Features of the clinical course of endometriosis in papillomavirus infection

Background: To date, the etiology and pathogenesis of endometriosis are still unclear and are determined by a number of factors (genetic, immunological and endocrine), including microbiological ones.

Aim: The aim of this study was to characterize the clinical course of endometriosis in papillomavirus infection.

Materials and methods: This retrospective analysis included 185 outpatient records of patients with genital endometriosis and comprised complaints, anamnesis data, objective examination, cytological and molecular biological examination results. All patients were divided into two study groups. Group 1 (main) consisted of patients with endometriosis and human papillomavirus (n = 56), and group 2 (comparison) included patients with endometriosis and no human papillomavirus (n = 129).

Results: The frequency of human papillomavirus detection among patients with endometriosis was 30.3 (95% confidence interval 24–38)%. The most frequent types detected were 31 (20%), 16 (18%), 18 (18%), 56 (16%), and 53 (13%). The conclusion of cervical cytological examination: in group 1 was the following 54/56 patients had negative for intraepithelial lesion or malignancy (NILM) and 2/56 patients had low grade squamous intraepithelial lesion (LSIL), all patients in group 2 had NILM. The average duration of endometriosis was 8.2 ± 5.0 years for patients in group 1 and 9.4 ± 5.9 years for patients in group 2 (p = 0.15). We found differences between the study groups with respect to the following parameters: the average age of sexual debut was 17.82 ± 1.47 years and 18.53 ± 1.43 years for groups 1 and 2, respectively. Dyspareunia occurred in 77 (95% confidence interval 63–87)% of women in Groups 1 and in 42 (95% confidence interval 33–51)% in groups 2 (p < 0.001). The average pain severity score according to the visual analogue scale was 6.7 ± 2.4 and 5.9 ± 2.8 points, respectively (p = 0.039). In group 1, impaired vaginal microbiocenosis was more common.

Conclusions: Human papillomavirus was detected in every third woman with endometriosis, most often in genotypes of high carcinogenic risk. Among the features of the clinical course of endometriosis in the presence of human papillomavirus, more pronounced pain syndrome and symptoms of dyspareunia were noted. In the group of women with human papillomavirus, impaired vaginal microbiocenosis was more often observed.