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.
Highlights
Cervical cancer is the second most common malignant tumor among women worldwide, second only to breast cancer [1]
Vaginal microecology - cervical human papillomavirus association bacterial vaginosis (BV) with Human papillomavirus (HPV) infection Eight studies reported a comparison of BV detection rates in HPV-positive and –negative individuals
The total results based on all eight studies were statistically significant (Fig. 1), indicating a positive association between BV and cervical HPV infection
Summary
Cervical cancer is the second most common malignant tumor among women worldwide, second only to breast cancer [1]. Human papillomavirus (HPV) infection, especially high-risk human papilloma virus (HR-HPV) persistent infection, is a prerequisite for the development of cervical intraepithelial neoplasia (CIN) and cervical cancer [2]. The HPV infection rate of Chinese women was 15.71% in the previous years, and 84.6% of sexually active women were infected with HPV at least once in their lifetime, but few HPV infections persist and progress to cervical cancer [3]. Over 90% HPV and CIN I, half of CIN II, and 30% of CIN III can be self-contained [4–6]. In most of the cases, the HPV infection. Identifying risk factors for the development of CIN and cervical cancer has been the objective of recent studies [11]. Normal vaginal microecology plays an indispensable role in the prevention of female genital tract infection and its alteration is inextricably linked to cervical lesions development
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