Vajinal Disbiyozisin Hpv Enfeksiyonu ve Preinvaziv Servikal Epitelyal Lezyonlar Üzerine Etkisi

Abstract

Kaya E., The Effect of Vaginal Dysbiosis on HPV Infection and Preinvasive Cervical Epithelial Lesions, Hacettepe University Faculty of Medicine, Obstetrics and Gynecology Dissertation, Ankara 2022 Cervical cancer is the fourth most prevalent malignant neoplasia in women worldwide, and it is a major public health issue. The most common viral infection of the reproductive system is the HPV infection, and high-risk genital HPVs are the primary etiological agents in the development of cervical cancer and its malignant precursor, cervical intraepithelial neoplasia. Infection with HrHPV is essential for the development of CC, however, it is not sufficient, and additional factors play a role in the onset, progression, and regression of the disease. While some of these factors such as the affecting viral type are virus-related; others, such as the individual's immunity, smoking, parity, hormonal contraceptive use, and sexual behaviors are host related. Recent studies evaluated the potential relationship between the vaginal microbiome (VM) and gynecological cancer. The VM compound can influence the local immune response, as well as be involved in cervical oncogenesis and HPV clearance. The vaginal microbiota is a unique and complex medium that changes in response to a variety of endogenous and exogenous factors. Therefore, it is critical to remember that vaginal microbiota can affect the host's reproduction physiology, and that the microbial compound can be affected by the host's physiology. In general, a healthy adult's vaginal microbiome contains Lactobacillus spp. predominantly, and other microbes in low densities. In addition to producing an acidic medium that allows growth, most Lactobacillus strains can produce antimicrobial-like compounds, bacteriocins, and hydrogen peroxide that are toxic to harmful microbes and prevent their growth. Lactobacillus-containing probiotics are used to cure vaginal flora for the treatment of urogenital infections. Recent data suggest that the presence and quantity of certain bacterial types can prevent HPV infection, and reduce the risk of developing precursor cancer lesions, contributing to virus clearance. On the contrary, other bacterial types can support the pathological situation. Therefore, understanding the effects of VM compounds and changes (dysbiosis) on HPV infection and persistence may therefore aid in better predicting the outcomes of infections caused by this virus. When the flora usage durations of 80 patients were examined in our study, it was discovered that 58 (72.5%) patients used flora for 6-9 months, 15 (18.8%) for 9-12 months, and 7 (8.8%) for 12 months or more. In comparison to the studies conducted, it was discovered that the treatment duration is adequate. The pre-treatment and post-treatment smear results of 80 patients in the treatment group were analyzed in terms of ASCUS in our study. According to the analyses, 48.8% of the patients' pre-treatment smear results were abnormal (≥ASCUS). This rate dropped to 33.8% after treatment, which was found to be statistically significant. The smear results of 37.8% of the 82 patients in the control group who were not treated were found to be abnormal in terms of ASCUS (≥ASCUS). Six months later, it was discovered that 24.4% of the samples had abnormal results. However, his difference was not statistically significant. In line with these data, the positive effect of treatment on smear results can be revealed. On the other hand when the other data of our study were examined, the treatment applied did not lead a statistically significant change in the LSIL and HSIL smear results. When the effect of the treatment on HPV change was examined; it was found in the treated group and untreated group that 46.2% and 56.7% of people tested negative for HPV-16, respectively. In the treated and untreated groups, 54.5% and 100% of patients tested positive for HPV-18, respectively. In the treated group and untreated group, 48.6% and 49.2% of people tested negative for HrHPV, respectively. When HPV-16/18 changes were examined, it was discovered that both of the patients in the untreated group tested negative for type 16 or 18, and in the treated group, 2 (50%) of the 4 patients tested fully negative, and the remaining 2 (50%) patients tested negative for type 16 or 18. No statistically significant difference was found.Although some effect of treatment on HPV clearance was observed in our study, no statistically significant difference was found when the results of the control group were compared.Undergoing colposcopy at the first admission rate in the treated and untreated groups was 76.2% and 59.8%, respectively. This difference was found to be statistically significant. In 19% of the treated group and 60% of the untreated group, abnormal colposcopy results were found. The rate of abnormal colposcopy results in untreated patients was found to be significantly higher. Undergoing colposcopy at the check-up, admission rates in the treated and untreated groups were 38.8% and 19.5%, respectively. This difference was found to be statistically significant. Of untreated patients, 66.7% had abnormal colposcopy results, while all treated patients had normal results. This difference was statistically significant. Keywords: Cervical Cancer, Cervical Cancer Screening, Colposcopy, HPV, Pap Smear, Vaginal Microbiota, Vaginal Microbiota State Diversity

Supporting Institutions: Hacettepe University Faculty of Medicine Department of Obstetrics and Gynecology