Prevalence and genotype distribution of Human Papillomavirus (HPV) among 14,110 women in Anqing urban area: A population-based cross-sectional survey

Tingting Han; Shijie Deng

doi:10.1371/journal.pone.0336959

Peer Review History

Original SubmissionJuly 8, 2025
7 Oct 2025 Decision Letter - Jonah Musa, Editor Dear Dr. Deng, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== Please submit your revised manuscript by Nov 21 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. 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There is no requirement to cite these works unless the editor has indicated otherwise. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: We have received sufficient reviews and have arrived at the editorial decision to proceed with minor revisions. The reviewers have provided constructive comments on how to improve the quality of the paper and these are available under the reviewers comments for your guidance. Provide appropriate responses to each of the comments in your revised version. I look forward to receiving your responses within 2 weeks. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: I Don't Know Reviewer #2: No ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Dear Editor-in-Chief Thank you for the opportunity to review this paper. The importance of the investigation is quite large sample size in a long period of time. There are some issues which could improve the quality if met in the manuscript. First, it would be interesting if the authors provide a graphical scheme of the findings besides the tables to ease the reading. Then, on important evaluation is assessing single and multiple HPV prevalence. It would be highly important to compare the possible impact of this issue on cervical changes with incorporating P-value. furthermore, did the authors seen ang HPV shifting after COVID-19 era according to the time window? It should reflect the discussion. Finally, comparison with the regions from Asia could be valuable to draw the differences or similarities, considering oral HPV infection as a trend in global population and suggestion for further investigation in Chinese population (https://doi.org/10.1016/j.jiph.2025.102814, https://doi.org/10.1002/dc.25465, https://doi.org/10.1186/s12985-025-02767-x). Reviewer #2: Congratulations to the authors of the paper titled "Prevalence and genotype distribution of Human Papillomavirus (HPV) among 14,110 women in Anqing urban area: a population-based cross-sectional survey." In the era of vaccinations and the development of research on new preventive and therapeutic vaccines, this paper raises a very important topic. The work is interesting but has some minor comments: Errors in the abstract results: It should be LSIL and HSIL. In my opinion, the percentage is incorrect or the group description is incorrect. "The overall prevalence of HPV infection in the study population was 18.97%." This is 18%, and below it, all HPV positivity rates were above 42%. "The highest HPV positivity rate was observed under 20 years old (79.17%), followed by those aged 50-59 (84.88%), and then those aged 59 and above (42.53%)" In my opinion, the introduction is too short; I would have written more about the possibilities of genotyping with the possibility of phenotyping as a screening test. It is especially recommended as a self-sampling test during the Covid-19 pandemic, allowing for the postponement of diagnosis. The study was conducted during the Covid-19 pandemic. The Covid-19 pandemic and the virus infection itself may have had an impact on the quality of medical care and the immune system, and thus on the chronicity of HPV infection. Wszołek K et all Women's Healthcare Services since the COVID-19 Pandemic Outbreak in Poland. Int. J. Environ. Res. Public Health 2022, 19, 180 “The normal and abnormal cervical lesions diagnosed by cytology were classified into five stages: negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US), atypical Squamous Cells which cannot exclude high-grade squamous intraepithelial lesion (ASC-H), low-grade squamous intraepithelial neoplasia (LSIL), high-grade squamous intraepithelial neoplasia, and atypical squamous cells – cannot exclude high-grade squamous intraepithelial lesion and cancer(HSIL) “ high-grade squamous intraepithelial neoplasia (HSIL), and cancer. There is no information whether the patients were vaccinated or not. Vaccination affects the recurrence of the disease and persistent infections !!! Table 2. I do not understand why in the entire population there were 18% of HPV positive patients and when divided into groups it is over 42% everywhere. There are a lot of typos in LSIL and HSIL. I suggest writing LSIL- CIN 1 and HSIL CIN 2 and CIN 3 according to the LATS terminology, which is clearer for histopathological diagnoses. - In the discussion you can compare the genotyping results not only from China but also from Europe, I propose to compare the results of our team – “ Clinical use of the Onclarity test with extended HPV genotyping and phenotyping in patients with suspected squamous intraepithelial lesions. Ginekol Pol. 2024;95(5):328-334. doi: 10.5603/gpl.96712. Epub 2023 Dec 15. PMID: 38099664”. This is a very similar study that does not include a vaccinated population. It also confirms the validity of vaccination with the 9-valent vaccine. It may be worth presenting the most common HPV types by country in a table. See below. Please separate the conclusions from the discussion. After corrections, I recommend publication. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: Yes: Amitis Ramezani Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. 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Revision 1
1 Nov 2025 Author Response Dear Editor and Reviewers, We sincerely thank you for handling our manuscript and for the constructive comments provided by the reviewers. We are particularly encouraged that both reviewers found the manuscript to be technically sound and agreed that the data support the conclusions We have carefully considered all the suggestions and have revised the manuscript accordingly. We believe that these changes have significantly improved the quality of our work. Our point-by-point responses to the reviewers' comments are detailed below. Response to Editor: Comment 1: Please state what role the funders took in the study. If the funders had no role, please state: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." Response: Thank you for this important comment. Our funders had no role in any aspect of this study. As suggested, we have now included the following statement in the 'Acknowledgments' section of the revised manuscript: "The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript." Comment 2: Please complete your Competing Interests on the online submission form to state any Competing Interests. If you have no competing interests, please state "The authors have declared that no competing interests exist." Response: We have received your message concerning the Competing Interests declaration for our submission.This is to confirm that we have no competing interests. As per the journal's policy, we have already stated "The authors have declared that no competing interests exist." in the designated field of the online submission form. Comment 3: PLOS requires an ORCID iD for the corresponding author in Editorial Manager on papers submitted after December 6th, 2016. Please ensure that you have an ORCID iD and that it is validated in Editorial Response: Thank you for your suggestion regarding the ORCID iD. We have followed your advice and successfully registered for an ORCID. My ORCID iD is: https://orcid.org/0000-0002-1999-061X. I believe this is a valuable practice for academic identity management, and I appreciate you bringing it to my attention. Comment 4: Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Response: Thank you for your comments on our manuscript titled "Prevalence and genotype distribution of Human Papillomavirus (HPV) among 14,110 women in Anqing urban area: a population-based cross-sectional survey". We have carefully revised the manuscript according to the editorial request regarding the Supporting Information. The specific changes we have made are as follows: We have added a "Supporting Information" section at the end of the manuscript file, immediately following the Reference list. In this section, we have provided descriptive captions for all Supporting Information files. We have updated all in-text citations to the Supporting Information throughout the manuscript to ensure they are formatted correctly and match the captions accordingly (e.g.,(S1 Fig), (S1 Table)). These changes have been incorporated into the revised manuscript file we have submitted. We believe that the manuscript now fully complies with the journal's guidelines for Supporting Information. We appreciate the time and effort you and the reviewers have dedicated to our work. Comment 5: Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: No Dear Reviewer #1 and #2: Thank you for raising this important question regarding the statistical analysis. We agree that rigorous statistics are fundamental to drawing reliable conclusions. We confirm that the statistical analysis in our manuscript has been performed appropriately and rigorously. The choice of statistical tests was determined by the experimental design and the nature of the data. For comparisons among aged- specific distribution of HPV infections groups, we used Fisher’s chi-square test, as appropriate. Because the infection rates of HPV genotypes were statistically low when grouped by age, we chose the more accurate Fisher's exact test to compare the positive rates across different groups. The Chi-square test was used to compare the effects of single infections and multiple infections across different cytological grades. A dedicated "Statistical Analysis" subsection in the Materials and Methods details all tests used, the software (SPSS 22.0), and the significance threshold (α = 0.05). We have defined statistical significance P < 0.05, and all specific p-values were reported. In summary, we have taken great care to ensure that our statistical approach is robust, appropriate for our data, and transparently reported. We are confident that the conclusions drawn are firmly supported by the statistical evidence. We thank the reviewer for their thorough review and hope this clarification fully addresses their concern. Comment 6: Add a graphical scheme of the findings besides the tables to ease the reading Response: Thank you for the suggestion. A new figure (Fig. 1) presenting the distribution of HPV genotypes from 2022 to 2024 has been inserted into the manuscript. Comment 7: Comparison of single and multiple HPV infections across cervical lesions with Statistical Assessment Response: A new table (Table 4) was added to comparing single vs. multiple infections across cytological grades with statistical analysis. Comment 8: Added discussion of COVID-19 pandemic impact and potential HPV genotype shifts. Response: As recommended, we have added this content to the third paragraphs of the Introduction and the fourth paragraphs of Discussion. All changes have been highlighted in yellow. Comment 9: Comparison with the regions from Asia could be valuable to draw the differences or similarities, considering oral HPV infection as a trend in global population and suggestion for further investigation in Chinese population. Response: We have revised the manuscript to include the suggested content in the designated sections: analysis of HPV genotypes in Asia has been added to the second paragraph of the Discussion and a context of oral HPV infection has been added to the eighth paragraph. These additions are also marked in yellow. Comment 10: Correct LISL and HISL to LSIL and HSIL. In my opinion, the percentage is incorrect or the group description is incorrect. Response: We sincerely thank the reviewer for this critical observation and for highlighting these important issues. We have thoroughly reviewed the entire manuscript and corrected all instances of "LISL" to "LSIL" and "HISL" to "HSIL". Comment 11: The overall prevalence of HPV infection in the study population was 18.97%, while all subgroup rates exceed 42%. Please explain this discrepancy. Response: We thank the reviewer for this critical observation. The percentages in the abstract and this section represent the HPV positivity rate within each age group (positive cases/total tested in that age group), not the percentage among all women tested. This explains why percentages exceed the overall 18.97% prevalence. Comment 12: Expanded introduction section to include discussion of HPV genotyping, phenotyping, and COVID-19 pandemic impact. Response: As recommended, we have added this content to the fourth paragraphs of the Introduction. All changes have been highlighted in yellow. Comment 13: There is no information whether the patients were vaccinated or not. Vaccination affects the recurrence of the disease and persistent infections. Response: We apologize for the lack of data on HPV vaccination status in our hospital's information system; therefore, this variable could not be included in the analysis. Comment 14: I suggest writing LSIL- CIN 1 and HSIL CIN 2 and CIN 3 according to the LATS terminology, which is clearer for histopathological diagnoses. Response: We thank the reviewer for the valuable suggestion regarding the classification of cervical lesions. While we acknowledge that histopathological grading offers high specificity, the current analysis is primarily based on cytological findings (TCT), as this constitutes the most routinely available and standardized screening data in our clinical setting. To ensure internal consistency across all our data, we have maintained the cytological classification (e.g., ASC-US, LSIL, HSIL) for this study. Comment 15: Added comparison with European data. Response: As recommended, we have added this content to the second paragraphs of the Discussion. All changes have been highlighted in yellow. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0336959.r002
4 Nov 2025 Decision Letter - Jonah Musa, Editor <p>Prevalence and genotype distribution of Human Papillomavirus (HPV) among 14,110 women in Anqing urban area: a population-based cross-sectional survey PONE-D-25-35198R1 Dear Dr. Deng, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Jonah Musa, MBBS, MSCI,PhD Academic Editor PLOS ONE Additional Editor Comments (optional): I am pleased to read your revised version which has been very responsive to the reviewer comments and suggestions. I therefore recommend for acceptance and publication after checking journal specific editorial requirements. Reviewers' comments: https://doi.org/10.1371/journal.pone.0336959.r003
Formally Accepted
Acceptance Letter - Jonah Musa, Editor PONE-D-25-35198R1 PLOS ONE Dear Dr. Deng, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Jonah Musa Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0336959.r004

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