Chlamydia trachomatis and Human Papillomavirus Infection in Women From Southern Hunan Province in China: A Large Observational Study.

Hongliang Chen,Hua Ling,Bei He,Ping He,Zhongyu Li,Yating Wen,Xiaoli Hou,Jinwei Shui,Lipei Luo,Shixing Tang

doi:10.3389/fmicb.2020.00827

Abstract

Chlamydia trachomatis and human papillomavirus (HPV) are the most common pathogens of sexually transmitted infections (STIs), which can increase the risk of cervical cancer and infertility. The purpose of this study was to evaluate the prevalence, genotype and risk factors of C. trachomatis and/or HPV infection in women attending the annual physical examination, assistant reproductive treatment and visiting the gynecology clinics from Southern Hunan province in China. Cervical-swab samples were collected from 5006 participants. We found that the overall prevalence of C. trachomatis, HPV infection and C. trachomatis/HPV coinfection was 4.7% (236/5006), 15.5% (778/5006) and 1.2% (59/5006), while the prevalence of asymptomatic infection of that was 3.8% (38/1006), 10.8% (109/1006) and 0.6% (6/1006), respectively. Furthermore, 25.0% (59/236) of C. trachomatis infection and 7.6% (59/778) of HPV infection were attributable to C. trachomatis and HPV coinfection. C. trachomatis and HPV infection were more often observed in young women of less than 25 years (10.4% and 21.3%, respectively) and in the outpatients from gynecology clinics (5.2% and 18.0%, respectively). Of note, a higher prevalence of C. trachomatis infection was observed in HPV-positive women (7.6%) than HPV- negative ones (4.2%), and vice versa. The top three C. trachomatis genotypes were E (1.4%), F (1.1%) and J (0.8%), and the counterparts of HPV genotypes were HPV52 (4.2%), HPV16 (2.3%) and HPV58 (2.2%), respectively. Among the 151 outpatients with colposcopy data, HPV infection was associated with severe cervical lesions with OR of 15.86 (95% CI 3.14–80.0, P < 0.001) while C. trachomatis infection was more likely associated with a low grade colposcopy impression (OR = 3.25, 95% CI: 1.22–8.65, P = 0.018). Our data highlight the high prevalence of asymptomatic C. trachomatis and HPV infection, particularly among women of <25 years. The two pathogens may serve as mutual risk factors to increase the risk of infections and cervical lesions. Widespread implementation of HPV and C. trachomatis screening programs, especially for young women, would be an effective strategy to relieve the burden of sexually transmitted infections.

Highlights

Chlamydia trachomatis (CT), an obligate intracellular parasitic bacterium, is the leading bacterial cause of sexually transmitted infections (STIs) (Witkin et al, 2017) while human papillomavirus (HPV) has been documented to cause cervical cancer (Harden and Munger, 2017)
The prevalence of C. trachomatis infection was higher in the outpatients (5.2%) from gynecology clinics (GC) than in those from physical examination center (PEC) (3.8%) or assisted reproductive technology center (ART) (3.5%)
These results indicated that young women of less than 25 years and the patients in the gynecology clinic are the risk group for C. trachomatis infection

Summary

Introduction

Chlamydia trachomatis (CT), an obligate intracellular parasitic bacterium, is the leading bacterial cause of sexually transmitted infections (STIs) (Witkin et al, 2017) while human papillomavirus (HPV) has been documented to cause cervical cancer (Harden and Munger, 2017). C. trachomatis is capable of triggering chronic or recurrent infections and long-term inflammations of the urethra (Chen et al, 2019), inducing local secretion of immune mediators, enhancing the production of reactive oxygen species (ROS) and generation of free radicals, which may cause damages to host mucosal barriers and cell-mediated immunity (CondeFerraez et al, 2017). These biological effects of C. trachomatis infection could facilitate the transmission and co-infection of HPV and decrease the host’s ability to resolve HPV infection

Objectives

Methods

Results

Conclusion