A meta-analysis of the relationship between vaginal microecology, human papillomavirus infection and cervical intraepithelial neoplasia

Abstract

Microecology is an emerging discipline in recent years. The female reproductive tract is an important microecological region, and its microecological environment can directly affect women’s cervical health. This meta-analysis aimed to analyze the effects of vaginal microecology on Human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN). PubMed and Web of Science were systematically searched for eligible publications from January 2000 to December 2017. Articles were selected on the basis of specific inclusion and exclusion criteria. The design and quality of all studies were evaluated using the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) with a 95% confidence interval (95% CI) were calculated. Thirteen eligible studies were selected to evaluate the association of vaginal microecology with HPV infection and CIN. The factors related to HPV infection were bacterial vaginosis (BV) (OR 2.57, 95% CI 1.78–3.71, P<0.05), Candida albicans (VVC) (OR 0.63, 95% CI 0.49–0.82, P < 0.05), Chlamydia trachomatis (CT) (OR 3.16, 95% CI 2.55–3.90, P < 0.05), and Ureaplasma urealyticum (UU) (OR 1.35, 95% CI 1.20–1.51, P < 0.05). BV was also related to CIN (OR 1.56, 95% CI 1.21–2.00, P < 0.05). This meta-analysis of available literature suggested an intimate association of vaginal microecology and HPV infection with CIN. BV, CT and UU were associated to increased HPV infection, VVC was associated to decreased HPV infection, Lactobacillus is not associated to increased HPV infection, BV was associated to increased CIN development risk. Further large-scale studies are needed to confirm our findings.

Vaginal Microbiota and Cytokine Microenvironment in HPV Clearance/Persistence in Women Surgically Treated for Cervical Intraepithelial Neoplasia: An Observational Prospective Study

“…Some taxa have emerged as being particularly associated with increased oncogenic risk, including Ureaplasma parvum, Atopobium vaginae, Prevotella, Gardnerella, Sneathia sanguinegens, and Fusobacteria (Brotman et al, 2014;Drago et al, 2016). Few data are otherwise available on non-bacterial components of the vaginal microbiome (mycetes, protozoa), although some reports have observed their association with increased CC risk (Liang et al, 2019).…”

Significance of the Viral Load of High-risk Hpv in the Diagnosis and Prediction of Cervical Lesions: A Retrospective Study

“…On the other hand, the present study supports the hypothesis that high HR-HPV viral loads are associated with more advanced cervical lesions. This view is supported by Long et al [19], who showed that the viral load of HPV-16, HPV-58, and HPV-33 was associated with high-grade cervical lesions, as well as by other studies in various populations [13][14][15][16][17][18][19][31][32][33]. Berggrund et al [14] showed that the HR-HPV viral load could indicate the course of the infection, as well as the presence of CIN II, CIN III, and CC.…”

“…The HR-HPV viral load indicates the activity of HPV-DNA in the body [13,14]. Studies showed that the type of HPV infection is closely related to the severity of cervical lesions and treatment prognosis [10][11][12], but there are inconsistent results from the studies on the correlation between the HPV viral load and the severity of cervical lesions [13][14][15][16][17][18][19]. At present, the correlation between the HPV viral load and cervical lesions has not been determined, and the signi cance of the HPV viral load in the detection and treatment of cervical lesions is still controversial [17,19].…”

Multiple sexual partners and vaginal microecological disorder are associated with HPV infection and cervical carcinoma development

“…Thus, other potential risk factors need to be investigated to better predict CC. It is known that the normal vaginal microecology plays an indispensable role in preventing HPV infection and accelerating HPV clearance ( 26 , 27 ). Abnormal vaginal microecology may be a synergistic factor of persistent HPV infection ( 28 ), which ultimately increases the risk of CIN/CC.…”

“…The severity of BV was determined using a gram-stained slide and was detected with the Cro vaginal microbiological evaluation system (ShanDong Shida Si Biological Industry Co., Ltd.). The results were hierarchically represented by the Nugent Gram stain scoring system ( 24 – 27 ). A Nugent score of 7 to 10 was defined as severe BV, a score of 4 to 6 was defined as mild BV, and a score of 1 to 3 was defined as negative BV.…”