Background and objectives: Vaccination hesitancy is a growing problem associated with decreasing chances for the elimination of vaccine-preventable diseases through immunization. This research was conducted to learn about parents’ attitudes toward vaccination, particularly against HPV, in the context of their beliefs and fears regarding immunization and the impact of these views on their children’s vaccination decisions. An additional goal was to determine what views or convictions most often lead to the phenomenon of delaying or refusing vaccinations, especially HPV vaccines, in the surveyed community. Materials and Methods: An online questionnaire was conducted in which parents marked how they vaccinated their children with mandatory vaccinations and whether they took the opportunity to protect their children with additional vaccinations, including HPV and COVID-19. Respondents also marked the extent to which they agreed with the statements, regarding the safety of vaccinations, doubts about them, as well as popular anti-vaccine myths. Results: A total of 250 questionnaires were collected with data on the immunization of 425 children. Associations between specific beliefs and vaccine abstention were established. The most motivating factor for vaccination against HPV was the parent’s awareness that the virus HP is the cause of cancer. The most inhibiting factor was respondent’s compliance with the opinion that HPV vaccines can affect the child’s sexual activity. Conclusions: The results indicate that information campaigns are needed, especially focusing on vaccine safety and the regularity and transparency of monitoring adverse effects. The obtained results will be used to create educational interventions against vaccination hesitancy more adapted to local conditions. The health programs of the World Health Organization (WHO) and all cooperating countries include improving the health and increasing the life expectancy of people by, among other things, eliminating the most common and most dangerous infectious diseases. The most effective and safe method to achieve this is immunization, which confers protection upon the vaccinated person and, on the other hand, reduces the risk of the transmission of pathogens throughout the community. An adequate vaccination rate of the population also protects non-immune individuals from the threat of infection—the phenomenon known as “herd immunity” ,2.The confirmation of the role of some chronic viral infections in the processes of oncogenesis has given hope that, through immunization, there will also be the possibility of reducing cancer ,4,5,6,7.In EU/EEA countries, 3300 cases of cervical cancer and more than 13,000 deaths from it are diagnosed annually. In Poland, cervical cancer is a common neoplasm, with about 3500 new cases diagnosed annually (in 2020–3862 cases), and it is the second most common neoplasm in women under the age of 50. Despite existing prophylactic cytological screening programs, which are attended regularly only by 18% of Polish women, the disease is usually detected in later stages, so the mortality rate of patients in Poland is high: 2137 deaths were reported in 2020 ,20.With the creation of the HPV vaccine in 2006, there was an opportunity to minimize the risk of cervical cancer in women, as well as other cancers caused by these viruses. Recent reports suggest that HPV infection may also be one cause of infertility ,22. OngoAccording to the plan included in the National Oncology Strategy , immunizOne of the biggest threats to the effectiveness of immunization programs is the decline in the number of people vaccinated. The phenomenon of so-called vaccination hesitancy as defined by the WHO is the delay in the acceptance or refusal of vaccines despite the availability of vaccination services . VaccineThe problem is global, although the scale depends on the specific community. The reasons for the growing trends of refusing or delaying mandatory vaccinations in children are varied. The WHO Strategic Advisory Group of Experts on Immunization (SAGE) working group on vaccine hesitancy identified the main determinants affecting parents’ decisions to immunize their children . They weThey are resulting from the farther environment in a certain society. They are primarily related to the influence of the media and the ideas presented in the information or disinformation campaigns, including the significant contribution of social media. The message coming from opinion leaders, politicians, celebrities, scientists in various fields is of particular importance. Determinants of the decision to vaccinate can include historical, religious, cultural, gender, geographic, and socioeconomic factors—depending on the circumstances of the particular society. There are a number of other factors including confidence in the reliability of government institutions, trust in the intentions of pharmaceutical companies, the organization of preventive immunizations, and the assessment of the connection between the ruling authorities and the pharmaceutical industry.The determinants of the closer surroundings, which are related to individual attitudes towards immunization of persons and the groups in which they function.The level of parents’ knowledge and their awareness of the idea of how vaccination works, their familiarity with vaccine-preventable diseases (VPDs), and the potential side effects of vaccines are the factors that affect the specific individual balance of benefits and risks. The experiences of previous vaccinations in a given child or in other children in a close circle of family and friends are of great importance. All these factors influence the personal perception of whether vaccination is a safe and necessary procedure or not.A significant effect is also exerted by the caregivers’ general attitude toward prophylaxis and health-promoting behavior, and the belief that some of these behaviors  can be as effective as immunization.Some vaccines are considered by communities to be more dangerous, ineffective, or unnecessary than others. In such situations, caregivers follow the vaccination program in the child/children, while refusal is associated with a specific vaccination. The individual perception of a particular vaccine as less safe than the others or redundant may depend on parents’ negative experiences with the product or their assessment of the disease threat as irrelevant. The conception that a vaccine, especially a new one, is untested, experimental and/or associated with the possibility of unknown adverse vaccine reactions, will increase the risk of wider refusal. An important determinant is the attitude of healthcare professionals: the way they provide information, and encourage or express doubts about the safety or potential benefit to the patient affect the final decision to vaccinate.The WHO SAGE Working Group’s identification of the reasons influencing immunization decisions helps to develop programs to popularize knowledge about vaccine prevention and develop arguments and solutions that will reduce the phenomenon of vaccine hesitancy. According to experts, programs to counteract the phenomenon of vaccine abstention should be preceded by analyses and “tailored” to the needs of a specific community, taking into consideration environmental peculiarities that affect immunization decisions .The study presented here was designed to examine parents’ attitudes toward HPV vaccination in the context of their decisions and beliefs about other childhood immunizations. An additional objective was to isolate the main beliefs and/or concerns in the parent community that determine vaccine hesitancy, especially towards HPV.This study was conducted in a community of parents in Central Europe (Poland) in Gdynia, a city of 240,000 people. The municipal authorities had funded and promoted an HPV vaccination program for 13-year-old girls living in Gdynia since 2008, but not all parents took advantage of this opportunity. The author’s survey questionnaire was distributed between February 2023 and May 2023, on social media, on pages dedicated to the city’s various districts, on the pages of the Gdynia Health Center and in some Gdynia schools. The criterion for including respondents in the survey was the age of their children.The survey targeted parents of children under 25 years of age covered by the city’s information campaign, about human papilloma virus and HPV vaccination, offered free of charge for girls. The content of the questionnaire referred to the parents’ vaccination decisions regarding mandatory and recommended vaccinations, including HPV and SARS-CoV-2.In the first part, the parents answered questions related to with which vaccines and when their children were vaccinated. They expressed also opinions about the impact the COVID-19 pandemic on general attitudes toward immunization and the overall realization of the mandatory vaccination program among children.In the second part, respondents determined their attitudes to common beliefs, regarding immunization, marking the extent to which they agreed with the mentioned statement on a 6-point scale. The last part was related to general data about the respondents—i.e., their gender, age, education  of people had a medical profession. The characteristics of the respondents are shown in A total of 250 completed questionnaires were obtained. Women were more likely to respond to the questionnaire, the majority of respondents marked higher education, and only 7% . Only four children were not vaccinated with any vaccinations. Some of the respondents chose to skip some vaccination(s) or significantly delayed mandatory immunization: in 4.45% (n= 18), the delays were due to medical reasons, while for 11.8% (n= 57), delays were due to parental decisions—which meets the criterion of vaccine hesitancy.The majority of those who took part in the survey vaccinated their children with mandatory vaccinations from the vaccination calendar on time ((n = 172) received both alternative combination vaccines (5in1 or 6in1) and all of the additional recommended vaccines. Among the children, 16% (n= 63) did not receive any alternative or optional vaccinations at parental expense.Most often, parents decided to purchase acellular combination vaccines of 5in1 or 6in1 type (DTaP), replacing free vaccines with: DTP , Poliomyelitis, Hemophilus influenzae and Hepatitis B in separate injections. They also vaccinated their children with some or all of the recommended but not reimbursed vaccines: 44% of children In the questionnaire, respondents rated their attitudes toward 15 statements about immunization on a six-point scale: (1) disagree; (2) rather disagree; (3) somewhat disagree; (4) agree more than disagree; (5) rather agree; (6) fully agree. The charts below were created by taking opinions 1, 2, and 3 as opposing to 4, 5, and as coinciding with respondents’ beliefs. Responses indicating a pro-vaccination attitude were marked in green and those favoring abstention from vaccination were marked in red.n = 21) holding the opposite view. Respondents generally had confidence in the idea of vaccinations and the effectiveness of immunizations: they believed that vaccinations are very effective in protecting against infectious diseases and their distant effects. The prevailing view among the surveyed parents was that vaccinations should be mandatory  held the opposite view. The view that vaccines developed many years ago are safer than those produced according to new technologies was shared by more than 22% (n = 56) of respondents. One-third (n = 79) believed that pregnant women should not be immunized. Nearly 74% thought that there was too little knowledge about how vaccines work, and tried to obtain information about planned vaccination on their own—from a leaflet or on the Internet , caused uncertainty or distrust among surveyed parents. Paid and additional vaccines were perceived by respondents to be safer than mandatory ones offered by the state. One-fifth of people (Internet .n = 31) of respondents, and about the possibility of altering the human genome by 10.2% (n = 28). Among the respondents, 28.6% (n = 63) were concerned that vaccinations could “overload children’s immune systems.” One of the more convincing statements introducing fears of vaccinations was the sentence that “Serious and numerous adverse reactions from vaccinations have been hidden from the public for years.” Among the parents, 33.6% (n = 84) agreed with this statement, including 12.8% (n = 32) with full conviction (response: “fully agree”).The influence of popular statements about immunization on a parent’s decision regarding mandatory immunization was analyzed using logistic regression. The parent’s decision took two states: “vaccinates their children on a calendar basis”; and “delays vaccination of their own accord or does not vaccinate”.Univariate models showed that agreeing with statements I, II, X, XII, XIV had a positive effect on the chance of “timely vaccination”, while agreeing with statements VI, VII, VIII, IX, XI, XV had a negative effect on the correct vaccination of children .The interpretation of the multivariate model allowed us to conclude that, with an increase in the level of agreement with statement I “Immunization is safe”, the chance of timely vaccination of a child increases 1.67 times, and an increase in the level of agreement with statement XIV “Vaccination effectively protects against distant effects on infectious diseases” increases the chance of vaccination by 1.56 times, as recommended. The area under ROC curve for the model is 0.7756 .n = 78) indicated that they did not know about the possibility of vaccination. Among the children, 13% (n = 53) were vaccinated as part of the local government’s vaccination program, and 36% (n = 142) had not yet reached the age recommended for vaccination, but parents said they planned to administer HPV vaccines.HPV vaccination was performed less frequently than obligatory immunization. Parents of 20% of children (n = 147) fully agreed with this information, 16% (n = 40) pointed out that they disagreed with this statement. The anti-vaccine myth that the HPV vaccine affects girls’ sexual activity was not widespread—only 3.6% (n = 9) marked that they agreed, to varying degrees, with this statement.Respondents mostly knew that HPV vaccination protects against certain cancers: 59% ((n = 100) have or will have their children vaccinated against HPV. Among parents who “do not vaccinate their children on time or at all”, only 37% (n = 14) have provided or declared to provide their children with additional protection against HPV. This relationship is not statistically significant (p = 0.103), perhaps due to the small number of people (n = 38) vaccinating in an untimely manner.The analysis of the association between mandatory immunization and HPV vaccination showed that among parents who “timely vaccinate their children with mandatory vaccination”, 51% Another univariate logistic regression model showed that caregiver agreement with statements I, II, X, XII, XIV had a positive effect on the decision to vaccinate a child against HPV. The parent’s convergence with statements VI, VII, VIII, IX, XI had a negative effect on the decision to immunize against HPV .n = 144) of respondents. This information was known to 13 out of 18 respondents with medical education. Among the respondents, 9.1% (n = 22) are vaccinated against HPV, 56.8% (n = 137) indicated that they are considering the HPV vaccine, and 34% (n = 82) of respondents do not intend to receive it.The fact that adults can also be vaccinated against the human papilloma virus was unknown to the majority of 60% (p = 0.004). Among parents who “timely vaccinate their children”, 9% (n = 18) were vaccinated against HPV, 61% (n = 121) were considering it, and 30% (n = 59) did not plan to vaccinate themselves against HPV. Among parents who “do not vaccinate their children on time or at all”, 10% (n = 4) were vaccinated against HPV, 33% (n = 13) were considering doing so, and 56% (n = 22) did not plan to  had been vaccinated against COVID-19. The question about vaccinating children against SARS-CoV-2 indicated that it was about underage children, where the vaccination status was due to a parent’s decision. Only 54.5% (n = 128) of parents decided to vaccinate their children against COVID-19 and 9.8% (n = 23) declared that they would vaccinate them. It was shown that, between persons not vaccinated against HPV, but considering the possibility, and those who are not vaccinated and do not plan to be immunized, there are statistically significant differences in 11 opinions about vaccinations out of 15: I, II, VI, VII, VIII, IX, X, XI, XII, XIV, XV.Among the respondents, 85.2% (n = 84) indicated that their children were not vaccinated against COVID-19. Among those who had vaccinated their children against HPV, 70% (n = 78) had vaccinated against COVID-19 or declared that they would. Among those who had not vaccinated their children against HPV, this percentage was lower at 58% (n = 67). This relationship was close to statistical significance (p = 0.062).In contrast, there is a difference only in two opinions between those who have been vaccinated against HPV and those that are considering it: VI—“Knowledge about how vaccines work is too low” and XII—“Vaccination is very effective in protecting against infectious diseases “ . MoreoveRespondents’ knowledge of HPV vaccination was quite high compared to the results obtained in a 2022 survey of parents of Polish teenagers conducted by the Ministry of Health ,26. OnlyIn other countries, the awareness of HPV as the reason for oncogenesis is greater, but also not satisfying: for instance, in Greece, 50% respondents knew the relation ; in NortAmong the respondents of our study, 20% did not receive the information about the possibility to immunize children against HPV. The option to be vaccinated against the papilloma virus in adulthood was new to most of the respondents. A significant number of parents, unvaccinated against HPV, began to consider such a vaccination for themselves. The dissemination of information about possible HPV vaccinations for adult people is extremely important. The risk of infection with an oncogenic virus is most often associated with a youthful period of increased sexual activity but in fact it can occur at any stage of one’s life. More importantly, the impact of HPV vaccination on ongoing infection has been proven. The immunization supports the elimination of oncogenic viruses ,29.The guardians who are considering the possibility of vaccinating themselves in comparison to the respondents who do not intend to get vaccinated against HPV had divergent views towards most of the statements about immunization included in the questionnaire.The confidence in the effectiveness of immunization, and therefore the possibility of preventing infections and their distant complications, including cancer, is conducive to the correct, timely vaccination of children, and it is worth increasing information on this topic ,26. In iThe individual decision to vaccinate oneself or one’s child depends on the peculiar balance of benefits and risks associated with vaccination. Respondents who perceived vaccination as safe and considered it effective in preventing disease and its remote effects were more likely to make a pro-vaccination choice. Those who were not convinced of the need or effectiveness of vaccines and feared side effects perceived vaccination as a procedure with significant risks versus questionable benefits .Vaccine-preventable diseases (VPDs) are mostly unknown to modern parents because they are extremely rare thanks to widespread immunization. The success of immunization programs paradoxically leads to questioning the need for vaccination ,34.Concerns about vaccinations are in line with the beliefs of some respondents, who do not trust full, reliable knowledge about vaccinations or official statistics regarding the number of adverse vaccine reactions. Suspicion of the intentions of pharmaceutical companies and the honesty of institutions reduces the motivation to vaccinate according to recommendations ,36. ConfAnti-vaccine myths are often linked to a particular vaccine and its characteristics, leading to the perception that it is extremely risky. The myth of autism as a consequence of vaccination first appeared as a result of published by A. Wakefield studies on the MMRII vaccine. Research results were later found to be falsified. A number of later studies demonstrated the lack of a link between MMR vaccination and autism diagnosis ,43,44,45The COVID-19 vaccination was produced at a rapid pace, using m-RNA technology, unknown in non-medical circles. The concerns appeared that the vaccine was not adequately tested and that the use of nucleic acids could introduce changes to the human genome . Doubts Vaccination for the human papilloma virus is associated with the myth of the earlier sexual initiation of the vaccinated. HPV is a sexually transmitted virus (STI), and concerns have been raised that vaccinated girls may perceive HPV immunization with parental consent as an acceptance of initiation at a young age and/or feel encouraged to begin their sexual lives early and engage in risky behaviors—such as not using condoms or frequently changing sexual partners ,50,51,52A myth related to “immune system overload” has been linked to the concern that children receive too many vaccines and this may weaken their immunity. No such connection has been documented . VaccineA parent’s compliance with anti-vaccine myths decreases the chance of vaccinating their child, especially on the recommended schedule .The group of parents vaccinated against HPV differed from those not planning to vaccinate against HPV significantly less than those considering vaccinating themselves. Parents already protected against HPV vaccinated their children on time as well as delayed immunization to a similar extent as the reluctant group. HPV vaccination status did not increase these parents’ compliance with pro-vaccination statements. There are no data on what proportion of this group was vaccinated in their teenage years by their parents versus by their own decision. No studies have been conducted on the association between parents’ HPV vaccination status and their decisions to vaccinate their children or their attitudes toward immunization.Limitations of our survey were the small percentage of respondents who did not vaccinate their children—making some of the results obtained not statistically significant.Questions about decisions respondents had made in the past were subject to the risk of s associated with forgetting the details of their children’s vaccinations.(1)Knowledge of the possibility of vaccinating adults against HPV was not widespread, including among respondents with a pro-vaccination attitude. Awareness campaigns should emphasize the possibility of HPV vaccination for adults as well, especially since they do not only have a preventive effect, but also have a potentially therapeutic role.(2)Factors positively influencing vaccination against HPV were respondents’ agreement with statements emphasizing vaccine safety and vaccine efficacy, and younger parental age. Most important for the positive decision to vaccinate a child was the awareness that the HPV vaccine protects against cancer; information about the human papillomavirus infection and its carcinogenic effects should be more widely publicized, together with the safety data of HPV vaccines.(3)Factors negatively influencing vaccination against HPV were parents’ agreement with statements presenting concerns about vaccination, anti-vaccine myths, and the parents’ older age. The most significant influence on the negative decision to immunize was the respondent’s compliance with the opinion that HPV vaccines can affect the child’s sexual activity.(4)The timeliness of mandatory immunization in children was associated, as with HPV vaccination, with beliefs about the safety and efficacy of vaccination. Concerns or belief in anti-vaccine myths, especially related to beliefs about the side effects of vaccination, had a negative impact on the timely vaccination of children according to the vaccination schedule. The greater availability of information on adverse vaccine reactions—both reported by medical professionals and patients themselves—could increase confidence in the data on this topic. Fear of vaccine side effects is one of the most significant determinants holding parents back from immunization, including against HPV.(5)It is important to increase the competence of medical personnel in communicating information about vaccination and its safety, as well as their ability to talk to fearful and/or skeptical parents. It should be emphasized, however, that the fight against vaccination misinformation must also take place on social media, with use of modern methods, as the Internet is one of the main sources of information for many parents.


Background: Oropharyngeal squamous cell carcinoma (OPSCC) patients are burdened by the effect of the disease process and treatment toxicities on organs important in everyday activities, such as breathing, speaking, eating, and drinking. There is a rise in OPSCC due to human papilloma virus (HPV)-associated OPSCC, affecting younger and healthier patients and with a better overall prognosis. Emphasis must be shared between oncologic outcomes and the effects on quality of life. While there have been efforts to study global and physical quality of life, the impact on psychosocial quality of life has not yet been specifically reviewed. Methods: A scoping review methodology was employed to explore the emotional, social, and mental quality of life in OPSCC patients and determine the impact of HPV status or treatment modalities. Results: Eighty-seven full-text articles were evaluated for eligibility. Fifteen articles met final inclusion criteria. The majority of the studies were conducted in the United States (n = 10) and study methodology was divided between cross-sectional (n = 6), prospective (n = 5), and retrospective studies (n = 4). Four psychosocial quality of life themes were explored: the impact on mental health and emotional wellbeing, social wellbeing and function, stress, and relationship and sexual behavior. Eighteen different patient-reported outcome measures were used, including both general head and neck oncology questionnaires and symptom-specific surveys. Conclusion: There is a paucity of research regarding the effect of OPSCC on patients’ psychosocial quality of life. Learning more about this component of quality of life can guide outreach programs and multidisciplinary involvement in improving patient care. While the number of head and neck cancer diagnoses is decreasing, the prevalence of oropharyngeal squamous cell carcinoma (OPSCC) has been increasing in North America due to human papillomavirus (HPV)-associated disease . CurrentHPV-associated OPSCC differs significantly from conventional OPSCC. Clinically, these patients are younger and healthier at baseline, with little or no tobacco exposure, and the prognosis is favorable with standard treatments ,4,5. As Oropharyngeal cancers originate at keystone areas for breathing, eating, and speech . PatientMost reviews assessing health-related QOL in OPSCC patients focus on xerostomia, dysphagia, mastication, and other physical complaints ,14. WhilThere has not yet been a review addressing the psychosocial impact of oropharyngeal cancer on patients. Most research focuses on survival and on physical aspects of the disease, in striking contrast with patient-centered concerns. The primary objective of this review is to assess the broad psychosocial QOL in oropharyngeal cancer patients using patient-reported outcome measures (PROMs). Secondary objectives are to determine whether treatment regimens or HPV status play a role.This scoping review seeks to identify the current literature published in this field, examine how the research was conducted, and detail the key factors and gaps in knowledge. We followed the scoping review framework proposed by Arksey and O’Malley, expanded by Levac et al. ,20. PrefThis scoping review was developed to describe the nature, number, and scope of published research articles examining the relationship of psychosocial QOL in patients with OPSCC using validated patient-reported outcome metrics. A systematic literature search of PubMed, Embase, PsycINFO, and CINAHL was conducted of all articles published between 1946 and August 2022. Search terms included a combination of appropriate database MeSH terms, subject headings, and keywords for the concepts of oropharyngeal cancer, QOL, patient-reported outcome measures, and different emotional and mental states . The seaThe titles and abstracts of all identified studies were screened by two independent reviewers , with a senior author available to resolve conflicts not agreed upon by discussion (MH). The abstract screening protocol was discussed among authors, and criteria defined using Rayyan, a software designed to allow multiple reviewers to independently select studies for inclusion or exclusion . A pilotThe full-text articles were screened by two reviewers  with more refined criteria . ArticleFrom the full texts, two authors (JS and RS) extracted the following data: author(s), year of publication, study design, study location, participant characteristics, PROMs employed, psychosocial QOL concepts discussed, and important findings. The psychosocial theme content analysis was compiled using NVivo software and inter-rater reliability was calculated . Risk ofThe data from the included studies were collated and included study demographics, PROMs employed, and psychosocial theme .The study selection process is outlined in Using the National Institutes of Health Quality Assessment Tool, the majority of the studies were rated as fair (n = 11), with the remainder graded as good (n = 3) and poor (n = 1).®-Depression 8b). Two different anxiety metrics were used: General Anxiety Disorder-7 (GAD-7) and the Patient-Reported Outcomes Measurement Information System-Anxiety 7a (PROMIS®-Anxiety 7a). The variability of components of stress required symptom PROMs for each specific element .This scoping review identified 18 different validated patient-reported outcome measures (PROMs) utilized by studies, summarized in The eligible studies reported on four main themes within psychosocial QOL , subdiviThe mental health domain comprised studies addressing impacts on depression, anxiety, mood, and emotional function.Only one study by Kaffenberger evaluated patient mental health after different treatment modalities . This reThe studies that evaluated mental health at different time points noted improvement in mental health scores over time. Janz’s prospective cohort study exploring differences between HPV-associated OPSCC patients (n = 21) and HPV-negative oral cavity cancer patients who smoke (n = 17) found that, at 12 months, the HPV-associated OPSCC cohort had an improved depression score on the CES-D . Rajeev-p = 0.005) but no significant difference in mood (p = 0.288), using the UW-QOL scale in 25 HPV-associated OPSCC patients treated with neoadjuvant chemotherapy and transoral robotic surgery (n = 25) compared to a normative cohort [Berg performed a cross-sectional study comparing BOT cancer patients (n = 190) to tonsillar cancer patients (n = 405) and to the general population (n = 190) . This ree cohort .®) Anxiety and Depression questionnaires [Several other studies did not associate worsening mental health with HPV status  ,31,34. Sonnaires ,36,37.The social wellbeing and function domain comprised studies addressing impacts on social quality of life, social contact, and social eating.Berg did not identify any significant difference in social domain of the EORTC QLQ-C30 or in the EORTC QLQ-HN35 scores in BOT OPSCC patients who underwent different treatment modalities . HoweverComparing HPV-positive and HPV-negative patients, Korsten identified better social functioning at baseline, which worsened to a greater extent during treatment, and recovered better and more quickly at follow-up compared to patients with an HPV-negative cancer . HoweverStress was a diverse theme within this scoping review, with five studies discussing four stress-related concepts: fear of cancer recurrence ,39, overCasswell employed the Fear of Cancer Recurrence Inventory and found that this fear was present in over half of the patients, with younger patients more likely to report this stress . Fear ofp = 0.003) and those receiving adjuvant CRT (p = 0.04) compared to those without adjuvant treatment [p = 0.56).Dziegielewski identified a significant difference in change in overall attitude in the Head and Neck Cancer Inventory  in patients who received adjuvant RT (reatment . There wp = 0.1) [p = 0.11, oral cavity: 16 to 15, p = 0.07).The study by Janz used the Assessment of Survivor Concerns instrument to compare cancer worry in HPV+ OPSCC patients with smoking oral cavity cancer patients and found that there was no statistically significant difference in cancer worry score (p = 0.1) . Cancer Goepfert and Shaverdian both examined decisional regret in their cohorts using the Decision Regret Scale ,40. GoepThe relationship and sexual behavior domain comprised studies addressing impacts on sexuality and relationship quality/function.p = 0.002 and 48 versus 31, p = 0.05, respectively). There was no significant difference in subgroup analyses comparing subsite (BOT vs. tonsillar), gender, or disease stage.Berg commented on sexuality in the context of a comparison of BOT cancer patients (n = 190) to patients with tonsillar carcinoma (n = 405) and to the general population (n = 190) . Those tCasswell utilized the EORTC Sexual Health Questionnaire (EORTC QLQ-SHQ-22) to assess the physical, social, and psychological aspects of sexual health . This stp < 0.01). Taberna’s prospective research compared the effects of diagnosis and treatment on relationship and sexual behavior in HPV-positive (n = 142) and negative patients (n = 120) . In bothp = 0.003) and adjuvant CRT (p = 0.04) compared to those without adjuvant therapy [Berg reported no difference in depression, anxiety, or social quality of life scores when comparing OPSCC patients treated with primary CRT versus surgery with adjuvant RT/CRT . Kaffenb therapy .A summary of all HPV-related results is included in Six studies reported specific mental health and emotional wellbeing-related results for HPV-associated OPSCC patients. Berg and Korsten noted better emotional functioning in the HPV-positive cohort and Janz described a significant decrease in depression scores in the HPV-positive OPSCC cohort, without a significant decrease in the oral cavity cancer patients ,30,33. IBerg reported better social functioning in the BOT OPSCC patients who were HPV-positive, using the EORTC QLQ-C30, while Dziegielewski did not find any difference in social function or social attitude between HPV-positive and negative cohorts, using the Head and Neck Cancer Inventory (HNCI) . KorstenDziegielewski found no difference in overall attitude based on HPV status, and Goepfert did not identify any difference in decisional regret in HPV-associated or non-associated patients ,40. TherTaberna conducted the sole study describing the effect of HPV on relationship, finding no difference at baseline, but higher distress, though not significant, in the HPV-positive patients .This scoping review aimed to understand the landscape of published literature on the psychosocial QOL in oropharyngeal cancer patients and determine whether treatment regimens or HPV status play a role. Despite the rise in OPSCC globally and the current efforts to de-escalate treatments to allow for better QOL outcomes with long-term survival, this review identified a lack of observational research in this field.The main mental health and emotional wellbeing theme findings are heterogeneous within the ten different studies. Interestingly, Janz, Berg, Qualliotine, and Korsten’s research all identified better mental health and emotional scores in patients with HPV-associated disease when compared to non-HPV-associated head and neck cancers  ,30,31,32Within the social wellbeing and function domain, there were significant positive findings. Kaffenberger identified worse social scores in patients with higher RT doses to their ipsilateral parotid gland, and Dziegielewski found that post-operative social scores reached a low at three months but returned to baseline after one year ,38. KorsThe stress category that emerged from the thematic analysis comprises four diverse concepts. These different feelings were identified in select subgroups within each study: younger patients and those with lower global QOL, higher symptom interference scores, and worse mental health scores had greater levels of fear of cancer recurrence ,39. A woThe three studies focusing on relationship and sexual behavior employed three different PROMs, creating a challenge in comparison. Interestingly, none of the studies identified significant differences in their scores based on HPV status ,37,41. HA secondary objective was to identify the impact of different treatment modalities on psychosocial QOL; however, only three studies addressed this topic. Kaffenberger compared advanced stage OPSCC patients treated for curative intent with CRT  to surgery and adjuvant RT or CRT  . Social With the rise in HPV-associated OPSCC, it is important to search for significant differences within the HPV-positive and HPV-negative cohorts. Higher emotional and social functioning and significant improvement in depression over time were found in the HPV-positive patients ,30,32. NWithin the thematic analysis, multiple PROMs were used for an individual symptom. It is clear that there is no standardized, uniform mental health survey specific for head and neck oncology patients, given that the ten studies within this review used eight different PROMs reporting on mental health or emotional well-being. The heterogeneity of PROMs utilized poses a difficulty in comparing outcomes. A recent study comparing different depression and anxiety PROMs in head and neck cancer patients found the prevalence of moderate and severe symptoms differed between surveys within the same patient cohort  . A meta-Many completed or ongoing clinical trials are attempting to change the standard treatments for HPV-positive OPSCC and reduce the treatment-related secondary effects ,12,13. PIn this scoping review, decision regret was measured in an HPV-positive OPSCC cohort enrolled in a de-escalation clinical trial . At 16 tThere are several limitations to note within this scoping review. While an extensive search of four large databases with diverse target audiences was performed, additional databases may have yielded further results. Grey literature was not explored and published abstracts were not included. This was decided because the lack of full available data would not allow for analysis. Finally, the heterogeneity of themes and patient-reported outcome measures limited the ability to compare studies and draw conclusions.This review has reported the current status of emotional, social, and psychological QOL in OPSCC survivors. With the rise of HPV-related OPSCC and characteristically younger, healthier patients with improved prognostication, treatment-related morbidity and associated psychosocial impact is now a key area of discussion amongst advocacy groups and oncology professionals alike. Specifically, decisional regret within the category of stress and the impact on relationships and sexuality have been recognized as unique avenues for future research, given the many ongoing clinical trials and the association of OPSCC with HPV, respectively. Few studies have explored these concepts, and no review has focused on these outcomes thus far. This scoping review identified a need to establish a uniform head and neck oncology-specific QOL metric to more consistently assess psychosocial burden within these patients.


HPV16 and 18 are positively correlated with cervical carcinogenesis. However, HPV prevalence tends to vary according to region, nationality, and environment. The most prevalent high-risk (HR) HPV genotypes are HPV16, 52, 58, 56, 18, 33, and 45), while the low-risk (LR) genotypes are HPV6 and 11 in the Chinese population. Importantly, undetectable low-copy HPV DNA could be an important indicator of integration into the human genome and may be a precursor to cancer progression. The HPV viral load changes dramatically, either increasing or decreasing rapidly during carcinogenesis, and traditional quantitative real-time PCR (qPCR) cannot accurately capture this subtle change. Therefore, in this study, a reliable droplet digital PCR (ddPCR) method was developed to simultaneously detect and quantify HPV genotypes. The ddPCR quantitative results showed high accuracy, sensitivity, and specificity compared to qPCR results employing the same clinical specimens and supplemented the ddPCR assay for HPV52/56/58/6 genotypes according to the infection specificity of the Chinese population. In summary, this procedure is valuable for quantifying HPV DNA, especially under conditions of low template copy number in cervical intraepithelial neoplasia (CIN) and/or cervical cancer. Additionally, this method can dynamically observe the prognosis and outcome of HPV infection and thus be used as an effective means for real-time monitoring of tumor load.The online version contains supplementary material available at 10.1186/s12885-023-11529-3. Cervical cancer is different from other cancers because persistent infection with high-risk human papilloma viruses (HR-HPVs) is a key step in carcinogenesis –3. Non-HThe detection of HPV DNA with a low copy number may be an indicator of tumor transformation, which in turn affects the occurrence and progression of CIN . The curDroplet digital PCR (ddPCR) is an innovative technology with improved precision and sensitivity (up to 0.001%) at low template concentrations , and hasIn view of the specificity of HPV infection in the Chinese population and the current methodological limitations, it is necessary to develop a more sensitive and reliable (with respect to accuracy and specificity) ddPCR method that can simultaneously detect and quantify multiple HPV genotypes.5 copies/µL) were used for accuracy and sensitivity evaluation. The samples of the remaining 15 HPV genotypes were mixed and named multi-positive control (M-PC) for specificity evaluation, together with negative control (NC) samples. Fifty clinical samples  were included for comparison between ddPCR and qPCR.This study was approved by Jinan Central Hospital Affiliated to Shandong University Ethics Service Committee. Samples from anonymized HPV-positive patients collected from 2020 to 2022 were used. Using the HPV genotyping test (which identifies 24 genotypes), positive samples with a low viral load of the most prevalent 7 high-risk genotypes  and 2 low-risk genotypes (HPV6 and 11) in the Chinese population were selected, as well as positive samples with a high viral load of HPV DNA  and 6 low-risk HPV genotypes .DNA was isolated using the DNA Blood, Cell, and Tissue Kit (TIANGEN TIANamp Genomic DNA kit) according to the manufacturer’s instructions. The concentration and purity of DNA were determined using an ultraviolet spectrophotometer . Microbial DNA extracts thus collected were stored at − 20 °C.The primers and probes were designed in a duplex, combining each HPV genotype  according to the full sequence of the HPV virus available in the NCBI database. The probes are double fluorescent designed, with the 5’ end as a fluorescent dye reporter and the 3’ end as a quencher. To avoid cross-reactivity between different HPV types, primers targeting the E7 gene, a region of the HPV genome with low similarity between HPV types, were used. Gene probes, primer sequences, and amplicon sizes are summarized in Table ◦C for 10 min, followed by 94◦C for 30 s, 70℃ for 20 s, 59.5℃ for 1 min for 4 cycles, followed by 4℃ 30 s, 70℃ 20s, 85℃ 30s, 70℃ 20s, 59.5℃ 1 min for another 36 cycles. The enzyme was then deactivated at 98℃ (10 min), and the reaction was kept at 4℃. The ramp rate of ≤ 2.5℃/s was maintained during the whole process. Following PCR, the 96-well PCR plate was placed in the QX200 Droplet reader™ (Bio-Rad) and the ddPCR data was analyzed using the QuantaSoft analysis tool.1× ddPCR Supermix , 1.0 µM primer, 0.25 µM probe, and 5 µL sample DNA were prepared into a 20 µL reaction liquid, thoroughly mixed, and transferred to a DG8 Cartridge. Next, droplet generation oil for probes was added to the bottom row of the DG8 Cartridge at (70 µL /hole), which was placed into the QX200 Droplet Generator™ (Bio-Rad). Droplets are generated in the top row of the DG8 cartridges. Thereafter, the generated droplets were carefully transferred to a 96-well PCR plate and sealed using the preheated PX1 plate sealer (Bio-Rad) for 175℃, 3.5 s. Subsequently, the sealed plate was placed in a thermal cycler (Bio-Rad), with the cycle conditions being as follows: the enzyme was activated at 955 to 100 copies/µL, and each concentration was tested three times. To evaluate specificity, two different negative controls were used: a human HPV-negative control and a pooled M-PC. To evaluate the repeatability of ddPCR, serial dilutions were tested in triplicate in one experimental run and in three independent experiments to assess reproducibility.To evaluate the accuracy of ddPCR, positive samples with a low viral load for each HPV genotype as determined by HPV genotyping were selected. For sensitivity evaluation, high concentrations of HPV DNA of different genotypes were diluted from 10Droplet reader software results were represented as copies/µL for each target (HPV genotype and control gene). For method optimization, intra-assay variability (repeatability) and inter-assay variability (reproducibility) were evaluated by calculating the coefficient of variation (CV). SPSS software  was used for descriptive statistics. Pearson’s correlation tests were used to compare the accuracy and consistency of the ddPCR and qPCR analyses. P < 0.05 was considered to indicate a statistically significant difference.Given the specificity of HPV infection in the Chinese population, primers and probes for HPV52, 58, 56, 6, 11, 16, 18, 33, and 45 were designed  of all tested HPV genotypes , the mean concentrations of viral load, and the standard deviations (SDs) are shown in Table To further prove the advantages of ddPCR, 50 clinical samples were analyzed using both ddPCR and qPCR Table , and 5. HPV viral load is closely related to viral persistence , and difqPCR obtains amplification times directly proportional to the fluorescent dye by amplifying DNA and comparing it with the standard sample to quantify the sample, which causes the results of qPCR to be affected easily by the standard curve, inhibitor, or background DNA , 25. HowddPCR is a new method based on quantitative PCR (qPCR)  that detBased on existing studies on HPV16, 18, 33, 45, and 11, the current study was designed to supplement and evaluate ddPCR for viral load quantification of HPV genotypes 52, 56, 58, and 6 in the Chinese population. To avoid overtreatment at the early stage of HPV infection, our ddPCR method is more applicable to clinical samples at pre-cancerous stages, especially when the template copy number is low in CIN and/or cervical cancer. Previous PCR/qPCR primers detected additional HPVs . To avoiIn conclusion, the ddPCR method used in this study exhibited high sensitivity, accuracy, and specificity in quantifying HPV DNA sequences. The technique may be used as a promising assay for the early detection of cervical cancer and may help to evaluate treatment response and timely monitoring of the disease to prevent overtreatment.Below is the link to the electronic supplementary material.Supplementary Material 1Supplementary Material 2


Guidelines recommend the human papillomavirus (HPV) vaccine for all adults through age 26, shared clinical decision-making for those aged 27 through 45 years who are inadequately vaccinated, and for all people with HIV up to age 45 years. The intent of this study is to evaluate HPV vaccination rates at the HIV Outpatient Program (HOP) at University Medical Center in New Orleans.Immunization records from patients aged 18 through 45 years attending a physician visit in the LSU Infectious Diseases fellows’ HIV primary care clinic at HOP in 2022 were reviewed. The purpose of this project was to assess compliance with HPV vaccination recommendations among the infectious diseases fellows.Among patients under age 27, 15 of 21 visits (71%) had completed HPV vaccines series. 4 visits (19%) had incomplete status and 2 visits (10%) did not have any HPV vaccines record. Among patients aged 27 through 45 years, 73 of 194 visits (38%) had completed HPV vaccines series. 34 visits (18%) had partial vaccination records and 87 visits (45%) had no records.Vaccination compliance among the LSU ID fellows was less than ideal, only 71% of visits for patient aged up to 27 years attending LSU ID fellows’ clinic had completed HPV vaccine series, compared to the Health People 2020 recommendation of 80%. Only 38% of visits for patients aged 27 through 45 years are fully vaccinated with HPV vaccines. Patients in this age group are often labeled “aged out” for HPV vaccines by health maintenance reminders however, due to having HIV, they are still eligible and should be vaccinated. These results led to the institution of quality improvement project to address HPV vaccinations. This intervention will focus on educating all HOP providers about the vaccination recommendations and updating the health maintenance care gaps reminder in the electronic medical record.All Authors: No reported disclosures


It is widely known that human papillomavirus (HPV) infection is sexually transmitted and can range from benign lesions such as genital warts to anogenital and oropharyngeal cancer.In the United States, among men and women, 33,700 individuals are diagnosed with HPV-associated cancer each year. Vaccination could prevent ∼ 90% of these cases, which means that 31,200 cases could be avoided each year.In Brazil, numbers from the Cancer Registries and of the Mortality Information System  for the year 2018, estimated the incidence of 16,370 new cases of cervical cancer, with 5,000 deaths. This rate has remained stable in recent decades, despite screening and prevention efforts.Among HPV-associated cancers, such as in the penis, the vagina, the vulva, the anus and in the oropharynx, the only type with screening recommendations is cervical cancer, which is performed by gynecologists. Thus, except for the cervix, cancers in other sites are usually detected after the development of symptoms.The association of periodic screening and HPV vaccination is the primary strategy for eliminating cervical cancer. The HPV vaccine has been recommended for all preadolescents and adolescents since 2011 by the World Health Organization (WHO). In Brazil, since 2014, this vaccine is offered by the Brazilian Unified Health System  for girls between 9 and 14 years old, and, as of 2017, also for boys. From 2020, the ages for vaccination of girls and boys will be the same, starting at 9 years old.Two doses of the vaccine are required to ensure vaccine protection, and they should be applied at a 6- to 12-month interval. Individuals between 9 and 26 years old living with HIV or with some immunodepressive conditions also receive the vaccine by the SUS. In this specific case, in 3 doses applied at 0, 2, and 6 months.st dose of HPV vaccine was administered in between 50 and 61% of the Brazilian population of girls aged 9 and 10 years old, and the second dose in only between 22 and 38% of this population, which is below the target of 80% coverage established by the National Program of Immunizations .Since 2014, the 1The HPV vaccine coverage of up to 80% can also prevent precursor lesions, and consequently reduce the need for screening tests and invasive treatments, exhausting follow-up and future obstetric harm.If HPV vaccines are available from the SUS, why has optimal vaccine coverage not been achieved?Since 2007, when vaccination began in Australia, and until now, several events or situations that temporarily hamper the expansion of the use of these vaccines have been repeated around the world. Among these situations, are some unfounded concepts that vaccination would stimulate early sexual activity or reduce the use of other protective measures for safe sex. Although the hepatitis B vaccine also has the sexual transmission factor, it does not present rejection or problems and is universally accepted.Another situation that interferes with vaccination coverage rates in Brazil is related to the concern with the safety of the vaccines available. The most common adverse events of HPV vaccines are transient and similar to symptoms related to other vaccines, such as pain at the site of injection, headache, dizziness, and syncope. Syncope is a characteristic situation of vaccination in preadolescents and in adolescents, who are targets of these vaccines.The Brazilian Ministry of Health  clarifies the safety and effectiveness of the HPV vaccine. Like all vaccines offered by the PNI, there is a strict process of validation and registration with the National Agency of Sanitary Surveillance . However, like any medicine, it can cause postvaccine adverse events, although they are rare.The HPV vaccine is being used in > 80 countries around the world, so far without any reported evidence linking its use to severe or neurological conditions. In 2017, the WHO Vaccine Safety Commission released a document reaffirming the safety of these vaccines after the administration of 270 million doses.nd dose of the vaccine. The fact was widely reported in the press and generated a negative highlight regarding vaccination. However, the immediate actions of the surveillance and vaccination authorities in the state of São Paulo and the subsequent follow-up of the cases confirmed that this was a transient reaction, possibly related to the anxiety of the adolescents. There were no sequelae, and the causal relationship with the HPV vaccine used was ruled out. Although these are enlightening facts, they were not properly released in the media.Although the safety of these vaccines is confirmed by scientific evidence and by epidemiological surveillance, unexpected situations causing some level of anxiety in the population have occurred all over the world. In Brazil, during a school-based vaccination campaign in the city of Bertioga, state of São Paulo, in 2016, there were reports of “paralysis” in 11 girls after the 2This imbalanced priority of bad and negative news, coupled with the reverberation of past messages through social media as if they were ‘current’, has helped to maintain a continuous negative effect on the population, interest of anti-vaccine groups, which affects vaccine coverage.More recently, in 2018, the press reported events possibly related to vaccination in a group of girls in the city of Rio Branco, state of Acre, Brazil. The PNI sent a team to Acre and, after evaluating each case together with a local team, most of them had no causal or temporal nexus, such as menstrual irregularity, ovarian cyst, appendicitis, leptospirosis, or cytomegalovirus, and were initially discarded. Among the remaining cases, conversion disorders stood out, some with diagnoses prior to vaccination. Two cases with seizures continued to be monitored by the local team and by neuropediatricians, one with known cerebral vascular malformation and the other under investigation.Due to the news spread from local media, ‘new’ cases started to emerge in Acre and, apparently, there were difficulties and lack of objectivity in local actions for the clarification of the diagnoses. Thus, part of the population remains unsure about vaccination, while other people involved appear to have secondary gains with the persistence of this situation. The local media foments the situation with some sensationalism. The result is a worrying and substantial drop in vaccination rates in Acre, which even reached the inadmissible point of state doctors not indicating vaccination.In conclusion, with the information collected so far in Acre, there is no confirmed association between the cause and the HPV vaccination performed; hence, vaccination should continue.Many parents and guardians of adolescents have refused vaccination against HPV. This refusal has been a phenomenon observed with other vaccines as well. For physicians facing this situation, it is advisable to provide information on the safety of vaccines and reasons not to delay vaccination. If parents or guardians decide not to apply the vaccine, it should be registered in the medical record that the vaccine was prescribed and refused. Physicians should continue to discuss the benefits of immunization in subsequent visits, because some parents may reconsider their decision not to vaccinate or simply postpone vaccination. Reasons for refusal to vaccinate should be addressed by all professionals.The choice of some parents or guardians to not vaccinate increases the risk for everyone. Only one adolescent that initiates his sexual activity without vaccination protection and acquires the infection can transmit it to all partners, even for those vaccinated, but who did not achieve sufficient levels of antibodies for protection. Vaccination with close to 100% coverage increases safety for everyone and the hope that we can eradicate cases of HPV-related cancer in a few decades.Finally, all tools for controlling HPV-related cancers are known and available, and there is no safety problem with HPV vaccines so far.In Brazil, the use of these tools must evolve, because they are already available and require no additional investments, only organization and clear direction. A simple and logical suggestion is to start with cervical cancer through routine HPV vaccination by using the winning strategy of school-based vaccination and achieve a population registration system that allows advances toward the organization of the national screening program.


Brachybacterium conglomeratum, traditionally considered an environmental bacterium, has recently garnered attention for its potential involvement in human health. While prior research hinted at its pathogenic role in humans, our study aims to determine its prevalence and associations in diverse clinical contexts. We examined vaginal swabs from three distinct patient groups: patients with low-grade squamous intraepithelial lesions (LSIL), patients with cervicovaginal infections, and patients with a history of precancerous lesions undergoing follow-up. B. conglomeratum was present in all three patient groups, with the highest prevalence observed in the LSIL group. Statistically significant associations were primarily identified in the LSIL group, where B. conglomeratum was present in 60% of cases. Notably, the LSIL group exhibited coinfections with multiple high-risk oncogenotypes of human papillomavirus (HPV), suggesting potential synergistic effects, and understanding these microbial relationships and their influence on viral persistence, particularly with HPV, holds promise for mitigating HPV-related carcinogenesis. Furthermore, Gardnerella vaginalis and Atopobium vaginae were frequently detected in this group, along with Ureaplasma parvum as the predominant sexually transmitted bacterium. In all cases, B. conglomeratum was found in association with these microorganisms rather than as a sole pathogen. This coexistence underscores the intricate microbial interactions within cervicovaginal infections and precancerous lesions. This study marks the first report of B. conglomeratum prevalence in women with these clinical conditions. Lactobacillus spp. are the bacteria primarily responsible for preventing colonization by other pathogenic microorganisms that could disrupt this balance. When this microbiota is present in low concentrations or absent, the microbial diversity, especially of anaerobes, increases, making the epithelial tissue more susceptible to colonization by external microorganisms [The normal human vagina is a balanced microenvironment in which the microbiota plays a crucial regulatory role. rganisms ,2,3.Gardnerella vaginalis and Atopobium vaginae have been considered markers of abnormal vaginal microbiota [Consequently, infections with sexually transmitted bacteria and bacterial vaginosis can find an excellent niche for implantation. crobiota , as theycrobiota ,6. Moreocrobiota .More than 200 HPV genotypes have been identified, each displaying distinct preferences and specificities in regard to invading the host . For insStudies have reported a direct relationship between the vaginal microbiome and racial groups . SpecifiBrachybacterium conglomeratum with HPV was reported [B. conglomeratum could serve as a potential biological marker for detecting precancerous cervical lesions in this population. This bacterium had been considered an environmental microorganism [B. conglomeratum and its relationship with pathogenic microorganisms in the female genital tract.In a study of the vaginal microbiome in Mexican women with low- and high-grade cervical intraepithelial lesions, an association of reported . This fiorganism  until itorganism  and in aorganism . HoweverB. conglomeratum in vaginal swabs of Mexican patients with dysbiosis and to describe its interrelation with sexually transmitted bacteria and bacterial vaginosis. Additionally, the study aimed to confirm the association of this bacterium with HPV in patients with low-grade squamous intraepithelial lesions (LSILs).The objective of this study was to determine the frequency of Chlamydiae, Mycoplasma, and Ureaplasmas . Written informed consent was obtained from all patients.Cervical exudate samples (194) were collected from Mexican patients who attended the colposcopy service between January 2022 and May 2022. The present study was approved by the Ethics and Research Committee of the Hospital Regional de Alta Especialidad Ixtapaluca (NR-014-2022), and the samples were collected using BD Universal viral transport medium for viruses, From a total of 194 patient samples analysed, 99 exudates were obtained from women with cervicovaginal infections and no epithelial lesions , 42 exudates were from patients with low-grade squamous intraepithelial lesions (LSIL) confirmed by histology , and 53 exudates were from patients who underwent cone biopsy or surgery due to LSIL and only attended for cervical cancer control . The age range of 25–29 years had the highest number of cases.Neisseria gonorrhoeae (N.g.), Chlamydia trachomatis (Ch.t.), Mycoplasma genitalium (M.g.), Mycoplasma hominis (M.h.), Ureaplasma urealyticum (U.u.), Ureaplasma parvum (U.p.), and Trichomonas vaginalis (T.v.). The procedures were carried out according to the manufacturer’s instructions using the following PCR cycling conditions: initial polymerase activation step , 35 cycles at 95 °C, 30 s, 55 °C, 15 s, and 72 °C for 30 s.Total DNA from patients with vaginal swabs was isolated using the Invisorb Spin Universal Kit  following the manufacturer’s instructions. One microgram of DNA was used for qPCR amplification. Two commercial kits were employed for the identification of HPV and bacterial sexually transmitted infections: HPV28 Detection  and STI-7 Detection (v1.1) . The HPV28 kit detects 19 high-risk human papillomavirus genotypes, such as 16 (HPV 16), 18 (HPV 18), 26 (HPV 26), 31 (HPV 31), 33 (HPV 33), 35 (HPV 35), 39 (HPV 39), 45 (HPV 45), 51 (HPV 51), 52 (HPV 52), 53 (HPV 53), 56 (HPV 56), 58 (HPV 58), 59 (HPV 59), 66 (HPV 66), 68 (HPV 68), 69 (HPV 69), 73 (HPV 73), 82 (HPV 82), and 9 low-risk human papillomavirus genotypes, such as 11 (HPV 11), 40 (HPV 40), 42 (HPV 42), 43 (HPV 43), 44 (HPV 44), 54 (HPV 54), 6 (HPV 6), 61 (HPV 61), 70 (HPV 70), and their respective internal control (IC). The STI-7 kit detects B. conglomeratum, Gardnerella vaginalis, and Atopobium vaginae, specific primers and probes were designed for qPCR identification as indicated in For the identification of https://www.bioinformatics.nl/cgi-bin/primer3plus/primer3plus.cgi, accessed on 25 January 2022), the specificity of the primers and probes was evaluated in silico, and amplification was performed using PCR master mix , with 10 pM of each forward and reverse primer, 1 pM of the probe, and 1 µg of each DNA sample as the template. PCR was performed using a CFX96 Real-Time System  under the following conditions: denaturation at 95 °C for 3 min, denaturation at 95 °C for 10 s, and annealing and extension at 58 °C for 30 s for 39 cycles.The primer sequences and probe were obtained using Primer3Plus software  was employed to assess the correlation of variables, considering a p value of <0.05 as statistically significant. To find the type of relationship  and the direction of the relationship, Kendall’s Tau test and bivariate normal correlation were used in IBM SPSS software (version 28.0.1), a commercial platform for statistical analysis. To calculate the statistical power and effect size, the G Power platform  was used.To establish whether B. conglomeratum, HPV, and sexually transmitted bacteria  was performed on all exudates obtained from these patients with cervicovaginal coinfection but not LSIL. B. conglomeratum was found in 58% of the analysed exudates (58/99). HPV detection showed 30% positive cases (30/99), with 19/99 (19%) presenting oncogenic HPV types  and 11/99 (11%) presenting low-risk HPV . For sexually transmitted bacteria, 64/99 (65%) were positive, with U. parvum being the most frequent (49%), followed by U. urealyticum (14%). T. vaginalis (1%) was also detected, along with coinfections of U. parvum-U. urealyticum (3%), U. parvum-M. genitalium (1%), and U. urealyticum-Mycoplasma hominis (1%). G. vaginalis and A. vaginae were detected in 43% and 47% of patients, respectively.qPCR testing for the identification of B. conglomeratum with HPV and sexually transmitted pathogens in each analysed group, a Venn diagram was constructed. This diagram illustrates the logical relationships between sets based on presence/absence data and the shared elements between subsets in the analysed groups.To obtain the interrelation of B. conglomeratum was mainly associated with two sets. The first association was with sexually transmitted pathogens (set 1), and the second corresponded to the intersection of four elements ). Within the association of B. conglomeratum with sexually transmitted pathogens, U. parvum  was the most frequent, followed by U. urealyticum  and T. vaginalis . In the association of B. conglomeratum with G. vaginalis, A. vaginae, and the sexually transmitted pathogens U. parvum , U. urealyticum (7%), and U. urealyticum/M. hominis (7%) were found , followed by the association of B. conglomeratum and sexually transmitted pathogens (16 elements). It was evident that B. conglomeratum had a greater association with sexually transmitted pathogens and G. vaginalis, and among these, U. parvum was the bacterium with the highest detected association  of the analysed exudates, and HPV was found in 74% (31/42), with genotypes 16 and 53 being the most frequent, and a 60% (25/42) prevalence of sexually transmitted pathogens were observed. B. conglomeratum was detected in 81% (25/31) of HPV, 84% (21/25) of sexually transmitted pathogens, and 40% (17/42) of G. vaginalis-positive and 38% (16/42) of A. vaginae-positive exudates. In this group, multiple coinfections with oncogenic HPV types, with two to seven HPV genotypes present in some cases , and sexually transmitted pathogens were observed. U. parvum 24% (4/17), U. urealyticum 12% (2/17), M. hominis 24% (4/17), and T. vaginalis 6% (1/17), and coinfections among sexually transmitted pathogens were detected and included U. parvum-U. urealyticum 6% (1/17), U. urealyticum-M. hominis 18% (3/17), U. parvum-M. genitalium 6% (1/17), and U. urealyticum-C. trachomatis-M. hominis 6% (1/17). G. vaginalis and A. vaginae were detected in 76% (13/17) and 88% (14/16) of patients, respectively, in this group.In Group 2 (LSIL patients), B. conglomeratum set were grouped within the sexually transmitted pathogens set (B. conglomeratum was associated with oncogenic HPV types in 25/32 swabs (78%), including all detected oncogenotypes of HPV 16  were associated, with M. hominis being the most common (44%), followed by U. urealyticum at 39%, U. parvum at 33%, C. trachomatis, M. genitalium, and T. vaginalis at 6% each. Multiple coinfections with different high-risk HPV genotypes (33%) and sexually transmitted pathogens (22%) were also detected in this group . Twenty of 53 (23%) had HPV, with 6/53 (11%) being high-risk HPV, 2/53 (4%) having double HPV coinfections (58–68 and 56–68), and 4/53 having low-risk HPV. Sexually transmitted bacteria were detected in 23% of these exudates, with U. parvum being present in 23% and U. urealyticum in 2%. No other pathogen coinfections were found in this group.In the group of patients who underwent cone biopsy or surgery for cervical cancer control , B. conglomeratum was found in 20 samples (37%). Of these, 6 were associated with HPV. B. conglomeratum was related to 3 elements with sexually transmitted pathogens, six elements with G. vaginalis, and seven elements with A. vaginae. Only one sample intersected with all the studied sets , ied sets .B. conglomeratum is independent or has a statistically significant relationship in the evaluated Groups 1, 2, and 3, a chi-square test was conducted. For the group of sexually transmitted bacteria and B. conglomeratum, a p value of 0.002 was obtained, indicating a statistical relationship. However, no statistical relationship was found with HPV , but in contrast, this group showed a medium-high association between B. conglomeratum and sexually transmitted pathogens (correlation of 0.446)  , Group 2f 0.446) , Group 3B. conglomeratum and sexually transmitted pathogens in Group 1, the effect size was 0.5531, which is considered medium. 2. No significant association was found between B. conglomeratum and HPV in Group 1. 3. In Group 2, the correlation between B. conglomeratum and sexually transmitted pathogens had an effect size of 0.6678, indicating a medium-high effect. The correlation between B. conglomeratum and HPV in Group 2 had an effect size of 0.5621, indicating a medium effect. 4. Only the association between B. conglomeratum and sexually transmitted pathogens in Group 2 represented a medium-high effect.To assess the impact of these associations, a bivariate normal model was used with the previous values to calculate the effect size, which indicates the magnitude of the effect under an alternative hypothesis. Using Cohen’s rules for effect size classification, where a small effect is 0.2, medium is 0.5, and large is 0.8, the following was determined: 1. For the association between B. conglomeratum and HPV in Group 1. In Group 2, the correlation between B. conglomeratum and sexually transmitted pathogens resulted in β = 0.0184 and a power of 0.9816, and the correlation between B. conglomeratum and HPV had β = 0.0169 and a power of 0.9831. No statistical power was found in Group 3 for the correlation between B. conglomeratum and HPV. All correlations were adequate, indicating that the alternative hypothesis suggests that the chi-square correlations and Kendall’s Tau-b correlations are representative of these analysed groups , in Group 1, the alternative hypothesis was accepted for the lesion-free group, as there was a correlation between B. conglomeratum and sexually transmitted pathogens, with a β value of 0.0014 and a power of 0.9986. No significant correlation was found between d groups .for B. conglomeratum and infection, a two-tailed bivariate normal distribution diagram was constructed using the G Power program, resulting in a 1-β error probabilistic value of 0.99. This value is associated with statistical power when making population inferences. With this obtained value, the correlation was generalized by calculating the effect using the normal distribution, resulting in a value of 0.394, indicating a medium effect according to the value scale, which can be considered clinically relevant.Using the correlation data Brachybacterium conglomeratum has been considered an environmental bacterium, and few studies have demonstrated its pathogenic role in humans [B. conglomeratum not only in vaginal swabs from patients with LSIL but also in patients with cervicovaginal infections and patients who had previously experienced precancerous lesions and were currently attending the hospital for follow-up. This is the first study to report the prevalence of this bacterium in women with these two clinical conditions.n humans ,20. Howen humans . Thus, iB. conglomeratum was found in all three groups of patients studied, with a higher prevalence in the group of women with LSIL, followed by the group of patients with cervicovaginal infections. However, statistically, B. conglomeratum was found only to be associated only with the group of patients with LSIL. In this group, B. conglomeratum was found in 60% of cases, and 16 high-risk HPV oncogenotypes were detected, with HPV 16 and 53 being the most common genotypes, followed by genotypes 51, 52, and 59. All women with HPV genotype 16 were associated with B. conglomeratum, confirming the previously reported result by Nieves-Ramirez et al., 2021. This group had the highest number of multiple infections with different high-risk HPV oncotypes compared to the other groups evaluated, which is consistent with the findings of González-Yebra et al. in 2022, who reported that the highest number of HPV genotypes is found in patients with precancerous lesions, and these tend to decrease in high-grade lesions [The fact that we found multiple coinfections with genotypes 16 and 53 in our results suggests the synergistic ability of these genotypes to coexist with other HPV types. Del Prete et al., 2019, reported this coexistence with other HPV genotypes in Italian women .G. vaginalis, along with A. vaginae, were the bacteria most frequently found in this group, and U. parvum was the most common sexually transmitted pathogen, followed by M. hominis. Within these groups, B. conglomeratum was always found in association with these microorganisms and was not detected as a sole pathogen. It has been observed that U. parvum, U. urealyticum, and M. hominis increase the risk of abnormal cervical cytology, while U. urealyticum and M. genitalium increase HPV colonization by influencing the development of cytological abnormalities caused by this virus [A. vaginae and G. vaginalis. These bacteria have been reported to be of significance in the uterine cervix and can be considered a normal part of the cervical microbiome. HPV infection alone could trigger a significant change in the abundance of bacterial populations. While the mere presence of these bacteria may not be associated with pathological conditions such as the presence of precursor lesions and HPV infection, there is a possibility that an increase in the bacterial load of these genera could play a role in some cervicovaginal diseases [is virus ,24. It idiseases ,26.B. conglomeratum was the one in which patients attended the hospital for follow-up, and 23% were also positive for HPV. Oyervides-Munoz et al., 2020, reported the persistence or recurrence of HPV infection in some patients after one year of treatment due to untreated subclinical HPV infections [Atopobium and G. vaginalis [Lactobacillus crispatus, L. jensenii, and L. helveticus, were identified as predominant species and could serve as biomarkers distinguishing between different groups. These findings may also identify potential microbial targets for future treatment [The group with the lowest prevalence of fections , as wellaginalis . They vaaginalis , as cervaginalis . The vagaginalis , and theaginalis . 16S rRNreatment . This apB. conglomeratum appeared to have no pathogenic capacity per se, as it was always found in coinfection with other sexually transmitted pathogens with a role in cervicovaginal infections or precancerous lesions. However, it could be considered an important coadjutant within these dysbiotic processes, as the interrelation of bacterial groups can create suitable niches for viral persistence. Understanding these relationships and eliminating them could contribute to reducing HPV-related carcinogenesis.In our study,