Decoding the Connection: Cervicovaginal Microbiome, HPV, and Cervical Cancer

Abstract

In low- and middle-income countries (LMICs), where access to screenings and preventative care is restricted, cervical cancer continues to pose a serious threat to world health. In these areas, it is the third most prevalent cancer among women, and increased incidence and mortality are a result of resource inequities. The human papillomavirus (HPV), a sexually transmitted infection, is the main cause of cervical cancer. Nonetheless, studies reveal a complex interplay among environmental, genetic, and epigenetic factors, with mounting evidence supporting the role of the cervicovaginal microbiome. This microbial community controls vaginal health and modulates HPV risks, with some bacterial species, such as those linked to bacterial vaginosis (e.g., Lactobacillus iners), potentially promoting HPV persistence and cervical dysplasia. On the other hand, beneficial species, including Lactobacillus crispatus and Lactobacillus gasseri, contribute to an acidic environment that counters inflammation and may limit HPV progression. Although progress has been made in understanding these dynamics, much remains unknown about the factors influencing microbiome variability and how to manipulate it to prevent disease. Meanwhile, established preventive measures, such as HPV vaccination, routine screenings, and early treatment of precancerous lesions, have proven effective. However, logistical and financial challenges in LMICs hinder broader implementation. To reduce the global burden, efforts must focus on affordable vaccines, integrated screening services, and increasing public awareness. Further microbiome research offers hope for innovative prevention and treatments. Addressing systemic barriers and advancing knowledge could signify meaningful steps toward eradicating cervical cancer as a public health threat worldwide.