Human papillomavirus (HPV) infection is a major driver of anogenital disease and virus-related carcinogenesis. Although most infections resolve spontaneously, persistent infection with high-risk genotypes may progress to high-grade squamous intraepithelial lesions (HSILs) and cancer, particularly in the setting of impaired immune surveillance. Unlike previous HPV-related reviews focused primarily on cervical disease, vaccination, or isolated immunosuppressed populations, this narrative review comparatively examines the clinical expression, colposcopic findings, screening strategies, and therapeutic implications of HPV-related disease across the immunological spectrum. This narrative review provides an integrative synthesis of HPV-related disease in the female lower genital tract across the immunological spectrum. A structured, non-systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted using terms related to “human papillomavirus”, “HPV”, “cervical intraepithelial neoplasia”, “colposcopy”, “immunosuppression”, “HIV”, and “vaccination”. Immunosuppressed populations, including individuals living with HIV, transplant recipients, and patients receiving immunosuppressive therapy, exhibit higher rates of persistent infection, multifocal disease, recurrence, and progression to HSIL and invasive malignancy. These patients also present greater diagnostic complexity, broader anatomical involvement, and reduced response to conventional treatment. Rather than representing a uniform condition, HPV-related disease reflects a biologically dynamic spectrum shaped by host immune competence. This review highlights the distinct clinical, colposcopic, and therapeutic challenges observed in immunosuppressed populations and reinforces the need for individualized, risk-adapted strategies integrating contemporary advances in screening, vaccination, and HPV-related disease management.

Introduction: Atypical glandular cells (AGC) are rare but clinically significant due to their association with cervical and endometrial lesions. Although human papillomavirus (HPV) is the main etiological agent of cervical lesions, not all AGC are HPV-related, particularly those of endometrial origin. Given the heterogeneity of associated findings, their characterization is essential to guide clinical management. Objective: To describe the distribution of AGC subcategories and evaluate subsequent diagnostic findings, comparing findings between AGC (not otherwise specified) NOS and AGC (favor neoplastic) FN in women evaluated at a Brazilian university hospital. Methods: This is an observational, retrospective, analytical study with a retrospective cohort design, based on the review of cytology reports with an AGC diagnosis and their subsequent diagnostic investigation. Associations between categorical variables were assessed using Fisher’s exact test, with a significance level of 5%. Results: Among 22,246 cytology samples, 161 showed AGC (0.72%). After exclusions, 126 cases were included: 85.7% AGC-NOS and 14.3% AGC-FN. Neoplasia at any site was identified in 22.2% of women and was more frequent in AGC-FN (55.6%) than in AGC-NOS (16.7%) (p=0.001). A statistically significant difference was observed in the distribution of cervical findings between groups (p=0.003), with a higher proportion of neoplastic lesions in AGC-FN. No significant difference was found for endometrial findings (p=0.400). Endocervical cytology was performed in 68 women, showing a significant association between the initial AGC classification and subsequent cytological findings (p=0.003), although 44.4% of AGC-FN cases had negative results. Conclusion: AGC represents a heterogeneous clinical entity, with a higher frequency of neoplastic findings in AGC-FN compared to AGC-NOS, particularly in the cervix. These findings reinforce the importance of a comprehensive diagnostic investigation, particularly in cases classified as AGC-FN. In settings without access to HPV molecular testing, clinical, colposcopic, and histopathological evaluation remains essential.

The vaginal ecosystem undergoes profound physiological adaptations during pregnancy and the puerperium through dynamic interactions among the vaginal microbiota, epithelial barrier, local immune system, and hormonal milieu. Disruption of this homeostasis may lead to vaginal dysbiosis and infection, with potential consequences for maternal, fetal, and neonatal health. This narrative review aimed to provide a comprehensive and updated overview of the vaginal ecosystem throughout pregnancy and the puerperium, integrating current evidence on physiological changes in the vaginal microbiota, mechanisms of dysbiosis, major vaginal infections, diagnostic approaches, therapeutic management, and maternal–fetal implications. A structured literature search was conducted in PubMed/MEDLINE and Scopus through July 2026. Priority was given to recent systematic reviews, meta-analyses, international clinical guidelines, randomized clinical trials, and observational studies addressing the vaginal microbiota, dysbiosis, bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, aerobic vaginitis, pregnancy, and the puerperium. Pregnancy is generally characterized by a stable, low-diversity, Lactobacillus-dominated vaginal microbiota, whereas the postpartum period is associated with reduced Lactobacillus abundance, increased microbial diversity, and gradual restoration of eubiosis. Disruption of this ecosystem promotes biofilm formation, microbial persistence, inflammation, and ascending infection. Bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis, and aerobic vaginitis represent the major vaginal infections during pregnancy and the puerperium and have varying associations with adverse outcomes, including preterm birth, preterm premature rupture of membranes, chorioamnionitis, postpartum infection, and neonatal morbidity. Molecular diagnostics and microbiome profiling have improved etiological characterization, while emerging microbiome-directed interventions offer potential strategies for restoring vaginal homeostasis. Current evidence supports an increasingly ecosystem-centered approach to vaginal health during pregnancy and the puerperium. Accurate etiological diagnosis and evidence-based treatment remain essential, while preservation and restoration of vaginal homeostasis may represent important complementary objectives for improving maternal, fetal, and neonatal outcomes.

Maternal immunization has ascended as a cornerstone of contemporary strategies aimed at safeguarding pregnant women, fetuses, and children in early childhood against vaccine-preventable diseases. The profound physiological and immunological adaptations inherent to gestation heighten maternal susceptibility to infectious morbidity, while several pathogens, including influenza, pertussis, COVID-19, rubella, and respiratory syncytial virus (RSV), pose significant risks of adverse maternal, fetal, and neonatal outcomes. Although an extensive body of evidence attests to the safety and effectiveness of maternal vaccines, global uptake among pregnant people remains markedly uneven and, in many settings, critically suboptimal. A nuanced understanding of national and international immunization programs, along with their structural and sociocultural challenges, is imperative to strengthen perinatal health protection. This narrative review synthesizes evidence drawn from peer-reviewed scientific literature, global health agency publications, and official national immunization guidelines. Extracted data were complemented by analyses of the immunological landscape of pregnancy, current vaccine recommendations, established safety profiles, and maternal immunization schedules across high-, middle-, and low-income countries. Particular emphasis was placed on the vaccines most consistently recommended during pregnancy, namely influenza, Tdap, COVID-19, and RSV, as well as on contextual determinants influencing vaccine hesitancy, access barriers, and global disparities in coverage.