Abstract
Introduction: Persistent high-risk human papillomavirus (hrHPV) infection is the main step in cervical carcinogenesis. The vaginal microbiota may modulate this risk, but the evidence is heterogeneous. This is because previous reviews have not provided a quantitative synthesis that specifically examines the persistence of HPV in the full progression of disease from dysplasia to invasive cancer. This specific gap reduces the transition of microbiota research into the stratification of clinical risks. The aim of the research is to systematically review and meta-analyze the association between the composition of the vaginal microbiota and hrHPV persistence in women with cervical dysplasia and cancer. Methods: The researcher searched PubMed, Embase, Cochrane Library, and Web of Science (Jan 2015-Feb 2026) for observational studies. Pooled odds ratios (ORs) were calculated using a random-effects model. Study quality was assessed using the Newcastle-Ottawa Scale. Results: Twenty-four studies were included. A non-Lactobacillus-dominant microbiota was related with 2.5 times higher odds of hrHPV persistence (pooled OR 2.51, 95% CI 1.95-3.23, I²=68%, 18 studies). The relationship was stronger in women with invasive cervical cancer (OR 3.40) than in those with dysplasia only (OR 2.15). Conclusion: Vaginal dysbiosis is significantly related to hrHPV persistence, with a significant effect in cervical cancer. The vaginal microbiome represents a potential biomarker for the stratification of risk and a target for therapeutic intervention.