Vaginal microbiome and human papillomavirus infection: mechanisms of interaction, diagnosis and therapeutic perspectives
Bebneva T.N., Minaeva A.V., Akhmatova A.N., Ramazanova F.U.
Background: Persistence of high-risk human papillomavirus (HPV) types is a necessary condition for the development of cervical neoplasia; however, most HPV infections are cleared spontaneously. The vaginal microbiota is considered a key modifiable factor determining the outcomes of HPV infection. Lactobacillus-dominant communities are associated with higher rates of viral clearance, whereas dysbiotic conditions contribute to the persistence and progression of cervical lesions.
Materials and methods: This paper is a narrative literature review based on a targeted search of publications in the PubMed, Scopus, Web of Science, and eLIBRARY.RU databases from 2015 to 2025 using the following keywords «vaginal microbiome», «HPV», «cervical intraepithelial neoplasia», «Lactobacillus», «bacterial vaginosis», «HPV genotyping». The review included original studies, systematic reviews, meta-analyses and clinical guidelines focusing on the relationship between the vaginal microbiome and HPV infection. When selecting sources, priority was given to clinical studies, high-quality reviews and current guidelines.
Results: The state of the vaginal microbiome was found to be associated with the outcomes of HPV infection and the progression of cervical intraepithelial lesions. Lactobacillus crispatus-dominant communities (CST I) are associated with a 3.5-fold higher probability of spontaneous regression of CIN2 compared with dysbiotic states (CST IV). Modern molecular methods make it possible to simultaneously assess the composition of the vaginal microbiota, the predominant species of lactobacilli (typing of L. crispatus, L. jensenii/L. mulieris, L. gasseri/L. paragasseri, L. iners) and extended HPV genotyping with individual identification of types 16, 18, 45 and pooled detection of types 31/33/35/39/51/52/56/58/59/66/68, which may broaden the possibilities for risk stratification.
Conclusion: The vaginal microbiome should be regarded as a promising risk biomarker and a potential therapeutic target in HPV-associated diseases. The FEMOFLOR II diagnostic system provides an optimal tool for personalized risk stratification, combining an assessment of the microbiota with Lactobacillus typing and extended HPV genotyping in accordance with current clinical guidelines.
Authors’ contributions: Bebneva T.N. – developing the concept and design of the review; Minaeva A.V. – collecting and processing the material; Ramazanova F.U. – performing the literature analysis; Minaeva A.V., Akhmatova A.N. – writing the text; Bebneva T.N. – editing the article. All the authors participated in the approval of the final version of the article.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: The study was conducted without sponsorship.
Disclosing AI use: In preparing this article, the virtual AI assistant Alice (Yandex’s Alice AI family of generative models) was used exclusively to translate the abstract. The generated text was checked, edited and approved by the authors. The authors bear full responsibility for the content of the manuscript.
For citation: Bebneva T.N., Minaeva A.V., Akhmatova A.N., Ramazanova F.U. Vaginal microbiome and human papillomavirus infection: mechanisms of interaction, diagnosis and therapeutic perspectives.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (4): 182-190 (in Russian)
https://dx.doi.org/10.18565/aig.2026.104
Keywords
vaginal microbiome
human papillomavirus
cervical intraepithelial neoplasia
Lactobacillus crispatus
bacterial vaginosis
HPV genotyping
FEMOFLOR
cervical cancer
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Received 27.03.2026
Accepted 23.04.2026
About the Authors
Tamara N. Bebneva, Dr. Med. Sci., Associate Professor at the Department of Obstetrics, Gynecology and Reproductive Medicine, Faculty of Continuing Medical Education, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba, 117198, Russia, Moscow, Miklukho-Maklaya str., 6, bebn@mail.ru,https://orcid.org/0000-0003-1095-2008
Anastasia V. Minaeva, Teaching Assistant at the Department of Obstetrics and Gynecology with Course of Perinatology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba, 117198, Russia, Moscow, Miklukho-Maklaya str., 6, +7(915)101-86-39, minaeva-av@rudn.ru, https://orcid.org/0000-0002-8066-0839
Anastasiya N. Akhmatova, PhD, Associate Professor at the Department of Obstetrics and Gynecology with Course of Perinatology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba, 117198, Russia, Moscow, Miklukho-Maklaya str., 6, +7(922)733-23-33, achmatova02@mail.ru,
https://orcid.org/0000-0001-8653-9389
Fatima U. Ramazanova, PhD, Teaching Assistant at the Department of Obstetrics and Gynecology with the Course of Perinatology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba, 117198, Russia, Moscow, Miklukho-Maklaya str., 6, +7(925)417-98-23, fatimasiren@yandex.ru,
https://orcid.org/0000-0002-4574-3874
Corresponding author: Fatima U. Ramazanova, fatimasiren@yandex.ru
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