EVALUATING A TOPICAL CERVICAL APPLICATION OF LACTOBACILLUS PROBIOTICS FOR THE CLEARANCE OF LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESIONS

Abstract

Background: Low-grade squamous intraepithelial lesions (LSIL) are commonly associated with persistent human papillomavirus infection and are frequently managed through conservative surveillance due to their potential for spontaneous regression. Emerging evidence suggests that disruption of the cervicovaginal microbiome, particularly depletion of Lactobacillus species, may contribute to lesion persistence. Microbiome-modulating therapies have therefore gained attention as low-risk adjuncts in cervical disease prevention.

Objective: To determine whether topical cervical application of Lactobacillus probiotics increases regression rates of LSIL to normal cytology.

Methods: A randomized controlled trial was conducted over 12 months in tertiary care gynecology clinics in the Lahore region of Pakistan. Women aged 21–45 years with cytologically confirmed LSIL were randomized to receive either topical cervical Lactobacillus probiotic therapy alongside standard surveillance or standard care alone. Cervical cytology was assessed at baseline, six months, and twelve months. The primary outcome was regression to normal cytology at 12 months. Data were analyzed using parametric statistical tests, with significance set at p < 0.05.

Results: At 12 months, regression to normal cytology was observed in 71.9% of women in the probiotic group compared with 50.5% in the control group, representing a statistically significant difference. Persistence of LSIL was lower in the intervention group, while progression to higher-grade lesions was infrequent in both groups. Probiotic therapy was well tolerated, with no serious adverse events reported.

Conclusion: Topical cervical Lactobacillus probiotic therapy significantly enhanced LSIL regression and reduced lesion persistence without added safety concerns. These findings support microbiome modulation as a practical and non-invasive adjunct to conservative LSIL management and cervical cancer prevention strategies.

Keywords: Cervical Intraepithelial Neoplasia; Lactobacillus; Papillomavirus Infections; Probiotics; Randomized Controlled Trial; Uterine Cervical Dysplasia; Vaginal Microbiome