**Conflict of interest**

tumour preventive potential by the microbes. Additionally, the genetic polymorphism might be related to genetic susceptibility to infections and so, the implementations of probiotics may reinforce the immune system. A better understanding of this line will allow for the develop-

The application of probiotic strains *Lactobacillus rhamnosus* GR-1 and *Lactobacillus reuteri* RC-14 concomitantly with specific anti-infective agents provides more reliable cytological diagnostics, reduces the number of false positive and false negative findings on cervical malignancy and normalizes vaginal microflora in higher percentage of patients with vaginal infections

The use of probiotics, such as L. acidophilus, concomitant with the subsequent use of antibiotics, helps to restore the natural bacteria in the digestive tract that eventually are killed by

Recently, due to changes in the sexual behaviour of the general population, especially in developed countries, there has been an increase in the incidence of HPV infection in other

In summary, a personalized clinical / therapeutic approach is suggested to avoid unnecessary treatments, based on previous history (onset of sexual activity, number of partners, anovulatory, parity, nutrition, alcohol, tobacco, genetics-immunity, etc.), in vaginal pH, Lactobacillus, in the diagnosis of HPV, viral load, mRNA, HSV, CMV, HSIL, AGC, CINI and CINII / III. *Chlamydia trachomatis, Mycoplasma, Ureaplasma, Neisseria gonorrhoeae*) and in the immunohisto-

The HPV is not a sufficient cause for developing of cervical cancer, therefore other factors may be involved in this susceptibility, namely the microenvironment in vagina and inter-individual genetic polymorphic variations. These variables must be integrated in a complex model that integrates other co-factors, such as, smoking, diet and oral contraceptives. According to this review based on recent data, it seems that a deficiency of an antioxidant mechanism associated to a compromise vaginal microflora and inefficient genetic profile may contribute to the development of cervical cancer. We hypothesis that the genetic background and dysbiosis

Therefore, the equilibrium of gut/vaginal microbiota and adequate supplementation for a homeostasis of oxidant and antioxidant species may contribute to the regression of the persis-

The authors would like to acknowledge the Instituto de Investigação Científica Bento da

ment of therapies that can manipulate the microbiome to reinstate homeostasis.

24 Cervical Cancer - Screening, Treatment and Prevention - Universal Protocols for Ultimate Control

compared with therapy including anti-infective agents only [49].

parts of the body, including oropharynx and anus, among others.

may contribute to increase risk for gynecologic advanced cancer.

Rocha Cabral and Sociedade Portuguesa de Papillomavírus for support.

tence of factors associated with cervical cancer.

**Acknowledgements**

chemical study (p16 and Ki-67) of dysplasia [50, 51].

antibiotics.

**4. Conclusions**

The authors declare that they have no competing interests.
