Microbiota cérvico-vaginal associada à infecção por HPV e lesão intraepitelial escamosa diagnosticada por citologia em base líquida

Abstract

The microbial community of the female genital system is predominantly composed of lactobacilli, which maintain an acidic pH and act as a protective barrier against pathogens. Bacterial vaginosis (BV), a dysbiosis affecting women of reproductive age, is associated with various gynecological and obstetric disorders, including preterm birth, pelvic inflammation, and squamous intraepithelial lesions (SIL). Moreover, its occurrence is linked to increased vulnerability to sexually transmitted infections (STIs), such as human papillomavirus (HPV), which is involved in nearly 30% of cancers associated with infectious agents—showing a high prevalence of high-oncogenic-risk subtypes 16 and 18. In Brazil, cervical cytology is the standard method for screening lesions that precede cervical neoplasia and cancer. Liquid-based cytology (LBC) has been introduced in private healthcare networks, offering advantages such as improved cell visualization and applicability in molecular testing, facilitating the identification of HPV and other medically relevant microorganisms. Objective: To analyze the association of bacterial species causing bacterial vaginosis with high- risk HPV and their correlation with cervical cytology in patients treated at private clinics in Fortaleza-CE. Methods: A descriptive and analytical cross-sectional study was conducted based on data extracted from exams and clinical records of women who underwent specialized cervical cytology assessment in a private laboratory in Fortaleza-CE between 2020 and 2021. The study included participants who simultaneously underwent sampling for SurePath liquid-based cytology, HPV genotyping, and multiplex PCR assay for BV. Results: The study evaluated exam data from 168 participants aged between 14 and 60 years (mean age: 34 years). Among them, 44 (26%) tested positive for bacterial vaginosis (BV). Lactobacillus spp. was the most prevalent bacterial species in BV-negative cases (66%), while Gardnerella vaginalis (Gv) was the most prevalent (95%) in BV-positive cases. In high-oncogenic-risk HPV genotyping, Gardnerella vaginalis (Gv) (59%) and Atopobium vaginae (Av) (25%) were significantly associated with high-risk HPV detection, whereas Lactobacillus spp. (64%) was linked to absence of high-risk HPV. In cytology findings, species significantly associated with cellular atypia were Gardnerella vaginalis (Gv) (45%) and Atopobium vaginae (Av) (41%), while lactobacilli (66%) were associated with absence of cellular atypia. Conclusion: The evidence gathered confirms a significant association between bacterial vaginosis and HPV, with predominance of the microbial species Gardnerella vaginalis (Gv) and Atopobium vaginae (Av).