.90\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.36(0.31\u0026ndash;0.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.25(0.20\u0026ndash;0.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.23(0.19\u0026ndash;0.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e410\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.84(0.76\u0026ndash;0.92)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.38(0.33\u0026ndash;0.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.24(0.20\u0026ndash;0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.20(0.16\u0026ndash;0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.82(0.74\u0026ndash;0.90)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.37(0.32\u0026ndash;0.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.21 (0.17\u0026ndash;0.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.17(0.14\u0026ndash;0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.75(0.68\u0026ndash;0.83)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.25(0.21\u0026ndash;0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.17(0.14-021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.11(0.08\u0026ndash;0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.54(0.48\u0026ndash;0.61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.18(0.14\u0026ndash;0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09(0.06\u0026ndash;0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.08(0.05\u0026ndash;0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.34(0.29\u0026ndash;0.39)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.10(0.08\u0026ndash;0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.06(0.04\u0026ndash;0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.07(0.05\u0026ndash;0.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.24(0.20\u0026ndash;0.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06(0.04\u0026ndash;0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.04(0.02\u0026ndash;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.06(0.04\u0026ndash;0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.15(0.12\u0026ndash;0.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.06(0.04\u0026ndash;0.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.03(0.01\u0026ndash;0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.03(0.02\u0026ndash;0.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.12(0.09\u0026ndash;0.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLR-HPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.35(1.25\u0026ndash;1.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.67(0.60\u0026ndash;0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.44(0.38\u0026ndash;0.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e2.46(2.33\u0026ndash;2.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.66(0.59\u0026ndash;0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.46(0.40\u0026ndash;0.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.31(0.26\u0026ndash;0.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.42(1.32\u0026ndash;1.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.53(0.47\u0026ndash;0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.34(0.29\u0026ndash;0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.26(0.22\u0026ndash;0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e553\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1.14(1.04\u0026ndash;1.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.36(0.30\u0026ndash;0.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.23(0.19\u0026ndash;0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.18(0.14\u0026ndash;0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.77(0.69\u0026ndash;0.85)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.12(0.09\u0026ndash;0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.05(0.03\u0026ndash;0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.08(0.05\u0026ndash;0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.25(0.21\u0026ndash;0.29)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07(0.04\u0026ndash;0.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.05(0.03\u0026ndash;0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.03(0.01\u0026ndash;0.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e0.15(0.11\u0026ndash;0.18)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTemporal trends in type-specific HPV prevalence\u003c/h2\u003e \u003cp\u003eSignificant temporal variations in genotype-specific HPV prevalence were identified through chi-square analysis of 21 HPV types over a four-year surveillance period (2021\u0026ndash;2024). Analysis of 48,717 cervical screening samples collected between 2021 and 2024 identified distinct temporal patterns in the prevalence of 21 HPV genotypes (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Chi-square tests revealed statistically significant trends for two genotypes (HPV52 and HPV42), while the majority exhibited stable prevalence profiles. The Prevalence of HPV52 decreased progressively from 6.10% (367/14,184) in 2021 to 5.04% (530/10,510) in 2024 (χ\u0026sup2; = 15.769, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). This genotype demonstrated the most pronounced downward trajectory among all high-risk types. However, A paradoxical rise in prevalence of HPV42 was observed, increasing from 1.29% (183/14,184) to 1.75% (184/10,510) over the study period (χ\u0026sup2; = 7.494, P\u0026thinsp;=\u0026thinsp;0.006). No significant temporal variations (P\u0026thinsp;\u0026ge;\u0026thinsp;0.05) were detected for in the other 19 genotypes 19 genotypes. Notably, HPV56 displayed a non-significant upward trajectory (1.00%\u0026rarr;1.25%, P\u0026thinsp;=\u0026thinsp;0.082), suggesting potential emergence requiring surveillance.\u003c/p\u003e \u003c/div\u003e\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTemporal Trends in HPV Genotype Prevalence (2021\u0026ndash;2024)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHPV type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e367(2.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e290(2.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e285(2.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e246(2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.989\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e109(0.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96(0.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e90(0.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72(0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.393\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80(0.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59(0.50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75(0.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50(0.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e164(1.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107(0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e140(1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e121(1.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.687\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47(0.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46(0.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41(0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e32(0.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.637\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e149(1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110(0.93)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e117(0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e105(1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40(0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29(0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24(0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.282\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e277(1.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212(1.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e205(1.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e183(1.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e865(6.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e668(5.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e655(5.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e530(5.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e15.769\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e375(2.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e333(2.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e327(2.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e285(2.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e141(1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106(0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e114(0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e131(1.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e378(2.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e280(2.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e284(2.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e265(2.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e122(0.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82(0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e97(0.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e99(0.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126(0.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e99(0.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99(0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e86(0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.505\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220(1.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e169(1.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e178(1.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e172(1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.654\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27(0.19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17(0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16(0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15(0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(0.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18(0.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7(0.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.534\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e127(0.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71(0.60))\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91(0.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e86(0.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37(0.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39(0.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(0.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21(0.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.153\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e183(1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e161(1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e166(1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e184(1.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e183(1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125(1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e135(1.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e110(1.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e336(2.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e285(2.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e294(2.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e285(2.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.119\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19(0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16(0.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13(0.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23(0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence Distribution of HPV Infection in Different Age Groups\u003c/h2\u003e \u003cp\u003eAmong the 48,717 cases analyzed, the prevalence of HPV infection in the \u0026le;\u0026thinsp;24 years old group, 25\u0026ndash;34 years old group, 35\u0026ndash;44 years old group, 45\u0026ndash;54 years old group and \u0026ge;\u0026thinsp;55 years old group were 28.74%, 18.40%, 18.73%, 21.76% and 30.41%, respectively. The prevalence of HPV infection across age groups demonstrated a distinct U-shaped pattern in this study. The highest infection rates were observed in the youngest (\u0026lt;\u0026thinsp;25 years: 28.74%, 95% CI 26.39\u0026ndash;31.10) and oldest (\u0026ge;\u0026thinsp;55 years: 30.41%, 95% CI 29.42\u0026ndash;31.40) age groups, while middle-aged participants exhibited lower rates, ranging from 18.40% (25\u0026ndash;34 years) to 21.76% (45\u0026ndash;54 years), as shown in Table \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. Single infections predominated across all ages but were most prevalent in older adults (\u0026ge;\u0026thinsp;55 years: 20.22%, 95% CI 19.36\u0026ndash;21.09). In contrast, double infections peaked in both the \u0026lt;\u0026thinsp;25-year (6.64%, 95% CI 5.34\u0026ndash;7.94) and \u0026ge;\u0026thinsp;55-year (6.79%, 95% CI 6.25\u0026ndash;7.33) groups. Notably, multiple infections (\u0026ge;\u0026thinsp;3 types) were highest in the youngest cohort (4.94%, 95% CI 3.81\u0026ndash;6.07) and declined with age, though a secondary rise occurred in the \u0026ge;\u0026thinsp;55-year group (3.40%, 95% CI 3.01\u0026ndash;3.79), as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Statistical analyses confirmed significant heterogeneity in infection rates across age groups (χ\u0026sup2; = 558.861, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with pairwise comparisons revealing no significant difference between the \u0026lt;\u0026thinsp;25-year and \u0026ge;\u0026thinsp;55-year groups (χ\u0026sup2; = 1.525, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.217) but marked disparities between these groups and middle-aged populations (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of HPV infection in different age groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, y\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSample\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eSingle infection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eDouble infections\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eMultiple infections\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eTotal infections\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePositive no\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePositive no\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePositive no\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e%(95%CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.16(15.20-19.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.64(5.34\u0026ndash;7.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.94(3.81\u0026ndash;6.07)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e407\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e28.74(26.39\u0026ndash;31.10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.22(13.54\u0026ndash;14.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e315\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.06(2.73\u0026ndash;3.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.12(0.91\u0026ndash;1.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1893\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18.40(17.65\u0026ndash;19.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.18(14.60-15.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.81(2.54\u0026ndash;3.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.74(0.60\u0026ndash;0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2693\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18.73(18.09\u0026ndash;19.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.68(16.07\u0026ndash;17.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.68(3.38\u0026ndash;3.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.40(1.20\u0026ndash;1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21.76(21.09\u0026ndash;22.44)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1679\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.22(19.36\u0026ndash;21.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.79(6.25\u0026ndash;7.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.40(3.01\u0026ndash;3.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2525\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e30.41(29.42\u0026ndash;31.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7959\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.34(16.01\u0026ndash;16.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1905\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.91(3.74\u0026ndash;4.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e773\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.59(1.48\u0026ndash;1.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21.83(21.47\u0026ndash;22.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAge-Specific Temporal Trends in HPV Prevalence (2021\u0026ndash;2024)\u003c/h2\u003e \u003cp\u003eThe age-specific prevalence of HPV infection exhibited dynamic temporal trends across the study period (2021\u0026ndash;2024), as shown in Table\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Among individuals aged\u0026thinsp;\u0026le;\u0026thinsp;24 years, infection rates showed a modest decline from 0.88% (124/14,170) in 2021 to 0.73% (77/10,522) in 2024 (χ\u0026sup2; = 3.985, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.046). Similarly, significant reductions were observed in the 25\u0026ndash;34 age group, with prevalence decreasing sharply from 4.69% (665/14,170) to 2.91% (306/10,522) (χ\u0026sup2; = 58.469, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Middle-aged cohorts displayed divergent patterns: while the 35\u0026ndash;44 group fluctuated between 5.01% (534/10,522) and 6.34% (898/14,170) (χ\u0026sup2; = 14.373, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), the 45\u0026ndash;54 group demonstrated a gradual decline from 7.00% (992/14,170) to 6.01% (632/10,522) (χ\u0026sup2; = 12.941, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Most strikingly, adults aged\u0026thinsp;\u0026ge;\u0026thinsp;55 experienced a marked increase in prevalence, rising from 4.11% (582/14,170) in 2021 to 31.8% (722/10,522) in 2024 (χ\u0026sup2; = 106.300, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). These trends collectively reflect significant age-dependent shifts (all \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), with younger and middle-aged groups showing stabilization or decline, contrasted against a doubling of infection burden in older adults.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHPV infection rates in different age groups from 2021 to 2024(n, %)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(y)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2021\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eχ\u0026sup2;\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124(0.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122(1.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84(0.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e77(0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e3.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e665(4.69)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e495(4.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e427(3.52)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e306(2.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e58.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e898(6.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e594(5.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e667(5.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e534(5.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e14.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45\u0026ndash;54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e992(7.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e767(6.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e728(6.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e632(6.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e12.941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e582(4.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e533(4.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e688(5.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e722(6.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e106.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3261(23.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2511(21.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2594(21.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2271(21.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eCervical cancer remains a leading contributor to cancer-related mortality among women globally, with persistent infection by high-risk human papillomavirus (HR-HPV) genotypes established as the predominant oncogenic driver in cervical carcinogenesis[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The HPV infection rate varies by region and population, the differences in lifestyle and economic development, viral genomic variation, and prophylactic HPV vaccination can all lead to differences in HPV infection rates between regions. Molecular epidemiological studies can clarify the prevalence and characteristics of HPV infection in different regions, which is crucial for the control and prevention of HPV-related cancers and for guiding prophylactic HPV vaccination.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].Notably, population-based HPV screening initiatives have demonstrated significant efficacy in reducing both incidence rates and disease-specific mortality of cervical cancer, particularly when integrated with timely follow-up interventions[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This retrospective analysis examines the epidemiological characteristics of HPV infection among 48,717 female participants in Loudi City, Hunan Province, China, from January 2021 to March 2024. By establishing a comprehensive regional HPV prevalence database and genotype distribution profile, our findings aim to provide an evidence-based foundation for optimizing HPV immunization strategies and enhancing precision medicine approaches in cervical cancer prevention within this specific geographical context.\u003c/p\u003e \u003cp\u003eAmong the 48,717 female subjects in this study, HPV genotyping identified 10,637 HPV-positive cases, resulting in an overall HPV infection rate of 21.83%. This rate was similar to that of Kunming City, China (22.03%)[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], lower than rates observed in Chongqing (26.15%)[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], Jilin (34.40%)[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], and Fujian (38.3%)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], but higher than Huzhou (15.50%)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Hengyang (10.16%)[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and Wuhan (15.33%)[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], indicating geographical variations in HPV infection rates across China. This study analyzed the trends in the HPV infection rate from 2021 to 2024. The results showed that there were significant differences in the infection rate among the years (χ2\u0026thinsp;=\u0026thinsp;16.949, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The infection rate was the highest in 2021 (23.01%), which might be related to the backlog of cases caused by the delay in screening during the initial stage of the COVID-19 pandemic[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Subsequently, it significantly decreased to 21.13% in 2022 (P\u0026thinsp;=\u0026thinsp;0.002), which might be associated with the promotion of the vaccination program and the denominator effect after the resumption of screening[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The infection rates in 2023 (21.36%) and 2024 (21.58%) tended to be stable (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05 between groups), suggesting that the effectiveness of the intervention measures may have entered a plateau phase, or there may be a continuously spreading population that has not been covered. It was crucial to understand the distribution of HPV genotypes in the local area before the widespread implementation of HPV vaccination, as it contributed to vaccine development and the establishment of optimal vaccine protection strategies. Our study revealed that the top five genotypes of high-risk HPV prevalence among female subjects were HPV52/53/58/16/51, while the top five genotypes of low-risk HPV prevalence were HPV81/42/43/6/11. Interestingly, the top five genotypes of high-risk HPV prevalence in Loudi differed only in specific genotypes when compared to Shanghai (HPV52/16/58/53/39), but were in line with the high-risk HPV infection types observed in Kunming (HPV52/16/58/53/51). This study shows that HPV52, HPV53 and HPV58 are the dominant HPV types in this region, with infection rates of 5.58%, 2.71% and 2.48% respectively. In the Southwest region, the infection rate of HPV52 is the highest, followed by HPV16 and HPV58. In the Guangdong region, the infection rate of HPV16 is the highest, followed by HPV52 and HPV58[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The HPV susceptibility genotypes identified in this region exhibit distinct discrepancies when juxtaposed with those documented in other regions across China. This divergence not only accentuates the remarkable complexity inherent in the distribution patterns of HPV genotypes but also serves as a compelling testament to the indispensable role of localized HPV investigation and research. Such findings underscore the necessity of region - specific studies, as they can capture the unique epidemiological characteristics of HPV infections that may be overlooked in broader, national - scale analyses. These local investigations are crucial for formulating targeted public health strategies, improving screening protocols, and ultimately enhancing the prevention and control of HPV-related diseases. The present study systematically investigated the temporal trends of HPV infections in the designated region during the period from 2021 to 2024. Statistical analyses revealed a significant upward trend in the prevalence of the HPV42 subtype over time. Of particular concern is the fact that HPV42 is not among the genotypes targeted by the nine-valent prophylactic HPV vaccine, which encompasses HPV6, 11, 16, 18, 31, 33, 45, 52, and 58. Given these findings, HPV42 infection should be prioritized in future research and public health surveillance efforts, as it represents an unaddressed gap in current vaccination strategies and may pose a substantial health risk that warrants further investigation. In this region, HPV52 and HPV58, the predominant and highly susceptible genotypes, exhibit relatively high and stable infection rates. Epidemiological investigations have unequivocally demonstrated that the detection frequencies of HPV 52 and HPV 58 are notably elevated among patients diagnosed with cervical cancer[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Current HPV vaccination regimens comprehensively incorporate immunogenic components targeting these specific subtypes. However, multifaceted barriers impede widespread vaccination uptake. Predominantly, inadequate public awareness regarding the efficacy and importance of HPV vaccination, coupled with the financial burden associated with vaccine administration, has led to suboptimal vaccination coverage rates. Consequently, the endemicity of HPV52 and HPV58 infections persists at elevated levels, posing a significant challenge to cervical cancer prevention and control efforts within the population.\u003c/p\u003e \u003cp\u003eThe observed bimodal age distribution of HPV infection rates, with peaks among adolescents/young adults (\u0026le;\u0026thinsp;24 years, 28.74%) and postmenopausal women (\u0026ge;\u0026thinsp;55 years, 30.41%), highlights distinct biological and behavioral risk factors across age strata. The elevated prevalence in the \u0026le;\u0026thinsp;24-year cohort likely reflects behavioral vulnerabilities during sexual debut, where high rates of single (17.16%) and multiple infections (4.94%) align with early sexual activity and multi-partner exposure in unvaccinated populations[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. In contrast, the second peak in older women (\u0026ge;\u0026thinsp;55 years) demonstrates a shift toward biological mechanisms, as evidenced by the predominance of single infections (20.22%) and cumulative double infections (6.79%). This pattern suggests viral persistence rather than incident exposure, potentially driven by immuno-senescence-related declines in T-cell-mediated viral clearance and estrogen depletion-induced epithelial fragility[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Intermediate age groups (25\u0026ndash;54 years) exhibited lower infection rates (18.40\u0026ndash;21.76%), likely attributable to standardized cervical screening protocols and stabilized sexual partnerships. However, the gradual increase from 35\u0026ndash;44 to 45\u0026ndash;54 years (18.73% to 21.76%) may signal early immunological or hormonal shifts preceding the pronounced risk in postmenopausal women. Notably, the \u0026le;\u0026thinsp;24-year cohort\u0026rsquo;s high multitype infection prevalence (4.94%) indicates concurrent exposure to multiple HPV strains during sexual networking, whereas older women\u0026rsquo;s multitype infections (3.40%) may represent decades-long accumulation of persistent subtypes. This divergence underscores the need for age-specific interventions: prophylactic vaccination for adolescents to prevent incident infections versus enhanced surveillance for viral persistence in older populations. The bimodal distribution parallels findings from Fujian Province[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], suggesting regionally conserved risk factors, yet contrasts with Western cohorts where prevalence declines monotonically after age 25[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Such discrepancies may reflect differences in screening adherence, sexual norms, or environmental cofactors. Future studies integrating longitudinal HPV genotyping and immunological profiling are needed to delineate persistence versus reactivation in aging populations. Public health strategies should prioritize accelerated vaccination in pre-sexual debut groups, risk-adapted screening protocols for postmenopausal women, and targeted education addressing adolescent behavioral risks and age-specific immune maintenance. These findings emphasize the importance of tailoring prevention to the unique etiological pathways governing HPV transmission and persistence across the lifespan. The HPV infection rate among women aged 25\u0026ndash;34 was the lowest at 18.40%, showing a year-on-year decline from 2021 to 2024. Women in this age group possess mature immune systems that can both prevent HPV infections and eliminate existing HPV infections. By elucidating HPV infection patterns across different age groups of women, this study provides guiding significance for implementing preventive HPV vaccination programs and cervical cancer screening initiatives targeting high-risk age groups in the region.\u003c/p\u003e \u003cp\u003eThe simultaneous detection of three or more HPV types in a certain sample of the body is called HPV multiple infection. In our study, the prevalence of single HPV infections is higher than that of double and multiple HPV infections, accounting for 16.34% of the total cases, and HPV52 was the most commonly detected genotype in a single HPV infection. HPV52 is linked to persistent infections that may cause cervical dysplasia (pre-cancer) or cancer. Thus, more attention should be paid to single HPV52 infection. The double HPV infections and multiple HPV infections accounted for 3.91% and 1.59% of the total cases, respectively. The multiple infection rate is lower than the 3.95% multiple infection rate in the Southwest region and the 2.62% multiple infection rate in Guangdong Province[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Prior studies have clearly shown that patients with multiple HPV infections exhibit more severe cervical lesions and a higher incidence of cervical cancer compared to those with single infections[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Consequently, patients with multiple HPV infections demand close clinical monitoring. The infection rate of HPV varies due to differences in regions and ages. China has a large population, and there are disparities in its social and economic development. Preventive HPV vaccines are expensive, making it highly unlikely for all women to be vaccinated against HPV. Therefore, vaccinating high-risk groups against HPV can play a beneficial role in the prevention and control of cervical cancer. Effective strategies for the prevention and treatment of HPV should be formulated based on the local distribution characteristics of HPV. Investigative studies on the complexity of the local distribution of HPV genotypes and its epidemiology are of great significance for guiding local HPV vaccination and cervical cancer screening.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, this study has estimated the prevalence of HPV infection rates, annual trends, age-specific prevalence, and type distribution in Loudi, China. The overall infection rate of HPV was 20.13%, and the top five genotypes in terms of prevalence of HR-HPV and LR-HPV were HPV52/53/16/58/39 and HPV54/61/81/42/44, respectively. HPV infection peaks were observed in women aged\u0026thinsp;\u0026le;\u0026thinsp;24 and \u0026ge;\u0026thinsp;56 years, highlighting the importance of HPV screening in these age groups. Furthermore, enhancing HPV vaccination rates and health education for Chinese women, particularly young women, is crucial. Developing a multivalent HPV vaccine that includes HR-HPV types 52, 53, 16, 58, 39, 58, and 68, prevalent in the region, and increasing vaccination coverage could offer targeted protection against cervical cancer in the female population of Loudi.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHuman papillomavirus\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePCR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePolymerase Chain Reaction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHR-HPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh-risk HPV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLR-HPV\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-risk HPV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e95% CI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e95% Confidence intervals.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study followed the ethical guidelines of the Declaration of Helsinki and was approved by the Ethics Committee of Loudi Central Hospital (NO.2024.013).\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003e All authors consent for publication.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study was supported by Hunan Provincial Natural Science Foundation of China (No. 2025JJ70365), and Loudi Science and Technology Bureau ([2023]35).\u003c/p\u003e\u003ch2\u003eAuthors' contributions\u003c/h2\u003e \u003cp\u003eYYB and ZLY designed and supervised the research. YYB, HCX, LLX, and LYG were involved in the design of the survey and the collection of data. YYB performed the statistical analyses. HCX chose the main directions for data analysis. LYG and LLX interpreted the data. YYB and ZLY wrote the manuscript. ZLY revised the manuscript before submission. All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eWe express our gratitude to the medical staff in the departments of gynecology and pathology medicine at the Loudi Central Hospital for their assistance in conducting this study.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e \u003cp\u003eThe data collected from Loudi central hospital in Loudi city can be freely shared. 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Cancer Lett 198:187\u0026ndash;192. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S0304-3835(03)00312-4\u003c/span\u003e\u003cspan address=\"10.1016/S0304-3835(03)00312-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Loudi Central Hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"human papillomavirus, prevalence, genotype, high-risk HPV, low-risk HPV, cervical cancer","lastPublishedDoi":"10.21203/rs.3.rs-8593748/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8593748/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHuman papillomavirus (HPV) infection is the primary cause of cervical cancer, and understanding the infection rates and genotype distribution characteristics of HPV in different regions is of great significance for cervical cancer prevention and control. This study aims to analyze the HPV infection rate and genotype distribution characteristics among women in Loudi City, providing a scientific basis for the development of targeted prevention and control measures.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eOur study retrospectively analyzed the results of cervical HPV screening in 48,717 women in Loudi city. The cervicovaginal infection of 18 high-risk genotypes and 6 low-risk genotypes were analyzed by PCR and reverse dot hybridization techniques.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe overall prevalence rate of HPV infection among 48,717 cases was 21.83%, and the prevalence rate in 2021 to 2024 were 23.01%,21.13%,21.36% and 21.58%, respectively. Single infection (74.82%) was the main HPV infection pattern, followed by double infection (17.91%) and multiple infection (7.27%).The top five genotypes in terms of prevalence of HR-HPV and LR-HPV were HPV-52 (5.58%), 53 (2.71%), 58(2.48%), 16 (2.44%), 51 (1.80%) for HR-HPV, and HPV-81 (2.46%), 42 (1.42%), 43 (1.14%), 6 (0.77%), 11(0.0.25%) for LR-HPV. The Prevalence of HPV52 decreased progressively from 6.10% in 2021 to 5.04% in 2024, However, an increase in the prevalence of HPV42 has been observed, increasing from 1.29% to 1.75% between 2021\u0026ndash;2024. The prevalence of HPV showed a bimodal U-shaped curve with age; the first and second peak common occurred among females\u0026thinsp;\u0026le;\u0026thinsp;24 years old (28.74%) and \u0026ge;\u0026thinsp;55 years old (30.41%), respectively. The prevalence of women aged 25\u0026ndash;34 years was the lowest, which was 18.40%. Among single and double HPV type infections, the infection rate was highest in the age group of \u0026ge;\u0026thinsp;55 years, while among multiple infections, the highest infection rate was in the group\u0026thinsp;\u0026le;\u0026thinsp;24 years old. From 2021 to 2024, the infection rate of women in the \u0026ge;\u0026thinsp;55 age group had been increasing year by year over time.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study revealed the HPV prevalence and genotype distribution among different populations in Loudi city, which may provide guidance for HPV vaccination and cervical cancer prevention strategies in the region.\u003c/p\u003e","manuscriptTitle":"Prevalence and genotype distribution of HPV infections among women in Loudi, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-16 11:07:19","doi":"10.21203/rs.3.rs-8593748/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"658c30f3-3711-4850-8d01-14dfc4160037","owner":[],"postedDate":"January 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":61080227,"name":"Molecular Epidemiology"}],"tags":[],"updatedAt":"2026-01-16T11:07:23+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-16 11:07:19","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8593748","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8593748","identity":"rs-8593748","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}