The role of HPV in the pathology of the lower genital tract in women with infertility

Human papillomavirus (HPV) is the most common sexually transmitted infection. An increasing number of scientific works are devoted to studying the role of HPV in reproductive disorders in infertile couples. This virus is one of the most common sexual infections among men and women. Although most studies have focused on the oncogenic properties of HPV, the impact of the virus on fertility and reproductive capacity remains poorly understood.The objective: to assess the clinical significance of the impact of HPV infection in women with infertility based on clinical and laboratory indicators of HPV viral load and the state of the vaginal microbiome.Materials and methods. A survey of 184 women of reproductive age (20–40 years, mean age – 31–35 years) with infertility was conducted. 58 persons of them were diagnosed with infertility, chronic inflammatory processes of the female genital organs and positive HPV status (main group). The comparison group included 50 healthy women of reproductive age without HPV infection.Polymerase chain reaction (PCR) was used to detect HPV, as well as bacterioscopic, bacteriological methods and PCR to determine microbiological status. The results were analyzed using parametric and nonparametric statistical methods.Results. HPV was found in 31.5% of women with infertility, of which 60.3% had high-risk oncogenic strains – the most common were HPV-16, HPV-31 and HPV-53. HPV persistence was determined in 63.8% of cases. Secondary infertility was diagnosed in 74.1% of women in the main group, while primary infertility was diagnosed in 25.9%. A relationship was established between the presence of HPV and an increased risk of pregnancy complications, such as spontaneous abortions (20.7%) and recurrent miscarriage (8.6%).Gynecological examinations revealed a high level of chronic inflammatory processes of the genital organs in patients in the main group: vulvovaginitis (51.7%), inflammation of the appendages (31%), uterus (17.2%), as well as cervical pathologies, including background diseases (22.4%) and precancerous conditions (75.8%). HPV infection was often combined with other infections, such as Chlamydia trachomatis (8.6%), Ureaplasma urealyticum (24.1%), Mycoplasma hominis (27.6%).Imbalance of the vaginal microbiome, manifested by a decreased number of Lactobacillus (87.9%) and an increased amount of opportunistic microflora (Staphylococcus spp., Enterococcus faecalis, Gardnerella vaginalis), correlated with HPV persistence. Women with HPV and bacterial vaginosis had the highest degree of microbiome imbalance.Conclusions. HPV infection and its persistence significantly affect the course of chronic inflammatory diseases of the female genital organs and the reproductive function of women. HPV infection is associated with an increased risk cervical dysplasia, inflammatory diseases and obstetric complications. It is important to introduce HPV vaccination to prevent infection, as well as correct the microbiome imbalance as a component of complex treatment.