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Abstract

Background: Vaginal dysbiosis characterized by depleted lactobacilli is usually correlated with human papillomavirus (HPV) infection and cervical carcinogenesis, but the effect of the Lactobacillus genus and represented species on this process remains unclear.

Methods: PubMed, EMBASE, and CENTRAL databases were searched up to February 15, 2019. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a fixed-effect model and Review Manager (version 5.3) for Mac.

Results: Eleven studies comprising 1230 cases were included. Lactobacillus spp. was associated with the decreased detection of high-risk subtype (hr)HPV infection (OR = 0.64, 95% CI = 0.48-0.87, I2 = 6%), cervical intraepithelial neoplasia (CIN) (OR = 0.53, 95% CI = 0.34-0.83, I2 = 0%), and cervical cancer (CC) (OR = 0.12, 95% CI = 0.04-0.36, I2 = 0%). At the level of Lactobacillus species, Lactobacillus crispatus, but not Lactobacillus iners, was correlated with the decreased detection of hrHPV infection (OR = 0.49, 95% CI = 0.31-0.79, I2 = 10%) and CIN (OR = 0.50, 95% CI = 0.29-0.88, I2 = 0%).

Conclusions: Cervicovaginal Lactobacillus spp. is associated with the decreased detection of hrHPV infection, CIN, and CC; L. crispatus may be the critical protective factor.

Keywords: cervical cancer; cervical intraepithelial neoplasia; high-risk human papillomavirus; lactobacilli.

Research Insights

SupplementHealth OutcomeEffect TypeEffect Size
Lactobacillus crispatusReduced Detection of Cervical Intraepithelial NeoplasiaBeneficial
Moderate
Lactobacillus crispatusReduced Detection of High-Risk HPV InfectionBeneficial
Moderate
Lactobacillus crispatus LBV88Reduced Detection of Cervical Intraepithelial NeoplasiaBeneficial
Moderate
Lactobacillus crispatus LBV88Reduced Detection of High-Risk HPV InfectionBeneficial
Moderate
Lactobacillus crispatus LBV 88Reduced Detection of Cervical Intraepithelial NeoplasiaBeneficial
Moderate
Lactobacillus crispatus LBV 88Reduced Detection of High-Risk HPV InfectionBeneficial
Moderate
Lactobacillus crispatus LCr86Reduced Detection of Cervical Intraepithelial NeoplasiaBeneficial
Moderate
Lactobacillus crispatus LCr86Reduced Detection of High-Risk HPV InfectionBeneficial
Moderate
Lactobacillus crispatus LV5 88Reduced Detection of Cervical Intraepithelial NeoplasiaBeneficial
Moderate
Lactobacillus crispatus LV5 88Reduced Detection of High-Risk HPV InfectionBeneficial
Moderate
Lactobacillus crispatus UALcr-35Reduced Detection of Cervical Intraepithelial NeoplasiaBeneficial
Moderate
Lactobacillus crispatus UALcr-35Reduced Detection of High-Risk HPV InfectionBeneficial
Moderate
Lactobacillus crispatus VPro 31Reduced Detection of Cervical Intraepithelial NeoplasiaBeneficial
Moderate
Lactobacillus crispatus VPro 31Reduced Detection of High-Risk HPV InfectionBeneficial
Moderate

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