Vaginal biocenosis state assessment in patients with cervical ectopy relapse in the conditions of human papillomavirus infection

Abstract

Cervical ectopy is one of the most common benign processes, characterized by relatively high recurrence rate, and in the case of vaginal microbiota violations in the conditions of HPV infection combination deserves the aimed attention, particularly in the context of reproductive health care and cancer prevention. The objective: to study the vaginal microbiota features in patients withcervical ectopy relapsein the conditions of HPV infection. Materials and methods. The study included 98 women of reproductive age (18 to 46 years). Three groups were formed: a control group (n=30), in which conditionally healthy women were included, group 1 (n=33) – patients with firstly diagnosed cervical ectopy, group 2 (n=35) – patients with cervical ectopy relapse. All women wereexamined with a bacterioscopic, cytological, microbiological study of the vaginal biocenosis, as well as a determination of the vaginal environmentpH level. Results. In patients with cervical ectopy relapse the pH of the vaginal environmentwas significantly higher than that in women of the control group (p<0.001) and of the group 1 patients (p<0.05). About 9% of patients in both study groups had signs of bacterial vaginosis; in about 70% of group 2 patients the signs of mild and moderate severity aerobic vaginitis were found, significantly (p<0.05) more often than in patients with firstly diagnosed cervical ectopy. In group 2 patients a significant polymorphism of infects was detected in 40.00±8.28% of cases, the associations of 3 or more microorganisms determined simultaneously were significantly (p<0.001) more often foundin group 2 in comparison with patients with firstly diagnosed cervical ectopy. Сonclusion. The use of the short-term test system A.F.GENITAL SYSTEM (Liofilchem®, Italy) has a number of advantages for clinical practice: results being ready in short time, the detection of a wide range of infections, the possibility of quantifying M. hominis and U. urealyticum, and then determining the sensitivity to the most frequently used antibacterial drugs. Recurrent cervical ectopy often occurs in the conditions of colpitis, vaginitis, vaginal microbiota disorders with significant polymorphism of microorganisms and alkalization of the vaginal environment, which complicates the processes of ectopy epithelialization and can predispose to its recurrence. The observed cytological features in this cohort of patients suggest that long-term violations of the vaginal biocenosis in combination with the inflammatory processes of the vagina and cervix create favorable conditions for the realization of dysplastic changes caused by HPV. When determining the tactics of treatment of recurrent cervical ectopy, in particular in the conditions of HPV infection, first of all it is necessary to achieve both the cytological norm and the normalization of the vaginal biocenosis before any intervention, if necessary. Key words: relapse of cervical ectopy, vaginal biocenosis, vaginitis, cervicitis, HPV.