Abstract
BackgroundVaginal pH is related to genital tract inflammation and changes in the bacterial flora, both suggested cofactors for persistence of human papillomavirus (HPV) infection. To evaluate the relationship between vaginal pH and HPV, we analyzed data from our large population-based study in Guanacaste, Costa Rica. We examined vaginal pH and the risk of HPV infection, cytological abnormalities, and C. trachomatis infection.MethodsOur study included 9,165 women aged 18-97 at enrollment with a total of 28,915 visits (mean length of follow-up = 3.4 years). Generalized estimating equations were used to evaluate the relationship between vaginal pH and HPV infection (both overall and single versus multiple types) and low-grade squamous intraepithelial lesions (LSIL), the cytomorphic manifestation of HPV infection. The relationship between enrollment vaginal pH and C. trachomatis infection was assessed by logistic regression. Results were stratified by age at visit.ResultsDetection of HPV was positively associated with vaginal pH, mainly in women < 35 years (p-trend = 0.009 and 0.007 for women aged < 25 and 25-34 years, respectively). Elevated vaginal pH was associated with 30% greater risk of infection with multiple HPV types and with LSIL, predominantly in women younger than 35 and 65+ years of age. Detection of C. trachomatis DNA was associated with increased vaginal pH in women < 25 years (OR 2.2 95% CI 1.0-5.0).ConclusionsOur findings suggest a possible association of the cervical microenvironment as a modifier of HPV natural history in the development of cervical precancer and cancer. Future research should include studies of vaginal pH in a more complex assessment of hormonal changes and the cervicovaginal microbiome as they relate to the natural history of cervical neoplasia.
Highlights
Vaginal pH is related to genital tract inflammation and changes in the bacterial flora, both suggested cofactors for persistence of human papillomavirus (HPV) infection
Our study examined the relationship between vaginal pH and risk of HPV infection and HPV-related cytological abnormalities, with particular attention to possible differences between women in varying age groups in a large screening study of HPV infection and cervical neoplasia in Guanacaste Province, Costa Rica
As the current analysis focused on HPV-related cytomorphologic changes, a woman’s cytology was interpreted as low-grade squamous intraepithelial lesions (LSIL) if her conventional smear and/or ThinPrep results met the criteria for LSIL and the diagnosis of the alternative method was either atypical squamous cells of undetermined significance (ASCUS) or LSIL
Summary
Vaginal pH is related to genital tract inflammation and changes in the bacterial flora, both suggested cofactors for persistence of human papillomavirus (HPV) infection. Most HPV infections are transient [2] and only a small minority of women with long-term, persistent infections are at an increased risk of progression to precancerous cervical lesions and cervical cancer [2,3]. This causal role is well established, relatively little is known vaginal pH has been associated with decreased risk of C. trachomatis, trichomoniasis [11], urinary tract infections [12], and mycoplasma [11]. It has been theorized that this rise in vaginal pH is associated with a loss of natural epithelial defenses and an increased rate of colonization with pathogens in the vagina and the urinary tract [14]
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