The interplay between HPV, vaginal microbiota and host immunity in cervical carcinogenesis

Cervical cancer (CC) remains a major global health challenge, largely driven by persistent infection with high-risk human papillomavirus (HPV) genotypes. Emerging evidence suggests that the interplay between HPV, the vaginal microbiota (VM), and host immune responses critically influences viral persistence and disease progression. In particular, dysbiotic VM marked by reduced Lactobacillus dominance and increased prevalence of anaerobic bacteria such as Gardnerella, Sneathia, Prevotella, and Atopobium-can impair HPV clearance, promote chronic inflammation, and facilitate progression from cervical intraepithelial neoplasia (CIN) to invasive carcinoma. Understanding these tripartite interactions offers opportunities for novel preventive and therapeutic strategies, including microbiome modulation, immunotherapy, and gene editing. This review highlights the potential of microbiome-targeted interventions to enhance immune responses against HPV and reduce the burden of CC, although the underlying causal mechanisms require further investigation in prospective studies.