Aerobic Vaginitis-Underestimated Risk Factor for Cervical Intraepithelial Neoplasia.

Olga Plisko,Inta Liepniece-Karele,Amanda Prusakevica,Dace Rezeberga,Jana Zodzika,Irina Jermakova,Kristine Pcolkina,Gilbert G G Donders

doi:10.3390/diagnostics11010097

Abstract

The aim of this study is to analyse the association between vaginal microbiota and the histological finding of CIN. From July 2016 until June 2017, we included 110 consecutive patients with abnormal cervical cytology results referred for colposcopy to Riga East Clinical University Hospital Outpatient department in the study group. 118 women without cervical pathology were chosen as controls. Certified colposcopists performed interviews, gynaecological examinations and colposcopies for all participants. Material from the upper vaginal fornix was taken for pH measurement and wet-mount microscopy. Cervical biopsy samples were taken from all subjects in the study group and in case of a visual suspicion for CIN in the control group. Cervical pathology was more often associated with smoking (34.6% vs. 11.0%, p < 0.0001), low education level (47.2% vs. 25.5%, p = 0.001), increased vaginal pH (48.2% vs. 25.4%, p < 0.0001), abnormal vaginal microbiota (50% vs. 31.4%, p = 0.004) and moderate to severe aerobic vaginitis (msAV) (13.6% vs. 5.9%, p = 0.049) compared to controls. The most important independent risk factors associated with CIN2+ were smoking (OR 3.04 (95% CI 1.37–6.76), p = 0.006) and msAV (OR 3.18 (95% CI 1.13–8.93), p = 0.028). Bacterial vaginosis (BV) was found more often in CIN1 patients (8/31, 25.8%, p = 0.009) compared with healthy controls (8/118, 6.8%), or CIN2+ cases (8/79, 10.1%). In the current study msAV and smoking were the most significant factors in the development of CIN in HPV-infected women, especially high grade CIN. We suggest that AV changes are probably more important than the presence of BV in the pathogenesis of CIN and progression to cervix cancer and should not be ignored during the evaluation of the vaginal microbiota.

Highlights

Persistent human papillomavirus (HPV) infection is a necessary cause for the development of cervical precancerous lesions and cervical cancer [1]
Two patients in the study group had the histological result of cervicitis and during data analysis were added to the control group
In the current study we have found a significant association between low education, smoking, increased vaginal pH, abnormal vaginal microbiota and histologically proven cervical precancerous lesions

Summary

Introduction

Persistent human papillomavirus (HPV) infection is a necessary cause for the development of cervical precancerous lesions (dysplasia) and cervical cancer [1]. Most of the cervical HPV infections resolve spontaneously, but in a minority of women it persists and progresses to cervical dysplasia and cancer [2]. In the recent years there have been publications about the association between different vaginal microbiota changes and cervical intraepithelial neoplasia (CIN), suggesting the idea that an abnormal vaginal environment plays an important role in the development of CIN [4,5,6,7]. The relation between bacterial vaginosis (BV) and cervical neoplasia has been studied most frequently: 20 studies about the association between BV and CIN had been analysed in a systematic review, but only 10 showed a significantly higher CIN prevalence in BV-positive women [8]. Much less is known about a possible role of other abnormal vaginal microbiota types such as aerobic vaginitis (AV) and mixed AV-BV flora

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