Altered Vaginal pH Value and Enterobacteria as a Risk Factor in the Development of Precancerous Lesions of the Cervix

Abstract

Background: Vaginal microflora plays an important role in cervical carcinogenesis. An increase in vaginal pH is associated with the severity of squamous intraepithelial lesion (SIL) and a decrease in the number of lactobacilli. Microbial dysbiosis contributes to the damage of the epithelial barrier, as well as the reprogramming of immune and metabolic signaling. Dysbiotic bacteria cause damage to the epithelial barrier, immune dysregulation and genotoxicity and create a tumor-permissive microenvironment. Objective: The aim of this study was to determine the presence of risk factors (abnormal colposcopic and microbiological status, elevated pH of the vaginal environment) in regular Pap tests and LSIL. Methods: Retrospective prospective study 2021-2022. 90 women with pap smears were analyzed: 40 with LSIL at the Gynecological Center “Dr. Mahira Jahić” Tuzla and 50 with normal findings at the Tesanj Health Center. General data such as: age of the subjects, reproductive status, contraception, smoking and data on colposcopic examination, microbiological findings and vaginal pH value were analyzed. Statistical data processing was done in the SPSS program. Results: The average age of the test subjects is 39.94, in normal Pap 41.20 years, and in LSIL 38.38 years. The vital characteristics of the subjects did not differ significantly, except for smoking, where in LSIL findings, they consumed cigarettes significantly more often. Abnormal colposcopic examination were found in 85% (N-34) of women with LSIL. In subjects with LSIL, a positive microbiological test for enterobacteria was found in 47.5% (N-19) and a normal pap test in 12% (N-6). Statistically significant difference p=0.00523 p<0.05, E faecalis and E coli had the highest prevalence in LSIL. The mean pH value of the vaginal environment in LSIL is 5.38, and 4.96 in a regular pap test. Subjects with LSIL in 10% (N-4) had a normal pH test, and 48% (N-24) had a normal Pap test. P=0.00129 p < (0.05). A normal pH value was significantly more common in subjects with a normal Pap test. Microbiological flora, especially enterogenic bacteria, are more common in LSIL than in women with a regular pap test. Conclusion: when monitoring women with LSIL, special attention should be paid to the elimination of present enterobacteria (E.faecalis and E.coli) as a possible risk factor in the development of precancerous lesions (SIL) and cervical cancer.