Genital mycoplasma infections: a hidden factor in cervical cancer progression? A systematic review and meta-analysis

Abstract

BACKGROUND: Exploring the role of the microbiome, specifically genital mycoplasmas, in cervical cancer (CC) offers insights into tumorigenesis, potential therapeutic targets and personalized treatment strategies. Although mycoplasmas are generally identified as commensals, their contributions to gynecological cancers, mainly CC, is increasingly recognized. This study investigates the association between CC and genital mycoplasma infections, highlighting the interactions with human papillomavirus (HPV) and their impact on cellular and immune mechanisms. METHODS: We conducted a systematic review and meta-analysis of databases through June 2024. Association strength was determined using pooled odds ratios (ORs) with 95% confidence intervals (CIs). Six case-control studies involving 319 cervical cancer patients and 447 controls were included. RESULTS: Pooled results showed that genital mycoplasmas were associated with a significantly increased risk of CC (OR = 1.64; 95% CI 1.25-2.14). The species-specific analysis demonstrated that Ureaplasma urealyticum was linked with a high risk of CC (OR = 1.81, 95% CI 1.31-2.51), while no significant association was seen for Ureaplasma parvum. HPV-positive subjects co-infected with genital mycoplasmas had a markedly increased risk of CC (OR = 3.13, 95% CI 2.04-4.79), highlighting potential synergistic effects in tumor progression. CONCLUSION: Mycoplasmas, particularly U. urealyticum, constitute co-factors in the development of CC, likely by influencing HPV persistence and immune evasion. Systemic screening coupled with targeted treatment of genital mycoplasmas in high-risk populations is thus warranted for CC prevention.