Abstract: Objective To study the correlation between high-risk HPV infection and vaginal microecological environment. Methods A total of 280 women with gynecological outpatient health checkups, subjects aged 20~60 years, were randomly collected and divided into case and control groups, grouped based on the presence or absence of high-risk HPV infection. The case group: 153 cases were positive for high-risk HPV, and the control group: 127 cases were negative for HPV. The vaginal flora density, diversity, pH value, vaginal microecological function test, vaginal pathogenic microorganisms, and Nugent score were analyzed and compared between the two groups. Results The difference in the density and diversity of vaginal flora between the case group and the control group was not statistically significant (P>0.05); In the case group, the proportion of vaginal pH 4.5, catalase positive rate, sialidase positive rate and leukocyte esterase positive rate were all higher than the control group, and the differences were statistically significant (P<0.05). The BV detection rate was 20.00% (56/280), TV detection rate was 1.43% (4/280), and VVC detection rate was 5.00% (14/280) in all 280 subjects. The BV positivity rate was 33.33% (51/153) in the case group and 3.94% (5/127) in the control group, with a significant difference between the groups (P<0.05). There were no significant differences in the rates of trichomonas vaginalis and Pseudomonas vulvae positivity in the case group compared with the control group (P>0.05). The risk of high-risk HPV infection increased 4.986-6.791-fold with increasing Nugent score (χ²₁=21.489, P₁<0.05, OR₁=4.986, 95% CI₁: 2.424-10.258; χ²₂=17.573, P₂<0.05, OR₂=6.791, 95% CI₂: 2.503-18.420). Conclusion High risk HPV infection is closely related to vaginal microecology, especially BV is a risk factor for high risk HPV infection.

Key words: high-risk HPV infection, endovaginal microecologics, BV