VAGINAL MICROECOLOGY IN HPV-ASSOCIATED CERVICAL DYSPLASIA

Background. Cervical cancer (CC) has become a common malignancy, significantly contributing to the rising mortality rate among women worldwide. The vaginal microenvironment plays a key role in the development of the human papillomavirus (HPV) infection, thereby contributing to the development of CC. Objective. To characterize the main indicators of vaginal microecology in HPV-associated cervical dysplasia. Material and methods. The study involved 102 women of reproductive age (18-49 years). The study material consisted of posterior vaginal fornix swabs and cervicovaginal secretion samples. Vaginal swabs were cultured. The vaginal microbiome was assessed based on the number of microorganisms grown. All lactobacillus isolates were assessed for their functional activity, including their ability to produce hydrogen peroxide, form biofilm, and exhibit antagonistic activity against test strains of opportunistic microorganisms. Results. In HPV-associated dysplasia, there was a significant increase in the pH of the vaginal discharge (p<0.034) and a significantly higher incidence of vaginal dysbiosis (80%), with severe dysbiosis detected in 73.3% of patients. Antagonistic activity and hydrogen peroxide production in lactobacilli of the compared groups did not differ. Biofilmforming capacity was significantly reduced in lactobacilli isolated in the cervical dysplasia group. Thus, the ability to form the main substance was low in all lactobacilli isolates in this group (p=0.02), and the ability to form biomass was absent in 60% of isolates (p=0.003). The study of the parameters characterizing local vaginal immunity did not reveal significant differences between the groups. However, a trend towards an increase in proinflammatory cytokines, regulatory IL-2 and a decrease in sIgA was noted in the group with cervical dysplasia. Conclusion. We detected significant changes in several vaginal microecological parameters in a group of women with HPV-associated cervical dysplasia. It was found that dysplasia was associated with vaginal dysbiosis, and vaginal pH was elevated. Changes in the properties of the resident vaginal microbiota were also observed, including decreased antagonistic activity and the ability to form a physiological biofilm on the vaginal mucosa, leading to decreased colonization resistance of the vaginal biotope. These parameters may indicate a progressive course of HPV-associated dysplasia and can be used as additional markers in assessing the risk of developing precancerous pathology and cervical cancer.