Reviewer ’s report  
 
Title: The influence of probiotics on genital high -risk human papilloma virus clearance, 
associated lesions and quality of cervical smear: A randomized placebo -controlled trial  
 
Version: 1 Date: 27 May 2019  
 
Reviewer: Alessandra Pierangeli  
 
Reviewer's report:  
In the revised version of the paper with the new title "The influen ce of probiotics on genital high -
risk human papilloma virus clearance, associated lesions and quality of cervical smear: A 
randomized placebo -controlled trial " the issues raised by the reviewers were addressed but 
several weaknesses in the study were evid enced from answers.  
From both reviewers, one of the most important criticism was that bacterial vaginosis (BV) 
condition in enrolled women was not reported.  It's true that BV has been associated with a 
higher risk of HPV acquisition and decreased clearan ce of HPV (ref 5 reporting that association 
has been added to discussion as requested). However, BV diagnosis is often clinical, not 
microbiological, so that the association with HPV status is not so straightforward. In fact, the 
significant decrease in mi ldly abnormal cytology may be likely due to a reduction in BV 
condition.  It would have been a clinical plus of the study to evaluate probiotics effectiveness on 
BV.  Weakness in the study were also confirmed relating to the small sample size that conferre d 
a low statistical power.  
Moreover, the revised/added sentences are not written in good English, e.g in Discussion the 
meaning of the added sentence "status of BV and vaginal pH were not evaluated since these may 
be important variables determine HPV clea rance" is not understandable.  
Are the methods appropriate and well describ ed? 
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately  supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended,  please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the public ation of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently  applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other fi nancial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give detai ls below.  
 
I declare that I have no competing interests  
 
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