THE ROLE OF UROGENITAL INFECTIONS IN THE DEVELOPMENT OF CERVICAL INTRAEPITHELIAL NEOPLASIA

The aim of the study – to examine the species composition and role of infectious (bacterial) factors in the development of background and precancerous cervical pathology, in order to improve the treatment effectiveness of this condition. Materials and Methods. A comprehensive examination of 64 women of the reproductive age was conducted. The patients had verified precancerous cervical pathology (mild and moderate dysplasia – CIN 1 and CIN 2, respectively), diagnosed through objective examination. They underwent cervical inspection using mirrors, simple and extended colposcopy, cytological diagnostics, and cervical biopsy with subsequent histological examination and proliferation marker analysis (p16 and Ki-67, as indicated). The species spectrum of vaginal and cervical canal microflora was studied in the above- mentioned patients. The presence of pathogenic and opportunistic bacterial microflora, including sexually transmitted infection (STI) pathogens (chlamydia, trichomonas, Gardnerella, mycoplasma, ureaplasma, gonococci, viral agents such as herpes simplex virus type II), was determined. Diagnostic methods for vaginal and cervical canal microbiocenosis and STIs included bacterioscopy (Gram stain), bacteriological examination with the determination of microbial count and antibiotic sensitivity, polymerase chain reaction (PCR), and direct immunofluorescence assay (DFA). For opportunistic microflora and mycoplasma/ureaplasma infection (Mycoplasma hominis/Ureaplasma urealyticum), a titer of 1x10^4 and above was considered etiologically significant. A systematic analysis method was employed to process various sources available through PubMed, BMC, ScienceDirect, The Lancet, and The WHO. Results. As a result of the examinations, all patients (100 %) with confirmed cervical dysplasia had some form of pathogenic bacterial microflora or high-titer opportunistic microorganisms. The majority of women (81.2 %) had microbial associations (ranging from 2 to 5 microbial agents). High-risk human papillomavirus (HR-HPV) was detected in 51.6 % of the women, though it was not present in all patients. The combination of bacterial flora with HR-HPV correlated with the severity of dysplasia. Conclusions: 1. At the diagnostic stage, in patients with background cervical pathology and cervical neoplasia, in addition to HR-HPV DNA diagnostics, testing for urogenital infections, sexually transmitted infections, and opportunistic microflora is essential, with microbial counts and antibiotic sensitivity taken into account. 2. Treatment for the above category of patients should be phased, starting with a conservative course of therapy for urogenital infections.