Correlation analysis of the relationship between clinical data, HPV infection arriage and the state of the vaginal microbiota in patients with a combination of deep endometriosis and intraepithelial lesions of the cervix

   Introduction. Endometriosis is a chronic, hormone-dependent, slowly progressive disease that affects up to 190 million (10 %) women worldwide. Current literature lacks data on the characteristics of endometriosis in patients with cervical intraepithelial neoplasia, as well as on the choice of treatment strategies and recurrence prevention for these diseases.

   Study Objective. To evaluate the interaction between clinical and anamnestic data, vaginal microbiota status, and HPV infection in patients with deep endometriosis and cervical intraepithelial neoplasia.

   Materials and methods. A prospective comparative study was conducted on 103 patients of reproductive age who underwent surgical treatment for common forms of external genital endometriosis. These included 52 patients with deep endometriosis combined with grade 1 cervical intraepithelial neoplasia (the study group) and 51 patients with deep endometriosis without cervical intraepithelial neoplasia (the comparison group).A medical history was analyzed. Vaginal microbiota composition and HPV typing were assessed using real-time quantitative PCR.

   Results. When assessing the nature of concomitant somatic pathology, it was found that patients in the main group significantly more often suffered from alimentary obesity 1/52 (40.4 %) versus 8/51 (15.7 %) in the comparison group, p = 0.010, gastrointestinal diseases 1/52 (20.4 %) versus 4/51 (7.8 %), p < 0.001, diseases of the urinary system in 23/52 (44.2 %), versus 6/51 11.8 %, p = 0.001, skin diseases of viral etiology in 16/52 (30.8 %) versus 1/51 (2.0 %), p < 0.001. When comparing the correlations between opportunistic microorganisms in the vaginal microbiota and clinical and anamnestic parameters in patients with deep endometriosis and cervical intraepithelial neoplasia, strong and moderate correlations were found between the prevalence of the complex of opportunistic microorganisms Gardnerella vaginalis + Prevotella bivia + Porphyromonas spp. in the vaginal microbiota and the presence of chronic cystitis (r = 0.555894), sexually transmitted infections (r = 0.452654), and recurrent endometriosis (r = 0.504666);Strong positive correlations were found between highly carcinogenic virus types: HPV type 16 and a history of chronic endometritis (r = 0.401496); Between HPV type 31 and chronic cystitis (r = 0.532417), as well as a history of bacterial vaginosis (r = 0.545374); between HPV type 35 and a history of sexually transmitted infections (r=0.514113); between HPV type 45 and recurrent endometriosis (r = 0.56018), as well as a history of ovarian endometriectomy
(r=0.468031); between HPV type 53 and a history of hemorrhoids (r = 0.514113). Strong correlations were established between patients with 2 or more HPV types and the presence of chronic cystitis (r = 0.620546).

   Conclusion. The course of external genital endometriosis in combination with cervical intraepithelial neoplasia may represent a single pathological process involving the interaction and mutual influence of various factors within the host and microbiota, which determine the phenotype of polyproliferative pathology in women of reproductive age.

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