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BMC Womens Health. 2019 Feb 6;19(1):30. doi: 10.1186/s12905-019-0727-0.

Cervical microbiota in women with cervical intra-epithelial neoplasia, prior to and after local excisional treatment, a Norwegian cohort study.

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Department of Gynecology and Obstetrics, Østfold Hospital Trust, Kalnes, Norway.
Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.
Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Surgery & Cancer, IRDB, Faculty of Medicine, Imperial College, London, W12 0NN, UK.
West London Gynaecological Cancer Center, Queen Charlotte's & Chelsea - Hammersmith Hospital, Imperial Healthcare NHS Trust, London, W12 0HS, UK.
Department of Mathematical Sciences, Chalmers University of Technology, Gothenburg, Sweden.
Department of Pathology and Genetics, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
Department of Reproductive Medicine, Oslo University Hospital, Oslo and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Center for Laboratory Medicine, Østfold Hospital Trust, Kalnes, Norway.
Department of Clinical Molecular Biology (EpiGen), Division of Medicine, Akershus University Hospital and University of Oslo, Oslo, Norway.
Department of Gynecology and Obstetrics, Østfold Hospital Trust, Kalnes, Norway.



Local treatment for cervical intraepithelial neoplasia (CIN) by Loop Electrosurgical Excision Procedure (LEEP) has been correlated with reproductive morbidity, while the cervicovaginal microbiota is also known to affect the risk of preterm delivery. CIN and treatment by LEEP might change the cervical microbiota. The main aim of this study was to describe the cervical microbiota before and after LEEP and assess its associaton with cone depth and HPV persistence. Further, we aimed to compare the microbiota to references with normal cervical cytology.


Between 2005 and 2007, we prospectively identified 89 women planned for LEEP in a Norwegian hospital and recruited 100 references with a normal cervical cytology. Endocervical swabs were collected prior to treatment and at six (n = 77) and 12 months (n = 72) post LEEP for bacterial culture and PCR, and post LEEP for DNA testing for human papillomavirus (HPV). We compared the cervical microbiota composition before and after treatment and between women planned for LEEP vs references.


There was a reduction in the number of non-Lactobacillus bacterial species six and 12 months after LEEP compared to before treatment and a tendency towards a concomitant increase in Lactobacillus. No association between the detection of cervical bacteria, HPV persistence or cone depth was found. Women planned for LEEP carried significantly more Bacteroides spp., Gardnerella vaginalis, Mycoplasma hominis and Ureaplasma parvum as well as a greater number of bacterial species than the references.


Local excisional treatment appears to alter the cervical microbiota towards a less diverse microbiota. Women with CIN have a more diverse cervical microbiota compared to women with normal cervical cytology.


CIN; Cervical Intraepithelial Neoplasia; HPV; Human papillomavirus; LEEP; Lactobacillus; Vaginal microbiota

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