Vaginal microbial flora as a cofactor in the pathogenesis of uterine cervical intraepithelial neoplasia

Abstract

The vaginal microbial flora of 106 women with histopathologically confirmed cervical intraepithelial neoplasia and 79 women without disease, was evaluated for Gardnerella vaginalis, Trichomonas vaginalis, Candida albicans and other yeasts. Flora morphology was assessed by gram staining of secretions. Cervical cultures were examined for Herpes Simplex virus, Cytomegalovirus and Neisseria gonorrhoeae. Chlamydia trachomatis antigens in cervical secretions were detected by enzyme immunoassay. Human Papillomavirus was identified by koilocytosis in cytologic or histopathologic specimens. Human Papillomavirus infection (P less than 0.00001), vaginal infection with Mycoplasma hominis (P = 0.012) and abnormal vaginal flora (P = 0.006) were significantly associated with CIN, suggesting that CIN may be promoted by vaginal microorganisms in conjunction with human papillomavirus cervical infection.

Increased detection of clue cells in smears from cervical intraepithelial lesions with reduced expression of COX‐2

“…9,21 Studies on the vaginal A positive association between BV and CIN was found by some investigators, showing that women with BV incur a significant risk of developing CIN. 8,22 Conversely, other studies have found no correlation between BV and SIL. 9,23 Although, there is a large bulk of evidence favoring the plausibility of a relation between cervical inflammation and the risk for cervical cancer in HPV-infected women, the knowledge on the relations between clue cells, or even BV, and CIN remains incomplete notwithstanding.…”

“…7 It remains largely unknown, however, which biological mechanism underscores the relation between BV and cervical carcinogenesis. 8,9 Some studies have suggested that the abnormal micro flora can stimulate the release of cytokines, thereby affecting the immunological balance within the tissue. 9 There are several interconnecting biological mechanisms that lead to CIN.…”

Gynaecological Infections as Risk Determinants of Subsequent Cervical Neoplasia

“…There are controversial reports on the association between altered vaginal flora and cervical neoplasia (30,31). The association between yeast and cervical dysplasia has in different studies been either non-existent (32) or positive (33). Fungal organisms can be a sign of good genital hygiene, which makes the lack of a positive association credible.…”

Is bacterial vaginosis associated with squamous intraepithelial lesion of the uterine cervix?

“…A positive association between BV and SIL was found by some investigators, showing that women with BV incur a significant risk of developing SIL. [7][8][9] Conversely, other studies have found no correlation between BV and SIL. …”