Vaginal microbiota and human papillomavirus: a systematic review

Abstract

Accumulating evidence indicates the potential correlation between the vaginal microbioma and the acquisition and persistence of human papillomavirus (HPV) infection. This study aims to demonstrate the potential relationship through a systematic review of the current literature. A search was conducted on the following medical databases: PubMed and Scopus. Nineteen studies met the inclusion criteria and were incorporated in the present review. A total of 12.204 patients and their demographic characteristics were studied. Commercially available DNA tests and polymerase chain reaction (PCR) were used for the detection of different HPV subtypes, while the identification of the microbiomes was performed through specific diagnostic methods and PCR assay. The most frequently encountered species were classified based on their protective or detrimental impact on the progression of HPV infection. The beneficial role of some types of Lactobacillus (Lactobacillus gasseri, Lactobacillus jensenii, Lactobacillus crispatus) is generally supported. On the other hand, high microbial diversity and specific microorganisms such as Sneathia, Anaerococcus tetradius, Peptostreptococcus, Fusobacterium and Gardnerella vaginalis were found to be implicated with higher frequency and severity of disease, potentially resulting in pre-cancerous and cancerous cervical lesions.The role of vaginal microbiota appears to play an as yet not fully understood role in the susceptibility to HPV infection and its natural history.

Epidemiology and Burden of Human Papillomavirus and Related Diseases, Molecular Pathogenesis, and Vaccine Evaluation

“…However, its pathophysiological role in the context of HPV infection was unknown until recently. Recent studies have suggested that the cervicovaginal microbiome (CVM) plays an important role in the persistence of HR-HPVs and the occurrence risks of CIN2/3 and invasive cancers by influencing the natural history of HPV infection, and could serve as a complementary therapeutic target to prevent the occurrence of high-grade intraepithelial lesions leading to invasive cancers (126)(127)(128)(129)(130).…”

Cervical Squamous Intraepithelial Lesions Are Associated with Differences in the Vaginal Microbiota of Mexican Women

“…Some of these changes are responsible for increasing the levels of mucin-degrading enzymes, which may play a role in the degradation of the mucous layer that covers the vaginal and cervical epithelium and endocervical mucus ( 20 , 21 ). There is evidence of HPV evasion or infection mechanisms that support that microorganisms such as Sneathia , Anaerococcus , Fusobacterium , and Gardnerella are implicated with higher frequency and severity of disease, potentially resulting in precancerous and cancerous cervical lesions ( 22 ).…”

Cervical Squamous Intraepithelial Lesions are Associated with Changes in the Vaginal Microbiota of Mexican Women

“…Some of these changes are responsible for increasing the levels of mucin-degrading enzymes, which may play a role in the degradation of the mucous layer that covers the vaginal and cervical epithelium and endocervical mucus (20,21). There is evidence of HPV evasion or infection mechanisms that support that microorganisms such as Sneathia, Anaerococcus, Fusobacterium and Gardnerella are implicated with higher frequency and severity of disease, potentially resulting in pre-cancerous and cancerous cervical lesions (22) However, these findings are not uniform across studied populations, because, despite the fact that Latin American countries have a high prevalence of HPV and cervical cancer are one of the main causes of death in women in these areas (3,(23)(24)(25), including Mexico (7,9), most of the studies have been conducted in developed countries (26). Likewise, the projected demographic changes in Latin America imply that the current burden of new cervical cancer cases will increase in the next 20 years (2,27).…”

“…Some of these changes are responsible for increasing the levels of mucin-degrading enzymes, which may play a role in the degradation of the mucous layer that covers the vaginal and cervical epithelium and endocervical mucus (20, 21). There is evidence of HPV evasion or infection mechanisms that support that microorganisms such as Sneathia, Anaerococcus, Fusobacterium and Gardnerella are implicated with higher frequency and severity of disease, potentially resulting in pre-cancerous and cancerous cervical lesions (22)…”

“…Likewise, the projected demographic changes in Latin America imply that the current burden of new cervical cancer cases will increase in the next 20 years (2, 27). The evidence observed so far suggests that the ethnic and sociodemographic factors that influence difference in vaginal microbiome composition may also underlie dysbiotic patterns linked to HPV infection and cervical cancer across different Latin America women populations (3,7,9, 23–25). Therefore, there is a growing need for more evidence in Latin America to demonstrate the association between vaginal microbiota patterns and HPV infection and its relationship with the progression of SIL to cervical cancer.…”