The efficacy of prebiotics and probiotics on HPV clearance and bacterial vaginosis: a systematic review and meta-analysis

Background: Pre- and probiotics aim to restore microbial balance, potentially reducing BV recurrence. Objectives: To evaluate the efficacy of prebiotic and probiotic interventions in improving HPV clearance and BV outcomes, including recurrence and Nugent score. Search Strategy: PubMed and Cochrane Library were searched up to May 2025 for randomized controlled trials (RCTs) using terms including “prebiotics,” “probiotics,” “HPV,” and “bacterial vaginosis.” Selection Criteria: We included RCTs on pre/probiotics for HPV or BV in females of any age. Comparators were placebo, no treatment, standard care, or antibiotics. For HPV studies, pregnant, breastfeeding, and immunocompromised patients were excluded. Pregnant women were included in BV studies and analyzed separately. Data Collection and Analysis: Three reviewers independently extracted data into a standardized form. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated for dichotomous outcomes, and mean differences (MDs) for continuous outcomes. Analyses used Review Manager 5.4.1 with a random-effects model. Subgroup analyses were conducted by strain, route, duration, and comparator. Main Results: Thirty-two RCTs (2,997 women) were included. Coriolus versicolor gel significantly improved HPV clearance (RR = 2.13, 95% CI 1.28–3.53). Probiotics also showed benefit (RR = 1.23, 95% CI 0.97–1.55); L. crispatus oral sachets had the highest relative effect. Probiotics reduced Nugent score and improved BV cure (RR = 1.27, 95% CI 1.02–1.60). Seven studies reported reduced BV recurrence, with a 10-day L. delbrueckii vaginal course being most effective (RR = 0.24, 95% CI 0.15–0.37). Conclusions: : Pre- and probiotics show promise for HPV clearance and BV treatment. Further high-quality trials are needed.