Association between Bacterial Vaginosis and Cervical Intraepithelial Neoplasia: Systematic Review and Meta-Analysis

Abstract

ObjectiveBacterial vaginosis (BV), the most common vaginal disorder among women of reproductive age, has been suggested as co-factor in the development of cervical cancer. Previous studies examining the relationship between BV and cervical intra-epithelial neoplasia (CIN) provided inconsistent and conflicting results. The aim of this study is to clarify the association between these two conditions.MethodsA systematic review and meta-analysis were conducted to summarize published literature on the association between BV and cervical pre-cancerous lesions. An extensive search of electronic databases Medline (Pubmed) and Web of Science was performed. The key words ‘bacterial vaginosis’ and ‘bacterial infections and vaginitis’ were used in combination with ‘cervical intraepithelial neoplasia’, ‘squamous intraepithelial lesions’, ‘cervical lesions’, ‘cervical dysplasia’, and ‘cervical screening’. Eligible studies required a clear description of diagnostic methods used for detecting both BV and cervical pre-cancerous lesions. Publications were included if they either reported odds ratios (OR) and corresponding 95% confidence intervals (CI) representing the magnitude of association between these two conditions, or presented data that allowed calculation of the OR.ResultsOut of 329 articles, 17 cross-sectional and 2 incidence studies were selected. In addition, two studies conducted in The Netherlands, using the national KOPAC system, were retained. After testing for heterogeneity and publication bias, meta-analysis and meta-regression were performed, using a random effects model. Although heterogeneity among studies was high (χ2 = 164.7, p<0.01, I2 = 88.5), a positive association between BV and cervical pre-cancerous lesions was found, with an overall estimated odds ratio of 1.51 (95% CI, 1.24–1.83). Meta-regression analysis could not detect a significant difference between studies based on BV diagnosis, CIN diagnosis or study population.ConclusionsAlthough most studies were cross-sectional and heterogeneity was high, this meta-analysis confirms a connection between BV and CIN.

Molecular analysis and conventional cytology: association between HPV and bacterial vaginosis in the cervical abnormalities of a Brazilian population

“…Metaanalysis has shown a positive association between BV and cervical HPV infection, and the pooled prevalence of BV can be as much as 32% (Gillet et al, 2011(Gillet et al, , 2012. Therefore, the bacterial diversity in HPV-positive women is different and even more complex compared with HPV-negative women (Gao et al, 2013).…”

Scoring System and Management Algorithm Assessing the Role of Survivin Expression in Predicting Progressivity of HPV Infections in Precancerous Cervical Lesions

“…We found that STIs significantly increases the risk of developing CIN 3. By-products of these pathogens uch as propionate and butyrate may damage epithelial cells, and alterations in the vaginal environment to a proinflammatory state may contribute to the development of ervical lesions (Gillet, 2012).…”

Cervicitis: an Unresolved Gynecological Problem

“…Большой разброс в представленных показа-телях распространенности может быть связан с включением различных групп пациенток, с демографическими вариация-ми и разными диагностическими критериями. В целом по результатам 21 исследования общая распространенность БВ составила 27,1%, особо не различаясь в развитых (28,0%) и развивающихся (23,5%) странах [3,39].…”

“…В недавнем метаанализе, включившем более 10 000 жен-щин, доказана связь между БВ и предраковыми состояниями, а именно СIN [3].…”

“…Риск дисплазии и рака шейки матки резко повышается при сочетании ВПЧ с ИППП, а также изменени-ем дисбаланса вагинальной микрофлоры [1,2]. По мнению многих исследователей [3][4][5], изменение микробиоценоза влагалища способствует повышению частоты инфицирова-ния ВПЧ. Особенность нормальной микрофлоры урогени-тального тракта женщин -наличие многообразных видов облигатных и факультативных анаэробов и в меньшей сте-пени аэробов.…”