Dual effects of vaginal Candida albicans on human papillomavirus infection: A large-scale multicenter study in Chinese women

Objectives

Vaginal infections caused by Candida albicans and human papillomavirus (HPV) are common, yet their interactions remain complex and poorly understood.

Methods

We conducted a nationwide, multicenter cohort study in China involving 6,689 women aged 18 to 50 years to examine the association between C. albicans infection and HPV acquisition and persistence. C. albicans infection was defined by positive results on both wet-mount microscopy and culture. HPV genotypes (21 types) and other sexually transmitted infections (STIs, eight types) were detected using polymerase chain reaction. Cervical lesions were assessed via the ThinPrep cytologic test (TCT).

Results

In cross-sectional analyses, C. albicans infection was associated with a lower likelihood of concurrent HPV detection (odds ratio (OR), 0.92, 95 % confidence interval (CI), 0.88–0.96), affecting both high-risk and low-risk genotypes. However, longitudinal follow-up analyses revealed that baseline C. albicans infections was linked to an increased risk of persistent HPV infection among women already infected (hazard ratio (HR), 1.77, 95 % CI, 1.03–3.06). The presence of C. albicans was not significantly associated with other STIs or abnormal cervical cytology. These findings suggest a dual effect of C. albicans on HPV: protection against initial viral acquisition but promotion of viral persistence in those already infected.

Conclusions

Our findings reveal an unexpected dual role of C. albicans in HPV infection: initial protective effects, followed by enhanced viral persistence during co-infection. These results highlight the complexity of host-microbe interactions in the vaginal environment and underscore the need to consider fungal colonization in the natural history of HPV. The contrasting effects of C. albicans on HPV acquisition and persistence provide novel insights into the complex dynamics of polymicrobial interactions in the female reproductive tract.

Significance

Statement: This study demonstrates for the first time that C. albicans exhibits opposing effects on HPV infection at different stages, suggesting stage-specific host-microbe interactions that may influence viral pathogenesis. These findings have important implications for understanding the role of fungal colonization in viral infections and may inform strategies for HPV management.