A Role of the Lower Genital Tract Microbiome in Promoting Cervical Intraepithelial Neoplasia: A Premalignant Precursor of Cervical Cancer - A Literature Review

Sep 23, 2026

The cervicovaginal microbiome (CVMB) is critical for lower female genital tract homeostasis and serves as an influential modulator of cervical carcinogenesis. Persistent infection with high-risk HPV is required for CIN and subsequent cervical carcinoma, yet alone does not fully account for oncogenesis. Evidence indicates that CVMB composition shifts control HPV persistence, local immune responses, and disease progression. Lactobacillus-dominant states support immune regulation and HPV clearance, whereas dysbiosis promotes inflammation, oxidative stress, barrier disruption, and higher CIN progression risk.

LanguageEnglish

CategoryHealthcare

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Pages14

Reading Time35 min

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Abstract

Introduction

Materials and Methods

Review A Role of the Lower Genital Tract Microbiome in Promoting Cervical Intraepithelial Neoplasia: A Premalignant Precursor of Cervical Cancer—A Literature Review Weronika Knap-Wielgus 1,2, *, Agata Knap 3, Bronisława Pietrzak 2, Barbara Sucho ´nska 4 and Mirosław Wielgo´s 2 Academic Editor: Ian N. Hampson Received: 28 January 2026 Revised: 12 March 2026 Accepted: 18 March 2026 Published: 24 March 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland 2 Department of Obstetrics and Perinatology, National Medical Institute of the Ministry of the Interior and Administration, 02-507 Warsaw, Poland; [bronislawa.pietrzak@gmail.com](bronislawa.pietrzak@gmail.com) (B.P.); [miroslaw.wielgos@gmail.com](miroslaw.wielgos@gmail.com) (M.W.) 3 Maternal-Fetal Medicine Student Scientific Association, Medical University of Warsaw, 02-091 Warsaw, Poland; [agataknap28@gmail.com](agataknap28@gmail.com) 4 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, 02-015 Warsaw, Poland; [barbara.suchonska@wum.edu.pl](barbara.suchonska@wum.edu.pl) * [Correspondence: weronika.knap96@gmail.com](Correspondence: weronika.knap96@gmail.com) Abstract The cervicovaginal microbiome (CVMB) is pivotal in maintaining the homeostasis of the lower female genital tract and has emerged as a significant modulator of cervical carcinogenesis. Although persistent infection with high-risk human papillomavirus (HR-HPV) is a prerequisite for the development of cervical intraepithelial neoplasia (CIN) and subsequent cervical carcinoma, it remains insufficient alone to drive oncogenesis. Accumulating evidence suggests that alterations in the CVMB composition profoundly impact HPV persistence, local immune responses, and disease progression. A vaginal microbiota dominated by Lactobacillus species, most notably Lactobacillus crispatus, correlates with low microbial diversity, robust immune regulation, and facilitated HPV clearance. Conversely, microbial dysbiosis—characterized by Lactobacillus depletion and a concomitant proliferation of anaerobic taxa, typical of Community State Type (CST) IV and Lactobacillus iners-dominated profiles—is strongly associated with chronic inflammation, oxidative stress, epithelial barrier compromise, and an elevated risk of CIN progression. This review synthesizes current evidence regarding the multifaceted interactions among the cervicovaginal microbiome, HPV pathogenesis, immune dysregulation, and oxidative stress in the etiology of CIN. Elucidating these intricate host–microbiome dynamics may precipitate the discovery of novel microbiome-derived biomarkers, ultimately informing innovative prophylactic and therapeutic interventions for cervical cancer. Keywords: cervicovaginal microbiome; HPV; cervical intraepithelial neoplasia; cervical cancer; Lactobacillus species; community state types 1. Introduction Over recent decades, the human microbiome has garnered intense scientific interest, with global research initially focusing predominantly on the gut microbiome. Its involvement in numerous immunological and oncological processes has been extensively documented. In contrast, the clinical significance of the vaginal microbiome—despite its profound impact on women’s health—emerged comparatively later. Unlike the intestinal microbiome, where high microbial diversity is indicative of a healthy state, the healthy lower female genital tract is typically dominated by one or a few Lactobacillus species [1,2] . Anatomically, the ectocervix is colonized by a distinct microbial community, whereas the endocervix and upper genital tract have traditionally been considered sterile in healthy women [2,3] . The Human Microbiome Project (HMP), initiated in 2008, marked the first la

FAQs

Why is the cervicovaginal microbiome (CVMB) important in cervical carcinogenesis?

CVMB helps maintain genital tract homeostasis and can modulate HPV persistence, local immune responses, and progression toward CIN and cervical cancer.

How does Lactobacillus dominance relate to CIN risk?

Vaginal microbiota dominated by Lactobacillus species, especially Lactobacillus crispatus, is associated with low diversity, strong immune regulation, and facilitated HPV clearance.

What microbiome features are linked to higher CIN progression?

Microbial dysbiosis with Lactobacillus depletion and increased anaerobic taxa, typical of Community State Type (CST) IV or Lactobacillus iners-dominated profiles, correlates with chronic inflammation, oxidative stress, epithelial barrier compromise, and elevated progression risk.

Sep 23, 2026

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