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. 2026 Mar 17;16:1767224. doi: 10.3389/fcimb.2026.1767224

Figure 1.

Diagram showing the interactions among HPV infection, cervicovaginal dysbiosis, and bacterial biofilm (Gardnerella), illustrating processes such as immune evasion, inflammation, dysbiosis, cancer progression, and persistent infection. Co-infections are indicated centrally.

The HPV-microbiome-biofilm triad. Schematic representation of bidirectional interactions between HPV infection (including E6/E7-driven oncogenic activity), cervicovaginal dysbiosis, and bacterial biofilm formation (e.g., Gardnerella). These interconnected processes modulate host immune and inflammatory signaling (e.g., IL-36g, NF-kB), promoting HPV persistence, treatment failure/recurrence, and progression to cervical intraepithelial neoplasia and cancer. Co-infections are shown as additional modulators of the system.